## LOW PROTEIN INTAKE OR KILOCALORIE? WHICH, ACTUALLY, CAN INTERFERE IN HAND-GRIP STRENGTH AND IN BODY COMPOSITION IN PATIENTS ON HEMODIALYSIS?

(1)Sanches, Fabiana; (2)Pereira, Leticia; (2)Francotti, Julia; (2)Lopes, Natalia; (3)Ali, Mohamed.

(1)Ms. Nutritionist. University Católica de Santos; (2)Nutritionist. University Catholic of Santos; (3)Md. Santa Casa da Misericordia de Santos.

**Background and objectives:** The ideal recommendation of proteins for patients on hemodialysis (HD) to promote neutral or positive nitrogen balance must be between 1,1 to 1,2 g/kg/day. This recommendation allied with an average intake of 35 kcal/kg/day, seems to avoid the PEM, which is a frequent condition associated with increase of morbidity and mortality. So, the purpose of this study is to measure the impact of protein and energy intakes on the hand-grip strength (HGS) and on the body composition of the patients with chronic renal diseases subjected to HD.

**Methods:** the body composition of the patients with chronic renal diseases subjected to HD. Cross-sectional study. 104 patients were measured, from both gender, over 18 years of age and on a regular program of HD. It was gauged after HD session: weight, stature, AC, DCT, HGS and the adductor muscle thickness. The BMI and the AMC were calculated. Protein and energy intakes were calculated from the food register of three days.

**Results:** were calculated from the food register of three days. The groups were divided by protein and energy intake adequate or not (0,78 vs 1,56 g/kg/day; p<0,01) and (32,4 vs 23,7 kcal/kg/ day, p<0,001); respectively. The group that consumed less protein demonstrated lower HGS (21,6 vs 17,1 kg; p=0,02), BMI (24,3 vs 19,9 kg/m²; p<0,01), AC (28,5 vs 24,5 cm; p<0,01), AMC (23,5 vs 20,7 cm; p<0,01) and DCT (16 vs 11 mm; p<0,01). However, the group that consumed less kcal presented just lower BMI (20,4 vs 25,8 kg/m²; p<0,05) and APMT (10,1 vs 13,5 mm; p<0,02).

**Conclusions:** These results suggest that protein intake is determining to changes in the body composition and overlaps to energy intake for patient with chronic renal disease in HD.

**Keywords:** Hd, Body Composition, Protein Intake

**Further Collaborators:** Mohamed

## SELF-PERCEPTION OF CORPULENCE IN AN ADULT POPULATION SAMPLE ACCORDING TO GENDER, AGE AND EDUCATIONAL LEVEL

(1)Pentreath, Carolina J.; (2)Katz, Mónica; (3)Cappelletti, Ana María;

(4)Saenz, Silvia Alicia; (5)Martin, Giannini; (6)Aguirre Ackermann, Marianela; (7)Cafaro, Lilia; (8)Papalia, Liliana; (9)Kawior, Ines;

(10)Viñuales, Martin.

(1)B Cs, RD. Teacher, Universidad Favaloro. Nutritionist Club Atletico Lanus. Director, Nutritionist Centro de Especialidades en Nutricion. Argentina; (2)MD. Nutritionist. Director Dr. Katz Centre. Director posgrade on Obesity Favaloro University. Argentina; (3)MD. Coordinator, Professor. Favaloro University. Posgrade on Obesity. Coordinator ETICO, Interdisciplinary team for management of obesity. Argentina.; (4)MD. Private medical practice. Argentina.; (5)MD. Nutritionist. Dr. Katz Centre. Argentina.; (6)MD. Doctor. Cien Centre,.Corrientes. Argentina.; (7)MD. Nutritionist. Private medical service. Argentina.; (8)B Cs. RD. Nutritionist. Private practice. Teacher. University of Buenos Aires. Argentina.; (9)MD. Nutritionist. Private medical practice. Coordinator Posgrade Obesity Favaloro University.

**Background and objectives:** BACKGROUND: Evidence shows that distortion of body weight perception is more prevalent in people with a lower educational level, particularly in men and racial minorities. As a result, people may be less likely to demand medical care and this could limit the effectiveness of public health campaigns.

**OBJECTIVES:** To analyze the ability to self-perceive corpulence in an adult population according to their referred BMI, gender, age and educational level.

**Methods:** MATERIAL AND METHODS: Cross-sectional, descriptive and analytical observational study. An anonymous questionnaire was provided to individuals belonging to private institutions not related to health. Data obtained included: gender, age, weight and height; perception of body weight (low, normal, overweight, obese); level of education (primary or elementary school, secondary or high school, tertiary-university or college/university). Data were analyzed using the STATA statistical software program.

**Results:** RESULTS: Respondents surveyed were 1617 individuals aged 18 to 70; female 66.6% and male 33.4%. According to weight and height: underweight 2.2%; normal 49.1%; overweight 30.2% and obese 18.6%.

According to age groups: from ages 18 to 29: 28.4%, 30 to 49 48.3% and 50 to 70 23.3%. According level of education: primary 22.5%, secondary 40.4% and tertiary / university 37.1%.

There was no evidence of a significant relationship between age and corpulence perception discordance.

While 27.3% of women underestimate their weight, 47.7% of men do. (P <0.001).

9.7% of normal weight individuals, 47.8% of overweight and 80.7% of obese perceive themselves to as thinner than they actually are and in all paired-comparisons the differences were significant
(P <0.001). Obese respondents had the lowest levels of correct weight perception (2 out of 10).

The highest percentage of underestimation of body weight occurs among respondents with primary education (47.8%) and diminishes as the educational level increases: 36.5% for the secondary level and 23.0% for the tertiary / university level (P <0.001).

**Conclusions:** CONCLUSIONS: In the population surveyed, conditions of lower educational level, higher BMI and male gender, were related to underestimation of body weight.

**Keywords:** Key words: weight perception, BMI, level of education, gender, obesity.

**Further collaborators:**

MD, Cecilia Pedernera.

144/2289

EVALUATION OF AN INTUITIVE EATING WEIGHT MANAGEMENT PROGRAMME TO SUPPORT WEIGHT MANAGEMENT PATIENTS

(1)Kruger, Rozanne; (2)Yovich, Franica; (3)Haarhoff, Beverley.

(1)PhD. Dietitian. School of Food and Nutrition. Massey University. New Zealand.; (2)PG Dip Diet. Dietitian. Waitemata District Health Board. New Zealand.; (3)PhD. Psychologist. School of Psychology. Massey University. New Zealand.

**Background and objectives:** Overweight and obesity rates are increasing exponentially worldwide, resulting in high rates of chronic diseases. Maintaining weight-loss can reduce associated risks, however, many dietary restriction weight-loss interventions have poor sustainability. The impact of psychological factors on managing weight and supporting related changes is critical. This study explored whether an intuitive eating weight management programme is an effective intervention for people classified as obese within the hospital system.

**Methods:** Participants (n=49) were enrolled in a 28-week evaluation study: 4-week usual diet run-in; 4-week intervention; 24-week follow-up. Of these participants, 14 failed to start, four withdrew during the study, and 18 failed to complete all components. Data were collected at baseline and end of periods for anthropometry (height, weight, circumferences), behavioural and cognitive approaches to food (Intuitive Eating Scale (IES-2), Dutch Eating Behaviour Questionnaire (DEBQ), Quality of Life Questionnaire (QoL), dietary intake (24h-Recall)).

**Results:** Changes in reasons for eating (mean±SD) occurred after attending group sessions, improving significantly from baseline to 6-month follow-up: 'eating for physical rather than emotional reasons' (2.87±.80 to 3.44±.72, P=0.002), 'reliance on hunger/satiety cues' (2.80±.95 to 3.38±.83, P=0.004), and total IES-2score (2.93±.54 to 3.31±.41, P=0.000). Positive changes was observed in the DEBQ emotional and external trigger eating style scores, decreasing from 2.67±1.04 and 3.06±.67 respectively from baseline to 1.98±.86 (P<0.002) and 2.56±.63 (P<0.001) at 6-month follow-up. Participants' reported mean (±SD) intuitive eating level (percentage of total eating times) increased from

baseline to end of intervention, and further increased at 6-month follow-up (35.9±22.0 to 60.0±23.5 (P<0.000) to 67.50±26.356, P<0.001, respectively). Participant's median [95%CI] confidence levels increased significantly after completing the group sessions, from 6.0 [5, 7.5] to 8.0 [7, 9] (P<0.001, r=0.8) and remained higher (7.5 [5,8]), at 6-month follow-up. Weight (mean±SD) did not change significantly from baseline (112.33±26.67 kg) to follow-up (112.04±28.52 kg). However, 32% of participants lost >3% of their initial body weight and 74% either lost or maintained weight.

**Conclusions:** Group-based intuitive eating weight management programmes can improve psychological factors associated with weight management, and support weight maintenance long term. It further initiates the process of making changes to improve food-related behaviour and lifestyle.

**Keywords:** Weight management, Intuitive eating, Obesity, Eating behavior, Cognitive approaches.

144/2295

ASSOCIATION BETWEEN PHYSICAL ACTIVITY LEVELS, SEDENTARY BEHAVIOR AND INCIDENCE OF RISK FACTORS IN PATIENTS WITH CARDIOMETABOLIC RISK

(1)Perovic, Nilda Raquel; (2)Del Rosso, Sebastian; (3)Carrizo, Lidia Ana del Valle; (4)Flores, David; (5)Barale, Adrián; (6)Defagó, Maria Daniela.

(1)PhD. Nutritionist. CENINH Centro de Investigación en Nutrición Humana. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina; (2)BSc. Physical Education. CENINH Centro de Investigación en Nutrición Humana. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.; (3)MSc. Nutritionist. Dirección del Área de Alimentación y Nutrición. Hospital Nacional de Clínicas. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.; (4)MD. Servicio No Invasivo de Cardiología Hospital Nacional de Clínicas. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.; (5)BSc. Nutritionist. CENINH Centro de Investigación en Nutrición Humana. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.; (6)PhD. Nutritionist. CENINH (Centro de Investigación en Nutrición Humana. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina. INICSA-CONICET. Argentina.

**Background and objectives:** The interrelationship between physical activity (PA) levels and sedentary behavior could promote health or increase the incidence of risk factors to develop cardiometabolic diseases. The aim of this study was to assess the association between auto-reported physical activity levels, sedentary behavior and the incidence of cardiometabolic risk factors.

**Methods:** To analyze the aforementioned associations, an observational and correlational design was used. Participants (n = 117, mean ± SD for age = 61±1.43 years) were recruited from the non-invasive cardiology division at HNC of Cordoba city during the period between 2014-2016. Physical activity was recorded by
means of the Spanish version of the International Physical Activity Questionnaire (IPAQ) and analyzed using a spreadsheet that allow to estimate three weekly levels of PA (low, moderate and high), the energy expenditure of PA (EEPA) and the sedentary behavior. Incidence of cardiometabolic risk factors was assessed by exploring the patient's medical history. The selected risk factors were: body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure and serum lipid profile. Comparisons between men and women were made using independent samples T tests. All analyses were carried out using the Stata v.11.

**Results:** Average PA levels for the total sample was 240.00 ± 116.44 METS·min/week; representing an EEPA of 1388.31 ± 600.26 Kcal/week. Further analysis showed that 25.63% of women and 18.80% of men reported to be engaged in PA of moderate intensity while only 5% of women and 11% of men were engaged in vigorous PA. Sedentary behavior was reported to be 360 ± 37.82 min/day. Significant associations were observed between BMI and sex (p<0.05), were women tended to have less weight than men. A very high risk regarding WC was found in 82% of the total sample, being the risk higher in women than in men (p<0.05). Moreover, an inverse relationship was found between both SBP (r = 0.51, p<0.01) and DBP (r = 0.35, p = 0.04) and moderate intensity PA levels.

**Conclusions:** Physical activity was related to an increased risk for metabolic diseases, being this risk higher in women compared to men.

**Keywords:** Cardiometabolic Risk, Blood Pressure, International Physical Activity Questionnaire, Waist Circumference.

144/2297

CITIES CHANGING DIABETES MELLITUS: A REPRESENTATIVE SURVEY OF MEXICO CITY

(1)Barquera, Simon; (2)Tolentino Mayo, María Lizbeth; (3)Hernández, César; (3)Mendoza, Kenny; (4)López-Ridaura, Ruy.

(1)PhD. Instituto Nacional de Salud Pública; (2)MSc. Nutritionist. Instituto Nacional de Salud Pública. México.; (3)MSc. Instituto Nacional de Salud Pública. México.; (4)PhD. Instituto Nacional de Salud Pública. México.

**Background and objectives:** Currently in Mexico, diabetes mellitus type 2 represents a serious public health problem and a challenge for the health system. Diabetes is the second cause of death in the adult population and the main cause of hospitalization related to complications.

A representative survey of adults between 20 to 69 years was performed in Mexico City to know the risk factors and other health indicators of non-communicable diseases to describe aspects in the attention process, quality of services and vulnerability of people who lives with diabetes, hence to obtain information about their socio-economic conditions.

**Methods:** We applied a questionnaire of seven sections that identified the socio-demographic characteristics of people that integrated the household, the health situation, the usage of

health services, general aspects of the household, goods and expenses of the household, and other section that explores aspects about health and usage of medical services. Blood samples and serum were obtained from a sub-sample of participants to obtain the prevalence of diabetes Mellitus in Mexico City, and to compare the results with data shown in the ENSANUT 2012. Different risk biomarkers were used to define metabolic syndrome such as: cholesterol, triglycerides, HDL, LDL, and glycosylated hemoglobin.

**Results:** The prevalence of diabetes mellitus was 13.9% (9.9% for known diagnosis (KD) and 4.0% known by the survey (Sv). From the total of people with KD, 29% had an adequate control of their disease. In people with KD, the determination of HbA1c was more frequent in people who were not controlled in their disease (67%), than in those people that were controlled (52.7%) (p<0.05). From the total of people that received treatment, only 25.6% had an adequate control of their disease.

**Conclusions:** A high proportion of the sample presented high levels of glucose, and they are not aware of it. The absence of prevention measures for non-communicable diseases in the adult population are reflected in the results.

**Keywords:** Diabetes, Non-Communicable-Diseases, Survey, Mexico-City, Changing

144/2306

ASSOCIATION OF VITAMIN B12 AND HOMOCYSTEINE WITH COGNITIVE DECLINE IN ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES

(1)Peçanha, Daniela; (2)dos Santos, Elisa Maia; (3)de Paula, Laís Silva;

(3)Marotto, Deborah; (3)Costa, Mariana Ribeiro; (3)Souza, Paula;

(4)Huguenin, Grazielle Vilas Bóas; (2)Moreira, Annie Seixas Bello.

(1)MSc. Nutritionist. Institute of Nutrition. University of the State of Rio de Janeiro. Brazil; (2)National Institute of Cardiolog. Statue University of Rio de Janeiro. Brazil; (3)Statue University of Rio de Janeiro; (4)National Institute of Cardiolog. Brazil

**Background and objectives:** Dementia and Cognitive Dysfunction are common in elderly and lower intake of B-vitamins may contribute to the development of neurological diseases, since they participate in the metabolism of homocysteine that, in altered levels, is associated with cognitive disorders. The objective of this study was to associate serum homocysteine, dietary intake of B-vitamins and their markers with cognitive impairment in elderly patients with cardiovascular disease.

**Methods:** A cross sectional study with 194 elderly patients with a mean age of 70,7±7,0 years of both sexes, participants of a multicenter randomized clinical trial that studies the effects of a Brazilian Cardio protective Food Program on reduction of events and risk factors in prevention of CVD. Anthropometric evaluation and blood collection were performed. Dietary assessment (by food frequency questionnaire) was made using Food Processor program. The evaluation of cognitive function were performed
through the Mini Mental Health Examination (MMME). Data was expressed in frequency and medians (P25-75), analyzed in SPSS 21.0, considering a significance level of 5%.

**Results:** The majority of the population had a clinical suspicion of mild cognitive decline (CDL), 40,2%, male 65,4%. The median score obtained in MMME was 24 (22 - 25) for the group with mild cognitive decline and for the group with dementia was 17 (16 - 19) points and 27 (26 - 27) for those who did not Cognitive decline (CD) p <0.05. The serum homocysteine level of the dementia and DCL groups was adequate 10.87 ± 4.28 µmol / L and 10.69 ± 3.46 µmol / L, and was not significantly different from the group without DC 10.19 ± 3, 11 µmol / L p> 0.05. The group with dementia consumed 3.8mg (2.77 - 7.74) of vitamin B12, 78.4% had consumption according to the recommendation by the EAR and 83.3% with DCL had adequate intake of this nutrient.

**Conclusions:** We conclude that the consumption of vitamin B12 and its blood marker and serum homocysteine are adequate in the groups that presented clinical suspicion of cognitive disorders such as dementia and mild cognitive decline, not being associated with this pathology in these elderly people.

**Keywords:** Cognitive decline, cardiovascular disease, dementia, vitamin B12, homocysteine

**Further collaborators:**

To the scientific initiation students, post-graduation and master's students, who contributed to the elaboration of this study.

144/2308

ASSOCIATIONS OF STRESS MANAGEMENT WITH METABOLIC SYNDROME IN JAPANESE -SAKU COHORT STUDY-

(1)Morita, Akemi; (2)Yasukawa, Jun; (3)Kawashima, Nobuhisa; (4)Aiba, Naomi; (5)Miyachi, Motohiko; (6)Watanabe, Shaw.

(1)PhD. MD. Koshien University. Japan.; (2)Mr. RD. Koshien University. Japan.; (3)PhD. RD. Koshien University. Japan.; (4)PhD. RD. Kanagawa Institute of Technology. Japan.; (5)PhD. National Institutes of Biomedical Innovation, Health and Nutrition. Japan.; (6)PhD. MD. Life Science Promotion Foundation. Japan.

**Background and objectives:** Background: The Japanese government launched the Stress Check Program as a new occupational health policy. Stress management is considered useful strategies to prevent the metabolic syndrome (MetS). The effective methods to reduce stress on preventing MetS remained unclear.

**Objectives:** To evaluate the role of stress management in preventing or exacerbating MetS, we examined the associations between their ways to release stress and the risk factors of MetS in the cohort subjects undergone health checkup.

**Methods:** 4450 Japanese men and women were enrolled at the Saku Central Hospital. They received an anthropometric and clinical examination and were assessed for present illness, lifestyle factors such as physical activity, smoking, drinking, dietary habits and present stress level and stress busters at the enrollment. Eating behavior was analyzed by the Sakatas Eating Behavior Questionnaire.

Dietary assessment was made using a brief self administered diet history questionnaire. 2602 men and 1844 women aged more than 20 were analyzed.

**Results:** The mean age in men and women were 59.2 and 58.4 years old, respectively. The percentages of MetS were 20.6 in men and 6.1 in women. There was no significant difference in prevalence of MetS between with or without perceived stress in men and women. However, there were significantly more men with Mets in people who reduce stress by eating. The scores of all the categories in eating behavior were worse in subjects with perceived stress than those without perceived stress. Furthermore, the scores in eating behavior were bad in subjects with emotional eating regardless of perceived stress.

**Conclusions:** The influence of the way to stress management, especially for emotional eating, on MetS was suggested in men and women.

**Keywords:** Metabolic Syndrome. MetS. Stress Management. Eating Behavior.

144/2313

APPETITE AND SYMPTOMS OF WOMEN WITH GYNECOLOGICAL CANCER ATTENDED AT BARRETOS CANCER HOSPITAL: A PILOT STUDY

(1)Bernardes Spexoto, Maria Cláudia; (2)de Brito, Ligia Zampieri;

(2)Silva, Gesieli; (3)dos Reis, Ricardo.

(1)PhD. Faculdade de Ciências da Saúde. Universidade Federal da Grande Dourados. Brazil.; (2)Student of Nutrition. Curso de Nutrição. Centro Unificado de Educação Barretos Ltda. Brazil;

(3)MD. Hospital de Câncer de Barretos. Brazil.

**Background and objectives:** The decrease or lack of appetite, affected by both the treatment and the disease itself, are inherent characteristics of the patient with cancer, and can promote weight loss, early satiety, gastrointestinal symptoms and others. The objective was to evaluate the Appetite/Symptoms of women with gynecological cancer treated at the outpatient clinic of the Barretos Cancer Hospital (HCB), Brazil.

**Methods:** This is a pilot study with the participation of 37 women, cross-sectional, prospective, with sample collection for convenience. All women with an initial diagnosis in HCB were included in the study. Sociodemographic and clinical information were collected. The appetite and symptoms were assessed using the global score of Cancer Appetite and Symptom Questionnaire (CASQ) translated and adapted to the Portuguese language, composed of 10 items with answers arranged in a five-point Likert scale, where the score ≤1 represents low impairment of the Appetite/Symptoms, 1 to 3 moderate impairment and a score > 3 severe impairment.

**Results:** The average age of participants was 50.6±16.0 years, body mass index equal to 28.4±7.4 kg/m2, belonging to economy class C (62.2%) and married (51.4%). For this sample, 70.3% (n=26) presented moderate impairment, 27.0% (n=10) severe impairment and 2.7% (n=1) low impairment of the Appetite/Symptoms.
**Conclusions:** Most participants find themselves with moderate impairment of Appetite/Symptoms.

**Keywords:** cancer, appetite, symptoms

144/2318

CORRELATION BETWEEN ANTHROPOMETRIC AND BODY COMPOSITION INDICATORS OF PEOPLE LIVING WITH HIV/AIDS WITH HIV ASSOCIATED LIPODYSTROPHY CLINIC DIAGNOSES

(1)Sacilotto, Lívia Bertazzo; (2)Pereira, Paulo Câmara Marques;

(3)Mendes, Adriana Lúcia; (4)Corrente, José Eduardo; (5)Manechini, João Paulo Vieira; (6)Justina Papini, Silvia.

(1)MD. Nutritionist. Department of Tropical Disease and Imaging Diagnosis. São Paulo State University (UNESP). Botucatu Medical School. Brazil.; (2)Adjunct professor. Department of Tropical Disease and Imaging Diagnosis. São Paulo State University (UNESP). Botucatu Medical School. Brazil.; (3)PhD professor. São Paulo State University (UNESP). Botucatu Medical School. Brazil.; (4)Adjunct professor. Department of Bioestatisc. São Paulo State University (UNESP). Institute of Biosciences. Botucatu. Brazil.; (5)MD student. University of São Paulo (USP), Ribeirão Preto Medical School, Brazil: (6)PhD. Nutritionist. Department of Nursing. São Paulo State University (UNESP). Botucatu Medical School. Brazil.

**Background and objectives:** Nowadays, one of the major problems among people living with HIV/Aids (PLHA) is body composition alteration accompanied to the accumulation and/or loss of body fat in specific locations, being this impairment known as lipodystrophy. The fat accumulation in body central area is associated to an increased risk of developing cardiovascular diseases, glucose intolerance, type 2 diabetes mellitus and, still, decreases in bone density. For the early evaluation of these individuals and a nutritional diagnosis establishment, the protocol must be easily accessed in the clinical practice. The present study had the objective to correlate the anthropometric and body composition indicators of PLHA with HIV associated lipodystrophy diagnosis by means of Pearson correlation test.

**Methods:** The study was observational and transversal, with its sample selected by convenience and performing clinical immunological characterization, anthropometric assessment, nutritional diagnosis, body composition of PLHA during the follow-up of specialized outpatient service in infectiology with a clinical HALS diagnosis from July 2015 to July 2016, in regular antiretroviral therapy use for at least a year, ranging from 18 to 60 years old. Pregnant women, people with chronic kidney failure, nephrotic syndrome, B and C virus chronic infection, uncontrolled hypothyroidism were excluded from the study.

**Results:** It was possible to identify strong correlation between Body Mass Index (BMI) with abdominal circumference (AC) and fat visceral area (FVA) (R = 0,86 and R = 0,83, respectively), and between AC and FVA (R = 0,78).

**Conclusions:** These results deserve to be highlighted because the utilization of simple measures as BMI and AC, despite their limitations, is important in facilities where is not possible to perform more specific evaluations on these individuals, once those measures present low cost and easy applicability in clinic routine, making the nutritional follow up of this population simpler. Considering the follow up of PLHA as complex as it is, the usage of parameters which may indicate increased cardiovascular risk or fat accumulation is determinant for the adoption of specific strategies, beyond the inclusion of low cost and easy access evaluations to correctly monitor the nutritional state of these patients.

**Keywords:** People living with HIV/aids, lipodystrophy, body composition

**Further collaborators:**

Support: FAPESP (process 2015/10103-7)

144/2326

NUTRITIONAL STATUS OF HOSPITALIZED PATIENTS BY SUBJECTIVE EVALUATION IN PUBLIC HOSPITALS OF ASUNCIÓN AND METROPOLITAN AREA DURING 2017. PRELIMINARIE STUDY

(1)Bordón Riveros, Claudia; (2)Ferreira Heyn, Ana Maria; (3)Figueredo Grijalba, Rafael; (4)Mayor Oxilia, Rosa; (3)Chirife Fernández, Graciela; (5)Argüello, Rocío; (5)Bareiro Arce, Alberto; (5)Romero Ausfeld, María Jose; (6)Joy, Laura; (6)Báez, Alicia.

(1)Nutritionist; (2)Médico. Sociedad Paraguaya de Nutricion. Paraguay; (3)Médico. Instituto Privado de Nutrición Integral. Paraguay; (4)Medico. Sociedad Paraguaya de Nutricion. Paraguay; (5)Nutricionista. Instituto Privado de Nutrición Integral. Paraguay; (6)Nutricionista. Sociedad Paraguaya de Nutricion. Paraguay.

**Background and objectives:** Hospital malnutrition is highly prevalent in Latin America. Studies done in Paraguay in 2003 showed a prevalence of malnutrition of 50,9%. The aim of this study was to determine the nutrition status by subjective parameters in adult hospitalized patients in Public Hospitals of Asunción and the Metropolitan Area during 2017.

**Methods:** Cross sectional study enrolled hospitalized patients older than 18 y hospitalized in 8 highly complex Public Hospitals of Asunción and Metropolitan Area during 2017. We used the Subjective Global Assessment tool to assess malnutrition.

**Results:** There were 145 patients enrolled whose mean age was 50,3 ± 16,7 years. The 51,7% (n=75) was men, 53% (n=77) had clinic pathologies and 13,9% (n=20) was infected.

The study showed that 51% (n=74) of patients had a BMI between 25 and 29.9 kg/m2. The mean of BMI was 25,6±5,4 kg/m2. We found that 35,2% (n=51) patients had lost more than 10% of their usual weight in the previous 6 months, 73,8% (n=107) had dietary intake change, 21,4% (n=31) had gastrointestinal symptoms and 80,7% (n=117) had functional capacity dysfunction.

Malnutrition was present in 50.3% (n=73) of the patients. Several malnutrition was present in 19,3% (n=28) of them.
**Conclusions:** Hospital malnutrition is still highly prevalent. Data related to severe malnutrition increased in relation to previous data.

**Keywords:** hospital malnutrition, nutritional assessment

**Further collaborators:**

Nidia Martínez, Andrea Báez, Patricia Cáceres, Raquel Franco, Viviana Gómez, Gisela Pineda, Nancy Rios, Olga Pintos, Amalia Benitez, Liliana Ibarrola, Pablo Ozuna, Anyelius Limprich.

144/2378

EFFICACY OF NUTRITION SUPPORT AMONGST TUBERCULOSIS PATIENTS AT SELECTED REFER- RAL HOSPITALS IN MALAWI

**Background and objectives:** Tuberculosis (TB) remains one of the world's deadliest communicable diseases. In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease.

**Objective:** To investigate whether high energy and/or multi-vitamin supplementation will improve the results of TB treatment based on sputum conversion rate, nutritional status, and clinical outcomes.

**Methods:** Randomized factorial design was used and patients were recruited at Bwaila and Queens referral hospitals. Patients were provided with multivitamin and/or high calorie and compared to the control group.

**Results:** A total of 81 patients were recruited, with 3.7% drop-out rate. The mean age of was 35.8 ± 8 years and 80% were males. Mean BMI was 18.7 ± 2.3 and 41.6% classified malnourished. They were gradual increase in BMI to 20.9 kg/m2, presenting 11.8% with p= 0.041. The mean weight gain was 5.9kgs ± 4.3. Performance improvement was recorded with (t=-14.717, p <0.001) using Karnofsky index. Our findings show that the treatment success rate was 86%. The sputum conversion for supplemented was also significant for the supplemented over the controls at RR, 0.39 [95% CI, 0.17 to 0.86, p=0.03] at 2 months.

**Conclusions:** On the basis of the result we found beneficial factors existing of supplements on enhancing sputum conversion rates, treatment success rates, weight gain, improve quality of life, improve dietary adequacy, and reduce mortality.

Nutritional supplements in tuberculosis patients are a feasible and low-cost intervention and have public health importance.

**Keywords:** Nutritional Supplements, Tuberculosis, Smear positive, Sputum conversion,

144/2391

PREVENTISSIMO – HEALTH ASSESSMENT AND COUNSELLING WITH E-HEALTH

**Background and objectives:** The Preventissimo project aimed to develop an evidence-based, preventive and interventive tool for health assessment and counselling, using e-Health methods.

**Methods:** We have developed an internet-based application that focuses on the prevention of the most common non- infectious chronic diseases. The application uses questionnaires to get a picture of the client's disease risks. This is followed by a person- alized counselling, based upon the individual's answers. Currently the project deals with the main non-communicable diseases: car- diovascular diseases; type 2 diabetes; the most common cancers: breast, prostate, colorectal and lung; chronic pulmonary disease (COPD); depression, dementia; glaucoma; cataracts; macular de- generation). The various questionnaires assess diseases running in the family, already existing abnormalities and various lifestyle factors including nutrition, physical activity, mental health and smoking. The counselling algorithm takes into account not only the risk factors, but also personal preferences and existing disor- ders, allergies. Last year we extended the original algorithm by in- cluding a set of cognitive games to get an indication of the person's performances on the relevant cognitive skills. The use of the cog- nitive games significantly improves the diagnostic and therapeutic power of the doctor for some patients having risk of dementia or depression.

**Results:** Preventissimo has been developed through the co-operation of medical doctors, dieticians, physiotherapists, psy- chologists and IT specialists.

The questionnaires contain 286 questions, 308 risk and protec- tive factor descriptions. 14 cognitive games are also included plus a performance reporting framework.

There is an evidence based knowledge base on the site with more than 300 videos and articles with topics in lifestyle, diseas- es, diet, stress-management, physical activity. There are illustrated questionnaires for the visitors to check the level of understanding of the various illnesses

The system already collected data from, provided advice to more than 60 thousand people of different regions of the country.

**Conclusions:** When using Preventissimo (filling out the questionnaires, playing games) the user can download the results and health plan and can e-mail them to their doctor or any oth- er healthcare provider for further input if needed. This helps as- sessing risk in a community, and can help planning preventative strategy.

**Keywords:** e-health, questionnaires, lifestyle, cognitive games

<footnote>(1)Banda, Mtisunge; (2)Kalimbira, Alexander; (3)Kalumizika, Zione;</footnote>

<footnote>(4)Mbendera, Kuzani.</footnote>

<footnote>(1)Student. Department of Human Nutrition and Health.Lilongwe University of Agriculture and Natural Resources. Lilongwe. Malawi; (2)Phd. Nutritionist. Lilongwe University of Agriculture and Natural Resources. Lilongwe. Malawi; (3)Msc. Nutritionist. Lilongwe University of Agriculture and Natural Resources. Malawi; (4)Phd. Medical Doctor. National Tuberculosis Control Programme. Lilongwe. Malawi.</footnote>

<footnote>(1)Szlanko, Janos Szlanko; (2)Palik, Éva; (3)Schmidt, Judit; (4)Nacsa, Zoltan.</footnote>

<footnote>(1)Msc. Computer-Engineer. Kognitos Ltd. Hungary; (2)Phd. Physician. Semmelweis University. Hungary; (3)Msc. Dietitian. Kognitos Ltd. Hungary; (4)Msc. Computer-Engineer. NIS Informatikai Ltd. Hungary.</footnote>
(1)Jiménez Pérez, José María; (2)Cao Torija, Mª José; (3)Garcia del Río, Ana; (4)Lopez Vallecillo, Maria; (4)Frutos Martin, Manuel; (5)Castro Alija, Mª José.

(1)RN, PhD. Faculty of Nursing. University of Valladolid.; (2)RN. PhD. Nursing Faculty, University of Valladolid. Spain. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.; (3)MSnc. Nursing Faculty, University of Valladolid. Spain.; (4)RN. PhD. Nursing Faculty, University of Valladolid. Spain.; (5)MD. PhD. Nursing Faculty, University of Valladolid. Spain. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.

**Background and objectives:** To evaluate weight loss during one year of adolescent patients submitted to gastric bypass by the percentage of the excess of body mass index (BMI) lost and to catalog the results according to recommendations.

**Methods:** Sample: 18 adolescents were operated through gastric bypass from a single laparoscopic anastomosis in the center of excellence for the study and treatment of obesity (CTO) in the period 2008-2010, 9 women (50%) and 9 men (50%) of average age = 16.6 years with a mean BMI of 42.9 ± 6.8 (range 34.6-56.8).

50% were morbidly obese patients: BMI >40. 27.7% supermorbid: IMC > 50 and 22.2% obese patients: BMI>35<40.

The weight loss efficacy was determined by percentage of the excess of lost BMI (PEIMCP) (Cigaine criteria).

**Results:** The results after 3 years correspond to 66.6% of the patients since the rest of them have not yet concluded the study.

100% had no surgical complications nor at the time of follow-up postoperative.

The weight loss results expressed as PEIMCP are:

PEIMCP to 3 months = 95,78% ±8,27;

6 months = 96,04 ± 4,39

12 months = 99,92±2,81

24 months = 99,77 ±1,85

36 months = 99,79 ± 2,13

Mean PEIMCP was 99,61% ±15,32 at the end of the review period (3 years).

100% of those who have completed the follow-up show excellent results with a PEIMCP>65%.

**Conclusions:** Bariatric surgery using laparoscopic One-Anastomosis Gastric Bypass Technique is effective for the treatment of morbid obesity in terms of immediate weight loss and maintained in the time.

**Keywords:** Bariatric Surgery, Obesity, Weight Loss, Adolescent.

**Further collaborators:**

José Mª Jiménez Pérez (RN, PhD)¹,², Mª José Cao Torija (RN, PhD)¹,², Ana García del Río (MSc)¹, María Lopez Vallecillo (RN, PhD)¹, Manuel Frutos Martín (RN, PhD)¹, Mª José Castro Alija (MD, PhD)¹,².

¹Nursing Faculty, University of Valladolid. Spain.

²Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.

(1)Castro Alija, Mª José; (2)Cao Torija, Mª José; (3)Garcia del Río, Ana;

(4)Lopez Vallecillo, Maria; (4)Frutos Martin, Manuel; (2)JIMENEZ PEREZ, JOSE MARIA.

(1)MD, PhD. Faculty of Nursing. University of Valladolid. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.; (2)RN. PhD. Nursing Faculty, University of Valladolid. Spain. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.; (3)MSnc. Nursing Faculty, University of Valladolid. Spain.; (4)RN. PhD. Nursing Faculty, University of Valladolid. Spain.

**Background and objectives:** Dietary-nutritional preparation to achieve a weight loss prior to bariatric surgery implies benefits in the surgical act and in the postoperative period, since it allows patients adaptation to a healthy and balanced diet, which must be its habitual pattern for life.

To study the weight loss of patients with morbid and extreme obesity prior to surgery.

**Methods:** Observational, descriptive, longitudinal study with 192 patients, average body mass index (BMI)=42.24 in the first consultation, of which 22 patients present BMI > 50.

The mean time of preoperative preparation in the group with BMI<50 is 85 days and in the group with BMI >50 is 136 days. To the BMI<50 group, a mixed hyperproteic hypocaloric diet was prescribed for 66 days and the remaining 20 days was prescribed center protocol. Group with BMI > 50, pattern in 3 phases, 1st: 60 days hypocaloric-hyperproteic mixed diet; 2nd: 56 days hypocaloric-hyperproteic exclusived diet with substitutes; 3rd: the same pattern as the previous group. Statistical analysis: mean determination, standard deviation, confidence interval and Pearson coefficient.

**Results:** Regarding to the mean weight loss in the group with BMI < 50, the decrease of the weight loss mean was 14.97 kg, it assumes that the BMI decreases 5.38 and the mean of the group with BMI>50 is 28.15 kg, which it supposes a decrease in BMI = 10.23 in the pre-surgical period.

The mean daily weight loss in the pre-surgery phases in the group with BMI<50 was 175 g/day and in the group with BMI>50 the weight decrease = 200 g/day.

**Conclusions:** It is effective to perform dietetic-nutritional interventions differentiated according to the BMI both with respect to the time and the pattern, to minimize the surgical risks.

Patients with extreme obesity require more days of dietetic-nutritional preparation before of the surgery to achieve equivalent results to patients with morbid obesity.

**Keywords:** Bariatric Surgery, Obesity Morbid, Weight Loss, Diet Therapy
**Further collaborators:**

Mª José Castro Alija (MD, PhD)<fnref n="1" />,<fnref n="2" />, Mª José Cao Torija (RN, PhD)<fnref n="1" />,<fnref n="2" />, Ana García del Río (MSc)<fnref n="1" />, María Lopez Vallecillo (RN, PhD)<fnref n="1" />, Manuel Frutos Martín (RN, PhD)<fnref n="1" />, José Mª Jiménez Pérez (RN, PhD)<fnref n="1" />,<fnref n="2" />.

144/2404

WHAT IS THE PERCEPTION OF BODY IMAGE IN A GROUP OF ADULT WOMEN?

(1)Jiménez Pérez, José María; (2)Cao Torija, Mª José; (3)Garcia del Río, Ana; (4)Lopez Vallecillo, Maria; (5)Frutos Martín, Manuel; (5)Castro Alija, Mª José.

(1)RN, PhD. Faculty of Nursing. University of Valladolid. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.; (2)RN. PhD. Nursing Faculty, University of Valladolid. Spain. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.; (3)MSnc. Nursing Faculty, University of Valladolid. Spain.; (4)RN. PhD. Nursing Faculty, University of Valladolid. Spain.; (5)MD. PhD. Nursing Faculty, University of Valladolid. Spain. Endocrinology and Clinical Nutrition Research Center (ECNRC), University of Valladolid. Spain.

**Background and objectives:** Body image has been defined as a multidimensional structure that differ in two underlying dimensions, the first refers to the perceptual aspects of body size estimation and the second includes the emotions or feelings that the individual has associated with his physical appearance and cognitive assessments that makes of its own body (Cash 1994). Having a negative body image can affect health. When this happens there is a greater predisposition to more disturbances such as anxiety, depression, low self-esteem, anorexia, bulimia, and many others that can have serious consequences. (Salaberria et al 2007)

Women have a greater vulnerability in light of these disorders due to the strong social pressure on their own appearance and socialization processes that emphasize aspects of appearance.

Set the perception of body image in a representative healthy adult women of Valladolid (Spain) collective.

**Methods:** Cross sectional study; sample of 500 women aged 40 to 60 years, mean age 51.16, and urban area of the city of Valladolid, intermediate between the Spanish cities, which guarantees that the probability of error will not exceed 5%.

We used a self-designed questionnaire formed by questions that assess anthropometric and attitudinal variables. This questionnaire takes as a reference: Body Image Questionnaire Questionnaire by Cooper and Attitude towards food by Gardner.

**Results:** From estimates of height and weight data we obtain a mean BMI of 24.43, within normal parameters. 87.5% of women are concerned about their body weight, between of them the 78% of the cases are concerned due to a combination of aesthetic and

health reasons. The 57.14%, have tried to hide their silhouette with clothes and if we calculate the IAC (Alvarez Rayon) it gives a score of 108.11 listed as moderate over estimation of weight. In the perception of body image, estimated by using models, we find that the 37.49% believe that the model that represent them has overweight or obesity.

**Conclusions:** The women in our study have a normal mean BMI. They are concerned about their weight, which overestimate moderately. They try to hide their silhouette and consider that their image corresponds to overweight in a high percentage of cases.

**Keywords:** Body image, Women, Health Care Surveys.

**Further collaborators:**

Mª José Castro Alija (MD, PhD)<fnref n="1" />,<fnref n="2" />, Mª José Cao Torija (RN, PhD)<fnref n="1" />,<fnref n="2" />, Ana García del Río (MSc)<fnref n="1" />, María Lopez Vallecillo (RN, PhD)<fnref n="1" />, Manuel Frutos Martín (RN, PhD)<fnref n="1" />, José Mª Jiménez Pérez (RN, PhD)<fnref n="1" />,<fnref n="2" />.

144/2409

EVALUATION OF DIETARY HABITS INFLUENCE ON THE ACNE VULGARIS MANIFESTATION

(1)Schlegel-Zawadzka, Malgorzata; (2)BOGDANOWICZ, KLAUDYNA;

(3)Blaszczyk-Bebenek, Beata; (3)Zwirska, Jasmina; (3)Piorecka, Beata;

(2)Jagielski, Pawel.

(1)Prof. Bromatologist. Department of Human Nutrition. Institute of Public Health. Faculty of Health Sciences. Jagiellonian University Medical College. Poland; (2)MSc. Public Health. Department of Human Nutrition. Institute of Public Health. Faculty of Health Sciences. Jagiellonian University Medical College. Poland.; (3)PhD. Public Health. Department of Human Nutrition. Institute of Public Health. Faculty of Health Sciences. Jagiellonian University Medical College. Poland.

**Background and objectives:** Acne vulgaris is a chronic dermatologic disease that manifests in adolescence. It is characterized by the presence of comedones, papules, pustules and scars on the skin. The disease is caused by hyper-secretion of sebaceous glands. The manifestation of acne is influenced by many factors. The aim of the study was to assess the relationship between diet and the manifestation of acne vulgaris.

**Methods:** The instrument used for the purposes of the research was a questionnaire prepared by the authors. The study subjects were individuals affected by acne currently or in the past as well as people not affected by acne. The participants of the study were selected by snowball sampling. Respondents were asked about the age of onset of the first symptoms of acne, the occurrence of acne among their relatives, the location of acne on the skin and its severity, methods of treatment and other ways of coping with acne as well as about the frequency of consumption of specific products/dishes and the change in the severity of acne

<footnote n="1">¹Nursing Faculty, University of Valladolid. Spain.</footnote>

<footnote n="2">²Endocrinology and Clinical Nutrition Research Center (ECN-RC), University of Valladolid. Spain.</footnote>

<footnote n="1">¹Nursing Faculty, University of Valladolid. Spain.</footnote>

<footnote n="2">²Endocrinology and Clinical Nutrition Research Center (ECN-RC), University of Valladolid. Spain.</footnote>
due to their consumption. In order to compare the results, cross tabulation, Chi-square test of independence, and Mann-Whitney U test (independent samples) were used. The significance level was α=0.05.

**Results:** 118 people participated in the survey, including 32 (27.12%) men and 86 (72.88%) women. More than half of the men (56.25%) and women (52.33%) in question had acne vulgaris. The average age of onset of the first symptoms of acne was 14 years. Most frequently acne occurred on the face (92.06%). The majority of the participants assessed the severity of acne as medium (51.61%). More women (57.78%) than men (29.41%) responded that a dermatologist treated them. Participants manifesting acne believed that salty food increases the severity of acne (45.76%, p<0.05). Consumption frequencies of certain products/dishes differed significantly between the surveyed groups (p<0.05).

**Conclusions:** Most of the products/dishes do not influence the severity of acne in respondents. The difference in responses concerning the change in the severity of acne following the intake of candies and cakes was significant between men and women (p<0.05).

**Keywords:** Acne vulgaris, Diet, Nutrition, Severity of acne.

144/2415

PREVALENCE OF CORONARY HEART DISEASE
RISK FACTORS IN PATIENTS WITH HIGH LDL
CHOLESTEROL LEVELS, WITH OR WITHOUT FA-
MILIAL HYPERCHOLESTEROLEMIA DIAGNOSES:
A CROSS-SECTIONAL STUDY IN RIO DE JANEIRO

(1)Pinto Gapanowicz, Débora; (2)Saraiva Dias Marques, Mariana;

(2)Barbosa Merlim Abrantes, Taciane; (3)Almeida Palles Ramos,

Caroline; (4)Vieira Assad, Marcelo Heitor; (5)Vilas Bôas Huguenin,

Grazielle; (6)Seixas Bello Moreira, Annie.

(1)BSc. Nutritionist. Education and Research Department .

Brazilian National Cardiology Institute. Brazil.; (2)Nutrition Student. Nutrition Institute. Rio de Janeiro State University. Rio de Janeiro. Brazil.; (3)BSc. Nutritionist. Master in Food Nutrition and Health. Nutrition Institute. Rio de Janeiro State University.

Rio de Janeiro. Brazil.; (4)MSc. Doctor. Education and Research Department. Brazilian National Cardiology Institute. Brazil.; (5)MD.

Nutritionist. Education and Research Department. Brazilian
National Cardiology Institute. Rio de Janeiro. Brazil.; (6)PhD.

Nutritionist. Education and Research Department. Brazilian
National Cardiology Institute. Rio de Janeiro. Brazil.

**Background and objectives:** Familial hypercholesterolemia (FH) is an autosomal dominant disorder, which can be caused by a mutation in low-density lipoprotein receptor (LDLR). This study evaluated the prevalence of coronary heart disease (CHD) risk factors in patients with high low-density lipoprotein cholesterol (LDL-c) levels, with or without confirmed mutation in LDLR (referred to as familial hypercholesterolemia [FH]).

**Methods:** A cross-sectional study of 63 patients with high index of FH suspicion (patients with elevated LDL-C levels > 190

mg/dL, significant personal or family history of premature car-
diovascular disease). A genetic test was done and HF diagnosis
was confirmed by mutation in LDLR. A standardized question-
naire was applied by the researchers to assess patient's personal
and clinical information. Medical charts were reviewed to collect
additional data on CHD risk factors such as diabetes or hyper-
tension and to obtain LDL-c baseline values. The anthropometric
measures were done and checked weight (Kg), height (m), waist
circumference (cm), BMI (Kg/m2) and waist/height ratio. Statisti-
cal analyses were performed using Software IBM® SPSS® Statistics
version 21 and P values were associated with a significance level of
.05 for all tests.

**Results:** Of the 63 patients with high LDL-c, 24 (38,1%) had confirmed HF diagnosis while 39 (61,9%) had unexplained hypercholesterolemia. Patients who carries LDLR mutation were mostly women (75%) and significantly younger than the ones without mutation (mean + SD, 49 + 16 vs 58 + 11 years; P = .008). No differences existed in prevalence of traditional CHD risk factors such as diabetes type II (25% vs 23%, P = .682), hypertension (58% vs 77%, P = .118), exposure to tobacco (43% vs 50%, P = .615), sedentarism (75% vs 95%, P= .06) and raised waist circumference (95 +13 vs 97 +11, P = .599), waist/height ratio (68% vs 87%, P = .051) and BMI (58% vs 69%, P =.378).

**Conclusions:** Our findings suggest that HF patients were younger, however none of the other evaluated risk factors showed significantly different between both groups. Besides, the food consumption of these patients must be assessed, since this is a modifiable risk factor.

**Keywords:** Familial hypercholesterolemia (FH), Low-density lipoprotein receptor (LDLR), Coronary heart disease (CHD)

**Further collaborators:**

Heart Institute (InCor), Hospital das Clinicas, Medicine School, University of São Paulo, Brazil.

144/2440

LIPID ACCUMULATION PRODUCT: A SIM-
PLE AND ACCURATE INDEX FOR PREDICTING
CHANGES IN SERUM LEVELS OF C REACTIVE
PROTEIN

(1)de Carvalho Vidigal, Fernanda; (2)Enriqueta Frandsen Paez de Lima Rosado, Lina.

(1)PhD in Nutrition Science. Professor of Nutrition. Faculty of Nutrition. Universidade Federal de Alfenas. Brazil.; (2)PhD in Nutrition. Nutritionist. Brazil.

**Background and objectives:** High sensitivity C reactive protein is increasingly associated with cardiovascular risk. There are several studies regarding the use of the lipid accumulation product as a risk marker for the development of cardiovascular disease. The aim of this study was to evaluate the predictive ability of the lipid accumulation product in detecting changes in serum levels of high sensitivity C reactive protein.
**Methods:** A cross-sectional study was conducted with 130 apparently healthy Brazilian adults men (20-59 years). Waist circumference was determined. Triglycerides were determined by enzymatic colorimetric method. The lipid accumulation product was calculated as (waist circumference [cm] - 65) x (triglycerides concentration [mM]). C reactive protein was measured by the high sensitivity nephelometry method. It was considered as cutoff point for high sensitivity C reactive protein ≥ 0.12 mg/dL. The statistical analysis consisted in construction of ROC curves (Receiver Operating Characteristic Curve). Statistical analysis was carried out using Medcalc version 12.7.

**Results:** The frequency of high sensitivity C reactive protein levels ≥ 0.12 mg/dL was 30.8%. The lipid accumulation product showed prediction accuracy to detect changes in high sensitivity C reactive protein with an area under the ROC curve (AUC) of 0.642 ± 0.054 (p < 0.01). The cutoff point value of 36.6 cm.mmol/L for the lipid accumulation product provided a sensitivity of 47.5% (95% CI: 31.5-63.9%) and specificity of 82.2% (95% CI: 72.7-89.5).

**Conclusions:** The lipid accumulation product has a reliable predictive ability to detect changes in serum levels of high sensitivity C reactive protein in apparently healthy Brazilian adults men. In other words, the lipid accumulation product was a good marker to detect individuals with higher cardiovascular risk.

**Keywords:** Adiposity. Cardiovascular diseases. Lipid accumulation product. Prediction.

(1)Joy, Laura; (1)Báez, Alicia; (1)Estigarribia, Mariela; (1)Ibarrola, Ana; (1)Benitez, Susana; (1)Arriola, Nidia; (2)Gonzalez Cespedes, Laura Elizabeth; (2)Araujo Pino, Silvia Stella; (2)Morínigo Martínez, Macarena.

(1)Departamento de Alimentación y Nutrición. Instituto Nacional de Cáncer (INCAN). Ministerio de Salud Pública y Bienestar Social. Paraguay; (2)Departamento de Nutrición. Dirección de Investigación. Facultad de Ciencias Químicas. Universidad Nacional de Asunción. Paraguay.

**Background and objectives:** Because of the characteristics of the disease and the treatments to which they are subjected, patients diagnosed with cancer (CA) have a high risk of malnutrition. The risk could vary according to the type of tumor, location and tumor stage. Therefore, we studied all patients admitted to the National Cancer Institute (INCAN) during 2016 and determined the risk of malnutrition at the time of admission based on the location of the cancer.

**Methods:** We conducted a cross-sectional study with data obtained from January to December 2016 at INCAN. We attended 912 patients with different types of CA. We analyzed demographic and clinical data and the nutritional status was determined by the screening method proposed by Gómez et al (2010). Patients with

location of CA abdominal/peritoneal, head/neck, gastric, colon/rectum/anus, digestive organs annex, and lung were considered in risk of malnutrition. Chi Square and Odds Ratios test was used to determine the risk of malnutrition based on the CA location.

**Results:** The final sample was 877 patients with CA. The average age was 55±14years (95%CI 54-56years), 65.5% were woman. The location most frequent of CA were gynecological (26.9%), head/neck (15.5%) y colon/rectum/anus (15.2%). In woman prevailed CA Gynecological type, breast and head/neck 38.7%, 21.4% y 12.5%, respectively and in man colon/rectum/anus (24.8%), head/neck (21.1%) y male reproductive system (13.2%). According to the nutritional evaluation, 38.9% presented malnutrition and 42.2% of patients have risk of malnutrition according by location of CA. Patients with Gastric, Abdominal/Peritoneal and Pulmonary CA present a higher frequency of malnutrition, while urinal, breast and skin CA patients present malnutrition in less frequent. 52.2% (n = 178) of the malnourished were patients with risk by CA localization, while 64.2% of the non-malnourished did not present risk by CA localization. The patients with head/neck, digestive (liver, pancreas, gastric, colon, rectum, anus), Abdominal/Peritoneal and Pulmonary CA have 1.957 more likely to present malnutrition (p <0.05).

**Conclusions:** In the patients treated at the INCAN the location of the cancer would predict the risk of malnutrition. However, it is important to continue the investigations considering that malnutrition in these patients is multifactorial

**Keywords:** Malnutrition, Cancer, Location, Risk.

**Further collaborators:** Anyelius Arami Limprich Soilán

(1)Aparecido da Silva, Silvano; (2)Renata Conte Lima, Thais.

(1)PhD Student. Pharmacist. Institute of Scientific and Technological Research. Catholic University of Santos. Brazil; (2)BS. Nutricionist. Institute of Scientific and Technological Research. Catholic University of Santos. Brazil.

**Background and objectives:** Thyroid cancer is a disease that affects an important endocrine gland. To achieve better treatment and cure efficacy, it is important to consider the polymorphic aspects of patient genetics, such as single nucleotide polymorphisms (SNPs) that may cooperate with therapeutic success in CYP3A4 cytochrome metabolism. Another characteristic of observed SNPs is mainly due to the enzymes Methionine Synthase and Methyl-enetetrahydrofolate Reductase involved in the maintenance of methyl group supply by S-Adenosylmethionine, in addition to corroborating cofactors for the epigenetic mechanisms. Objectives: To elaborate a therapeutic diet plan that does not compromise the treatment in thyroid cancer in its main cytochromic metabolizers and that can modulate the epigenetic mechanisms pertinent to the genetic characteristics of the tumor.

**Methods:** The dietary plan was developed using the databases of the International Human Epigenome Consortium (IHEC),
PharmGKB (Pharmacogenomics Knowledgebase), CIPIC (Clinical Pharmacogenetics Implementation Consortium) and USDA (United States Department of Agriculture).

**Results:** Bioactive compounds such as bergamottin and furanocoumarin inhibit cytochrome CYP3A4, which is the main drug metabolizer Vandetanib, Cabozantinib and Sorafenib. Inhibition of this cytochrome may alter drug plasma concentrations. Grapefruit juice, tomato fruit, St. John's wort and others with the same inhibitory potentials should be avoided. The correct functioning of the epigenetic mechanisms comes from a diet containing folic acid, vitamins B2, B6, B12 and betaine that aid in the altered kinetics in the presence of SNPs. The use of bioactive compounds active in the inhibition of DNA methyltransferases, such as genistein present in soybean or epigallocatechin gallate of green tea, may provide a decrease in growth and induction of apoptosis of cancer cells. Curcumin acts on gene regulation causing hypomethylation of DNA.

**Conclusions:** Knowledge of the SNPs of people with thyroid cancer, as well as histology, degree of differentiation and tumor genetics, may cooperate with therapeutic success. Allied to this conduct, a diet can provide elements that do not harm the treatment and act in the modulation of important mechanisms in the pathogenesis of the tumor.

**Keywords:** Thyroid Cancer, Nutrigenetics, Epigenetics.

144/2461

SPLENIC INTERSTITIAL FLUID PROTEOMIC PROFILE DURING PROTEIN MALNUTRITION AND LEISHMANIA INFANTUM INFECTION

**Background and objectives:** Protein malnutrition (PM), the most deleterious cause of malnutrition in developing countries, has been considered a primary risk factor for the development of clinical visceral leishmaniasis (VL). Protein malnutrition and infection with Leishmania infantum leads to lymphoid tissue disorganization, changes in cellularity and lymphocyte subpopulations in the spleen. A proteomic analysis of the interstitial fluid (IF) of the spleen in protein restricted BALB/c mice infected with L. infantum was undertaken in this study to define the mechanisms that drive splenic response during PM and infection.

**Methods:** We compared four groups of mixed IF samples: animals fed 14% protein (CP: iTRAQ 114), animals fed 4% protein (LP: iTRAQ 115), animals fed 14% protein and infected

(CPi: iTRAQ 116), and animals fed 4% protein and infected (LPi: iTRAQ 117). Samples were analyzed in a LTQ-Orbitrap-XL.

**Results:** A total of 344 proteins were identified and the fold changes in protein quantification were calculated from the intensities of iTRAQ reporter ions between the CP and CPi, LP and LPi using the PatternLab platform. A total of 74 proteins presenting a change in abundance were screened in the splenic IF of LPi mice, of which 27 proteins were upregulated and 47 proteins were downregulated. In total, 291 (85%) proteins were identified as secreted proteins. From the remaining proteins 53 were not predicted as secreted, 45 were previously reported as exosomal proteins, and 8 were neither predicted as secreted nor exosomal proteins.

**Conclusions:** We identify alterations in different points of the metabolism and splenic immune response, such as proteins of the pentoses phosphate pathway and purine biosynthesis, as well as response to oxidative stress, which may affect the proliferation of splenocytes and generate an imbalance of the oxidative state of splenocytes from LPi mice. We detected reduced levels of various proteins involved in the pro-inflammatory response and chemotaxis in the splenic interstitial fluid of LPi mice, such as: MIF, PPBP, ISG15 and ALDH1A1. Our results reinforce the idea that the increased parasitic load in the spleen of malnourished animals is associated with an altered pro-inflammatory response during protein malnutrition involving different molecules and biological processes during the immune response.

**Keywords:** Protein malnutrition, Leishmania infantum, visceral leishmaniasis, Apoptosis, T cell migration.

**Further collaborators:**

Co-author 10, Patricia Cuervo, PhD. Laboratorio de Pesquisa em Leishmaniose, Fiocruz, Rio de Janeiro, Brazil.

<footnote>(1)Losada, Monica; (2)Umaña-Perez, Adriana; (2)Cuervo-Escobar, Sergio; (1)Rodriguez, Andres; (3)Berbet, Luiz; (1)Porrozzi, Renato;</footnote>

<footnote>(3)Mendes-da-Cruz, Daniella; (3)Savino, Wilson; (4)Carvalho, Paulo;</footnote>

<footnote>(2)Sánchez-Gómez, Myriam.</footnote>

<footnote>(1)PhD. Laboratorio de Pesquisa em Leishmaniose, FIOCRUZ, Rio de Janeiro, Brazil; (2)PhD. Laboratorio de Hormonas, Universidad Nacional de Colombia, Bogotá, Colombia; (3)PhD. Laboratorio de Pesquisas sobre o Timo, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brasil; (4)PhD. Laboratorio de Proteômica e Engenharia de Proteínas, FIOCRUZ, Curitiba, Brazil.</footnote>
# EFFECT OF DIET ON GASTROINTESTINAL SYMPTOMS IN PATIENTS WITH IRRITABLE BOWEL SYNDROME (IBS) STRATIFIED BY ANTIGLIADIN (AGA) ANTIBODIES

(1)Pinto-Sanchez, Maria Ines; (2)Ignatova, Ekaterina; (3)Hansen, Suzanne; (4)Borojevic, Rajka; (5)Nardelli, Andrea; (6)Causada Calo, Natalia; (7)Collins, Stephen M; (8)Armstrong, David; (9)Verdú, Elena; (9)Bercik, Premysl.

(1)MD. MSc. Nutrition clinical fellow. Farncombe Family Digestive Research Institute. McMaster University. Canada.;

(2)Undergraduate student. Farncombe Family Digestive Health Research Institute. McMaster University. Canada.;

(3)RD.Nutritionist. Farncombe Family Digestive Health Research Institute. McMaster University. Canada.; (4)Research assistant. Immunohistochemistry. Farncombe Family Digestive Health Research Institute.McMaster University.Canada.; (5)MD. PhD.

Postdoctoral research fellow. Farncombe Family Digestive Health Research Institute. McMaster University.Canada.; (6)MD.

Postdoctoral research fellow. Farncombe Family Digestive Health Research Institute.McMaster University.Canada.; (7)MD. PhD. MBBS. FRCPC. Professor. Associate Dean of Research.

Farncombe Family Digestive Health Research Institute. McMaster University.Canada.; (8)MD.MA.MB BChir. FRCPC. FRCP(UK). FACG.

AGAF. Professor. Farncombe Family Digestive Health Research Institute. McMaster University.Canada.; (9)MD.PhD. Associate Professor.Farncombe Family Digestive Health Research Institute.

McMaster University.Canada.

**Background and objectives:** Diet plays an important role in IBS and there is evidence that foods with high Fermentable-Oligosaccharides-Disaccharides-Monosaccharides-and-Polyols (FODMAPs) content and gluten may worsen symptoms. IBS patients with positive antigliadin-antibodies (AGA) may preferentially respond to a gluten-free diet (GFD). Differences in dietary patterns were observed in IBS vs healthy volunteers (HV), however, the effect of food consumption on the symptomatic response to gluten withdrawal in IBS patients stratified by the presence of AGA has not been previously studied. We conducted a clinical trial to evaluate the dietary patterns and nutrient intake in IBS patients stratified by their AGA status, before and after one-month of GFD.

**Methods:** IBS patients (Rome III criteria) were stratified by the presence of AGA (INOVA Inc). A group of HV served as controls. All participants underwent a GFD for one month. Gastrointestinal symptoms were assessed by the IBS-Birmingham score. A food-frequency questionnaire (FDQ-VES2, Australia) was used to assess: 1)dietary patterns, 2)nutrient intake, and 3)FODMAP consumption before and after GFD.

**Results:** 44 IBS-patients (24 AGA+; 20 AGA-) and 23 HV were recruited. GFD improved symptoms (indigestion, diarrhea and abdominal pain) in IBS AGA+ patients while only pain improved in IBS AGA- patients. At baseline, IBS AGA+ had significantly lower consumption of protein (p<0.05 vs IBS AGA- and HV). Both IBS AGA+ and AGA- had significantly lower fiber intake compared to HV.IBS AGA+ increased the intake of foods with high content

of vitamin-A and C (carrots, lettuce, spinach and capsicum) and decreased the intake of some cereals (porridge). There was no change in amount of food high-in FODMAPs, except for multi-grain bread which was decreased in the three groups.

**Conclusions:** The type and quality of food differ between subsets of IBS patients, suggesting that patients may have their dietary preferences based on symptoms. GFD improves IBS symptoms in AGA+ patients, and this seems to be independent of overall FODMAPs consumption. The increase in food with high content of vitamin-A & C may play a role in the beneficial effect of the GFD in IBS AGA+ patients, due to their anti-inflammatory properties or by inducing changes in GI motility.

**Keywords:** Gluten. Diet. Nutrients. Gastrointestinal symptoms. IBS

**Further collaborators:**

Yuxi-Ge, undergraduate student. Farncombe Family Digestive Research Health Institute.

Paul Moayyedi. MD. PhD. Professor. Farncombe Family Digestive Research Health Institute.

# ESTABLISHMENT OF HEMOGULOBIN MEASURING METHOD FOR THE PREVENTION OF SPORTS ANEMIA IN FEMALE ATHLETES

(1)Abe, Hirotoshi; (2)Matsumoto, Megumi; (3)shirai, Anna; (2)KOYAMA, YUUZOU.

(1)MSc; (2)PhD; (3)BSc.

**Background and objectives:** For a female athlete, iron deficiency and anemia is one of the symptoms which remarkably lowers performance, and could cause health impairment. Athletes frequently undergo anemia due to rigorous training, reducing food intake for weight control and destruction of erythrocyte by repeated sole impulse. In addition, menses make it difficult for females to improve anemia. In this study, we focused on the collegiate female athletes of land jump, volleyball and fencing who often complain anemia, and tried to establish the simple method of measuring the hemoglobin concentration in blood using non-invasive fingertip sensor, in order to monitor the status of iron nutrition easily.

**Methods:** Subjects were composed of each 27 collegiate female athlete of land jump, volleyball and fencing. The hemoglobin concentration was measured at before training using measuring instrument of non-invasive fingertip sensor (Pront-7). Furthermore hearing investigation was performed to record the physical condition and food intake frequency of one week.

**Results:** In hearing investigation, the athletes who complained symptom of anemia were 70%, 40% and 35% in land jump, volleyball and fencing, respectively. The score of anemia condition negatively correlated with hemoglobin concentration. Hemoglobin concentrations were 12.4±0.2 g/dL, 12.1±0.4 g/dL and 12.9±0.2 g/dL in athletes of land jump, volleyball and fencing, respectively. As a result of surveying the meal intake frequency in the athletes of jumping events of athletic competition, there was a positive corre-
lation between the amount of iron, protein or zinc intake per day and hemoglobin level. (iron: r = 0.575, protein: r = 0.630 and zinc: r = 0.661, respectively)

**Conclusions:** The measurement of hemoglobin using fingertip sensor might be useful option for monitoring the status of iron nutrition to prevent sports anemia.

**Keywords:** Sports anemia, Fingertip sensor, Hemoglobin, Protein, Iron.

**Conclusions:** The pathogenesis of FABP 4 acceleration bone resorption in PMOP mice fed by HFD was regulation both LPS-TLR4-FABP4 pathway and stimulate the osteoclast cell activity induced by inflammation adipocytokines.

**Keywords:** Postmenopause osteoporosis, Fatty acid binding protein, LPS-TLR4-FABP4 pathway, Inflammation adipocytokines.

**Further collaborators:** This study was supported by the HKU Small Project Funding, Project NO: 201409176257

144/2499

ROLE OF FATTY ACID BINDING PROTEIN 4 AS AN ADIPOKINE TO REGULATION BONE RESORPTION DURING POSTMENOPAUSE OSTEOPOROSIS MICE FED BY HIGH FAT DIET

(1)Zhu, Cuifeng; (2)Pan, Yong; (3)Jin, LengGang; (3)Liu, Yan; (4)Xu, AiMin.

(1)Postdoctoral fellows. Department of Medicine, University of Hong Kong. China; (2)PhD, Dept of Medicine of Hong Kong University. Hong Kong. China; (3)Dept of Nutrition of Southern Medical University ShenZhen Hospital, China; (4)professor, Dept of Medicine of Hong Kong University. Hong Kong. China.

**Background and objectives:** Adipokines is involved in both onset and progression of postmenopause osteoporosis (PMOP). However, the link between adipokines and PMOP has not been explored. Present study was designed to investigate the role of fat-ty acid binding protein 4 (FABP 4/ap 2) as an adipokines with the effects on bone metabolism in the pathogenesis of PMOP mice.

**Methods:** 12 weeks old FABP -/- and FABP +/- mice were fed with standart chow diets (SCD) or high fat diet for (HFD) 8 weeks after ovariectomy or sham surgery, then re-function of FABP by implanted a osmos pump fill with FABP protein (1g/kg.BW.day) into FABP -/- mice or fill with FABP 4 inhibitor BMS309403 (200 ng/day) to FABP +/- mice fed by HFD for 28 days after ovariec-tomy. followed by micro CT and histological to evaluations the BMD and bone resorption in all mice of the ten groups ,Real-time PCR analysis the expression of TLR4, JNK, c-JUN-AP1, FABP 4 ,RANKL, OCs (TRAP, MIP-1α) and TNF-α,IL-6 in femur bone tissues and blood were detected.

**Results:** The BMD and mRNA exoreuction of TLR4, JNK, c-JUN-AP1, FABP 4, RANKL, OCs (TRAP, MIP-1α) and TNF-α,IL-6 in femur bone tissues and LPS, FABP 4, TNF-α,IL-6 in blood were decreased significantly(P<0.01 or P<0.001) in FABP -/- mice compared with FABP +/- mice afterovariectomy fed by HFD, Although the biomarkers of four groups of FABP -/- and FABP +/- mice after ovariectomy were different significantly to other mice after sham surgery, but there were no different significantly between FABP -/- and FABP +/- mice after ovariectomy fed by SCD compared with these biomarkers (P>0.05). When re-function and inhibitor of FABP 4, all biomarkers mentioned above reversed significantly in this two groups. Which indicated that there is a positive feedback loop between FABP4 and LPS-JNK-c-Jun-AP1 in the TLR4 pathway, which is involved in the process of bone metabolis in POMP.

144/2507

INTRAVENOUS ARGININE ADMINISTRATION PROMOTES ENDOTHELIAL PROGENITOR CELLS MOBILIZATION AND ATTENUATES LUNG INJURY IN MICE WITH POLYMICROBIAL SEPSIS

(1)Yeh, Chiu-Li; (2)Pai, Man-Hui.

(1)Department of Nutrition and Health Sciences, Chinese Culture University; (2)Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University.

**Background and objectives:** This study investigated the influences of intravenous arginine (Arg) administration on alteration of circulating endothelial progenitor cells (EPCs) and lung injury in polymicrobial sepsis.

**Methods:** There were 1 normal control group (NC) and 2 sepsis groups. Sepsis was induced by cecal ligation and puncture (CLP). One sepsis group wasinjected with saline (SS), whereas the other group (SA) was administered 300 mg Arg/kg of body weight once via the tail vein 1 h after CLP. Septic mice were sacrificed either 24 or 48 h after CLP.

**Results:** Results showed that compared to the NC group, septic mice had higher EPC releasing factors and circulating EPC percentage. Also, inflammatory cytokine concentrations and Ang/ Tie2 gene expression were upregulated in lung tissues. Arg administration promoted EPCs mobilization, downregulated inflammatory cytokine production and Ang-2 gene expression in the lungs. Histopathological findings showed that the severity of lung alveoli inflammatory lesions was attenuated after CLP when Arg was administered.

**Conclusions:** Our results suggest that intravenous administration of Arg after the onset of sepsis enhances the mobilization of circulating EPCs and reverses the imbalance of the Ang-Tie2 axis that may improve the vascular function, reduce inflammatory reaction and offer organ protection in polymicrobial sepsis.

**Keywords:** Arginine, Sepsis, Endothelial progenitor cell, Ang/Tie2, Lung injury.
# BECOMING MALNOURISHED CHILDREN, ONE YEAR AFTER NUTRITION EDUCATION IN KAYA (BURKINA FASO)

(1)Garanet, Franck; (2)Bayo, Abou; (3)Ouedraogo, Mohamed.

(1)Research Institute of Health Sciences; (2)Universite Polytechnique de Bobo-Dioulasso.Unite de Formation et de Recherche en Sciences et Techniques; (3)Ministère de la Santé ; District sanitaire de Kaya.

**Background and objectives:** The objective of this study is to determine the fate of malnourished children one year after nutrition education ain the nutrition éducation center in Kaya.

**Methods:** This is a cohort study of children who stayed at the Nutrition Education Center in Kaya in the year 2014.

**Results:** A total of 135 children were included in our study. The results showed a year after the nutrition éducation center release a relapse in 32% of the cases of which 7.69% in severe form. We recorded five deaths and 30 children were not found. Of 105 children recovered one year after discharge from nutrition éducation center, we noted a relapse in malnutrition in 32% of cases, 7.69% in severe cases. Also, 46.39% of the children received food before the age of 6 months and 86.73% of the mothers know that the food introduced is the porridge prepared from fortified flour and water. In addition, 17.35% of mothers evacuate the child's stool in an unhygienic manner and only 77.55% wash their hands with soap after handling the child's stool. Knowledge assessment revealed that 78.8% of mothers know that complementary food should be introduced at 6 months of age, 53.61% know that porridge and Hygiene and thus have the right knowledge in the care, nutrition and hygiene of the child.

**Conclusions:** The nutritional situation one year after children received at nutrition éducation center is critical and deserves special attention from the various institutions involved in improving the living conditions of households and the survival of children. Also, post-education monitoring is needed to strengthen mothers’ knowledge.

**Keywords:** Becoming children, Malnutrition, Nutrition education, Kaya.

# CALORIE RESTRICTION IN THE MANAGEMENT OF OBESITY ASSOCIATED OBSTRUCTIVE SLEEP APNEA - A NON-PHARMACOLOGICAL INTERVENTION STUDY

(1)Nemani, Harishankar; (2)Kallamadi, Prathapreddy; (3)Nemani, Shivaram; (4)Putchaa, Udaykumar; (4)Mullapudi Venkata, Surekha; (5)Pothani, Suresh.

(1)Ph.D.National Institute of Nutrition.ICMR.Hyderabad.India.; (2)M.Sc.National Institute of Nutrition.ICMR.Hyderabad.India.; (3)MDS.Orthodontist.Panineeya Institute of Dental Sciences & Research Centre. Dilsukhnagar. Hyderabad. Telangana, India.; (4)MD.Pathology.National Institute of Nutrition.ICMR.Hyderabad. India.; (5)MVSc.Microbiology.National Institute of Nutrition.ICMR. Hyderabad.India.

**Background and objectives:** Obstructive sleep apnea (OSA) is the result of a partial or complete blockage of upper airway structures and will reduce the oxygen flow to vital organs, resulting in irregular heart rhythms. Obesity is the strongest risk factor for the development of OSA. Our main objective is to see the fat infiltration in to the tongue of calorie restricted rats and its consequences on upper airway obstruction in comparison with lean and ad lib fed obese rats.

**Methods:** Eighteen Lean (223.33 g ±20.42), obese (584.22 g ± 5.65) and calorie restricted (CR) (303.00 g ± 16.97) obese rats were taken for the study. Body fat and lean body mass (LBM) was determined by total body electrical conductivity (TOBEC), radiographs of upper airway structure were analyzed by digital X-ray. Ex-vivo biochemistry was carried for leptin, lipids in blood/tissues, and fat infiltration by oil red O staining (ORO). The tongue, masseter muscle fat, fibre and taste buds morphology assessed by scanning electron microscope (SEM).

**Results:** TOBEC analysis showed higher body fat and low LBM, X-ray displayed excess fat in the neck region. Triglyceride levels were high and leptin levels were reduced in CR rats compared to lean and ad lib fed obese rats. ORO staining of tongue showed fat accumulation of varying degree in different groups. SEM analysis of the tongue and masseter muscle demonstrated an increase in fat infiltration with an increase in fat droplets. Tongue muscle fibres showed rugged abnormal folding, with an increase in width in obese rats. The distance and width between the taste buds of CR reduced to levels of lean rats.

**Conclusions:** There is a different degree of fat infiltration in the tongue of calorie restricted and adlib fed obese compared to lean rats. The calorie restriction in obese rats also increased the lunge volume and haemoglobin levels compared to adlib obese rats. The hypertrophy seen in the calorie restricted obese rat tongue may play a role in altered tongue neuromuscular function. These findings suggest that, future studies on the role of obesity in OSA should focus on tongue fat infiltration and its distribution with calorie restriction.

**Keywords:** Calorie restriction, Lipids, Masseter muscle, Obesity, Upper airway structures.
# ANALYSIS OF THE EVOLUTION OF NUTRITION-AL PARAMETERS IN PATIENTS TREATED IN BARIATRIC SURGERY THE CLINIC-SCHOOL

(1)Auler, Flavia; (2)Derosso, Ariadne Alves; (2)Pereira, Nicole Martins.

(1)PhD. Nutricionist. Pontifical University Catholic of Paraná.
Argentina; (2)Nutricionist. Pontifical University Catholic of Paraná.
Argentina

**Background and objectives:** Currently, bariatric surgery is accepted as the most effective tool in the treatment and control of morbid obesity. Several indicators are used to analyze the success of bariatric surgery. The objective of this study was to analyze the evolution of nutritional and clinical parameters in the postoperative period of patients submitted to bariatric surgery by the Roux-en-Y gastric bypass technique attended at a school-clinic.

**Methods:** Patients were selected from one month to one year after bariatric surgery without distinction of age and gender, and postoperative complications such as the presence of craving, vomiting and weight gain were evaluated, and clinical signs were more evidenced due to the deficiency Were micronutrients, hair loss and dry skin (protein, zinc and biotin). To obtain the results of the anthropometric evolution, we analyzed records of BMI, % PP and % PEP, CC, CA and CB.

**Results:** In the anthropometric analysis, the BMI and CB indicators in the 6th month already indicated a drastic reduction for classification for overweight, for the % PP and % PEP, the highest losses occurred until the 3rd month and the CC and CA measures were no longer presenting cardiovascular risk In the 9th month. As for food intake, there was an adjustment in relation to the consumption of dairy and cereal groups and reduction in meat consumption. In general, the individuals presented a reduction in the symptoms analyzed in the first trimester.

**Conclusions:** In the course of the present study, it is verified that the results obtained were already expected, although the patients' adherence was considered as unsatisfactory as of the 6th month. Nutritional monitoring is necessary so that it can achieve expected success in the indicators.

**Keywords:** Nutritional parameters, Patients, Bariatric surgery, Clinic-school.

# RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND CARDIOVASCULAR RISK IN PATIENTS WITH METABOLIC SYNDROME

(1)Dragut, Ramona Maria; (1)Rusu, Emilia; (2)Rusu, Florin; (1)Cursaru, Raluca; (1)Popescu, Horatiu; (3)Gheorghita, Andra; (1)Enache, Georgiana; (1)Radulian, Gabriela.

(1)University of Medicine and Pharmacy Carol Davila;

(2)Emergency Military Hospital Carol Davila; (3)National Institute of Diabetes Nutrition and Metabolic Diseases "N Paulescu".

**Background and objectives:** The objective of this study was to evaluate the relationship between nutritional status and cardiovascular risk in patients with metabolic syndrome (MetS).

**Methods:** This study is transversal and included 171 patients with MetS. The nutritional status was assessed using body mass index (BMI) score MNA (Mini Nutritional Assessment) and nutritional assessment score instantly - (instant nutritional assessment - INA). We also calculated a combined score of malnutrition: MNA results have merged, INA and BMI in a single combined score. We considered patients with malnutrition rezutatul based on the combined score, so it is considered malnourished individual score indicates if any is present. The diagnosis of MetS was established using a modified IDF definition. Cardiovascular risk was assessed for each patient using software UKPDS-CHD.

**Results:** MetS was present in 64.9% of patient. The age of patients with malnutrition and MetS was higher than that with MetS without malnutrition (57.75±6.16 years vs. 51.85±9.65 years, p=0.125). Using the combined score of the total number of patients, malnutrition was present in 18 patients (10.5%). Of these, 12 patients (66.7%) belong to the group with MetS. The combination of malnutrition - moderate cardiovascular risk level, was observed in a small number of patients, most of the malnutrition associating with a low cardiovascular risk (n=2). Cardiovascular risk among those with only 6 patients had moderate malnutrition, and among those at high risk, only 4 associated malnutrition. The presence of MetS is associated with a higher frequency of malnutrition in patients with hepatitis C. Obesity was present in 122 patients (71.3%) - 58 women and 64 men. Of these, 8 patients (4.7%) had malnutrition based on the combined score.

**Conclusions:** Assessment of nutritional status in patients with MetS brings significant benefits by identifying malnutrition risk and to which they are exposed. The prevalence of malnutrition was high in patients with MetS (10.5%). Assessing the relationship of cardiovascular risk - malnutrition, has placed patients with malnutrition among those with low cardiovascular risk (n=2) or moderate (n=6), only a small number of people with malnutrition (n=4) with a high cardiovascular risk.

**Keywords:** Metabolic syndrome, Nutritional status, Cardiovascular risk.
## GENOTYPE AND PHENOTYPE DETERMINATION IN CHILEAN SUBJECTS WITH PHENYLKETONURIA

**Background and objectives:** Phenylketonuria (PKU, OMIM 261600) is an autosomal recessive disease, caused by mutations in Phenylalanine Hydroxylase (PAH) gene situated in chromosome 12q22-q24.2. This gene has 13 exons. The genotype is one of the main factors that determine the phenotype of this disease. Objective: Characterize Chilean PKU genotype and phenotype.

**Methods:** 71 PKU subjects to study the PAH gene by restriction fragment length polymorphism (RFLP) and sequencing techniques to identify the genotype, previous exon and intron amplification through PCR technique. We classified the phenotype according to Guldberg predicted value.

**Results:** 26 mutations in 134 of the 142 alleles studied were identified (94.4%), completing the analysis in 88.7% of the subjects, 11.3% had one allele identified. 84.5% of the sample was heterozygous. Exon 7 included the majority of mutations (23%). 50% of mutations were missense. Most frequent mutations were IVS10-11G>A, p.Ex5del and p.Val388Met. According with results 52.3% of the subjects had a predicted classic phenotype.

**Conclusions:** The most frequent mutations can be identified by RLFP and MLPA, which lowers the costs of genetic analysis. It is possible to predict phenotype by detecting the genotype, with which we can establish the disease prognosis and ease patient's medical and nutritional management.

**Keywords:** Phenylketonuria, Genotype, Phenotype, Phenylalanine Hydroxylase gene, Mutations.

## INTERLEUKIN-6 PROMOTER -174 G>C POLYMORPHISM IS ASSOCIATED WITH PRIMARY IRON OVERLOAD IN MALE ADULTS

**Background and objectives:** Hereditary hemochromatosis (HH) is commonly associated with mutations in the HFE gene. Nonetheless, the variable penetrance of these mutations suggests that other genetic host factors may influence the development of overt iron overload (IO). There is a single nucleotide polymorphism (SNP) on position -174 G>C of the gene promoter of interleukin 6 (IL-6) which might be associated with primary IO. Carriers of the C allele were described to produce less IL-6. The aim of this study was to evaluate the SNP -174 G>C of the IL-6 gene and its interaction with iron metabolism and with inflammatory markers in male patients with primary IO.

**Methods:** Patients with primary IO, evidenced by liver histology, were consecutively recruited during a 12-month period (n=37). Patients were divided into two groups, treated (n=24; ferritin = 85 (28-225) ng/ml) and untreated (n=13; ferritin = 722 (558-986) ng/ml). Controls were age-matched male volunteers (n=37). High sensitive C reactive protein (HsCRP) concentration was determined by an immunoturbidimetric assay and IL-6 by enzyme immunoassay. SNP-174 G>C was evaluated by PCR-RFLP. Differences were analyzed by ANOVA. Genotype distribution was compared by the Chi square test.

**Results:** HsCRP was higher and IL-6 lower in untreated IO patients than in the other groups (p<0.05). The analysis of the SNP-174 G>C showed different genotype frequencies between patients

<footnote>(1)Hamilton, Valerie; (2)Santa María, Lorena; (3)Pérez, Belen;</footnote>

<footnote>(2)Fuenzalida, Karen; (4)Morales, Paulina; (5)Cornejo, Veronica.</footnote>

<footnote>(1)M.Sc. Nutricionist. Institution of Nutrition and Food Technology, Dr. Fernando Monckeberg Barros, University Of Chile.; (2)PhD. Biochemist. Institution of Nutrition and Food Technology, University of Chile.; (3)PhD. Genetist. Centro de Diagnóstico de Enfermedades Moleculares (CEDEM) Universidad Autónoma de Madrid, Spain.; (4)Medical Technology. Institution of Nutrition and Food Technology, University of Chile.; (5)M.Sc. Nutricionist. Institution of Nutrition and Food Technology, University of Chile.</footnote>

<footnote>(1)Tetzlaff, Walter Francisco; (2)Meroño, Tomas; (3)Sorroche, Patricia;</footnote>

<footnote>(4)Boero, Laura; (5)Martin, Maximiliano E.; (5)Botta, Eliana Elizabeth;</footnote>

<footnote>(6)Frechtel, Gustavo; (7)Daruich, Jorge; (6)Cerrone, Gloria; (4)Brites, Fernando D.</footnote>

<footnote>(1)Bsc. Lipids and Atherosclerosis Laboratory. Institute of Pathophysiology and Clinical Biochemistry (INFIBIOC). Department of Clinical Biochemistry. Faculty of Pharmacy and Biochemistry. University of Buenos Aires. Argentina;
(2)PhD. Lipids and Atherosclerosis Laboratory. Institute of Pathophysiology and Clinical Biochemistry (INFIBIOC). Department of Clinical Biochemistry. Faculty of Pharmacy and Biochemistry. University of Buenos Aires. Argentina; (3)Bsc. Central Laboratory. Italian Hospital of Buenos Aires. Argentina;
(4)PhD. Lipids and Atherosclerosis Laboratory. Institute of Pathophysiology and Clinical Biochemistry (INFIBIOC). Department of Clinical Biochemistry. Faculty of Pharmacy and Biochemistry. University of Buenos Aires. Argentina.; (5)Bsc. Lipids and Atherosclerosis Laboratory. Institute of Pathophysiology and Clinical Biochemistry (INFIBIOC). Department of Clinical Biochemistry. Faculty of Pharmacy and Biochemistry. University of Buenos Aires. Argentina.; (6)PhD. Genetic Chair. Institute of Immunology, Genetics and Metabolism (INIGEM). National Council for Scientific and Technical Research (CONICET). Faculty of Pharmacy and Biochemistry. University of Buenos Aires. Argentina.; (7)MD. Gastroenterology Service. José de San Martín Clinical Hospital. University of Buenos Aires. Argentina.</footnote>
(43% CC, 43% CG and 14% GG) and controls (10% CC, 41% CG and 49% GG) (OR= 4.094, 95%CI = 2.062 to 8.128, p<0.0001), being in Hardy-Weinberg equilibrium. IO was significantly associated with CC homozygosis in the SNP-174 [OR= 6.3, 95%CI = 1.9-21.4, p<0.005]. Such association remained significant even when the analysis was performed including age and body mass index in the model (p<0.005).

**Conclusions:** This study describes for the first time that the C allele in the -174 G>C SNP of the IL-6 gene was associated with primary IO. The probable mechanism by which this polymorphism influences the development of IO is through lowering hepcidin synthesis via IL-6 receptor signaling in hepatocytes. Indeed, untreated IO patients showed significantly lower IL-6 levels, which were not related with the inflammatory process or metabolic abnormalities associated with overt IO.

**Keywords:** Iron overload, Inflammation, IL-6, Polymorphism, Hereditary hemochromatosis.

**Results:** 42% adhered to integral treatment for hypertension. 79% adhered to the pharmacological treatment. 18% adhered to non-pharmacological treatment. The field of care was a modifying variable in adherence. 64% never consulted other professionals. 66% were never referred by their GP to other professionals. 32% consulted the nutritionist as part of non-pharmacological treatment.

**Conclusions:** It was observed a greater ease to carry out the medical prescription in relation to the pharmacological aspects of the treatment for hypertension, and not with the modifications in the changes of lifestyle.

**Keywords:** Arterial pressure. Life style. Patient Compliance. Nutritionists. Professional referral.

**Further collaborators:**

Marcela Leal.

144/2594

LEVEL OF HYPERTENSION TREATMENT ADHERENCE FROM TWO POPULATIONS THAT ARE TREATED IN PUBLIC AND PRIVATE AMBIT DURING THE MONTHS OF OCTOBER AND NOVEMBER 2016

(1)Markmann, Carlos Alberto; (2)Perri, Noemi; (2)Scuri, Micaela;

(3)Guida, Roxana.

(1)PhD. Centro de Nutrición. Hospital Oncológico Marie Curie. Argentina.; (2)Nutritionist. Centro de Nutrición. Hospital Oncológico Marie Curie. Argentina; (3)Nutritionist. Departamento de Nutrición. Hospital Dr Antonio Cetrángolo. Argentina.

**Background and objectives:** The prevalence of hypertension in Argentina is 34% with similar values in the world. It has been seen in different investigations that the knowledge, treatment and control in our country are very low and it is due to, among multiple factors, to poor treatment efficiency and low adherence on the part of the patients.

The objective is to describe the adherence level to the integral treatment for arterial hypertension and to compare obtained data from patients diagnosed and treated over 18 years of age, who were treated in outpatient clinics of one private and one public hospital in the city and province of Buenos Aires respectively, during the months of October and November of the year 2016.

**Methods:** Quantitative, descriptive, correlational research.

**Population:** hypertensive patients in treatment older than 18 years.

$n = 146$, not probabilistic.

**Variables analyzed:** sex, age, educational level, care system, age in treatment, compliance with medical prescription, lifestyle habits, and professional referral.

**Technique and tool:** survey, structured questionnaire CAT-HTA.

144/2619

THE RELATIONSHIP BETWEEN SUCCESS BARIATRIC SURGERY AND WEIGHT REGAIN AFTER AT LEAST FIVE YEARS POST POSTOPERATIVE

(1)Reynoso, Clarisa; (2)Gómez, Juliana Valeria; (3)Rodríguez, Eugenia;

(2)Curriá, Marina.

(1)BSc. Nutritionist. Endocrinology Department. Buenos Aires British Hospital. Argentina; (2)PhD. Endocrinology Department. Buenos Aires British Hospital. Argentina; (3)BSc. Nutritionist. Maimonides University. Buenos Aires. Argentina.

**Background and objectives:** A successful Bariatric Surgery (BS) is defined as Excess Weight Lost (EWL) of at least 50%. If the patient gains less than 15% of his nadir, it is considered weight loss maintenance. To our knowledge there are no reports about relationship between Weight Regain (WR) over 15% and failure of BS, defined by EWL < 50%. Objectives: To analyze the number of patients with WR above 15% after at least 5 years from surgery and to evaluate relationship between WR and BS success.

**Methods:** Analytical observational study. Between June 2007 and March 2012, 79 patients underwent on BS at Buenos Aires British Hospital. Anthropometric data, sex, age, date and types of surgery were collected from clinical histories. Current anthropometric data were recorded from 43 patients: 25 interviewed by telephone, 5 by e-mail and 13 personal encounters. Successful BS was considered as EWL at least 50% and weight loss maintenance if the patient gained less than 15% of his nadir.

**Results:** BS was performed in 79 patients: 57 sleeve gastrectomy (LSG) and 22 Roux-en-Y Gastric Bypass (RYGB). Data of 43 patients were recorded: LSG 27 (63%) and RYGB 16 (37%). Mean age was 51,3± 9,7 years; 29 (67%) female, mean baseline body mass index (BMI) 48,32 Kg/m2 (7,2DE). Mean percent of EWL: 71,32%. At least five years after surgery 8 (30%) of LSG were successful and 15 (94%) of RYGB (p 0.013). Successful patients with LSG 7 (87,5%) reported WR <10% and 1 (12.5%) WR 10-15%. In RYGB successful patients group 6 (43%) reported WR < 10%, 5 (36%) WR 10-15%, 1 (7%) WR 15-20% and 3 (21%) above 20%.
**Conclusions:** In RYGB group patients were more successful than those in the LSG, 5 years after surgery. None of the successful patients with LSG regained weight. Excessive weight gain was experienced by almost one third of patients in RYGB group, these results are consistent with literature. Even with this setback RYGB continued being successful, this would suggest that WR over 15% would not indicate BS failure in this group. Further extensive studies are needed in order to confirm these results.

**Keywords:** Bariatric Surgery, Regain weight.

144/2649

TRIGLYCERIDES/HIGH DENSITY LIPOPROTEIN CHOLESTEROL RATIO AS A PREDICTOR IN DETECTION OF INSULIN RESISTANCE IN TYPE 1 DIABETES MELLITUS

(1)García, Alicia Beatriz; (2)García, Alicia Beatriz; (2)Ruiz Morosini, María Lidia; (2)López González, Eva; (2)Milrad, Silvana; (2)Luongo, Ángela; (2)Houssay, Solange; (2)Varela, María Cristina; (3)FRADYC-DM1, Group.

(1)PhD. Servicio de Nutricion. Hospital General de Agudos Enrique Tornu. Buenos Aires. Argentina.; (2)PhD. Hypertension Committee. Argentine Diabetes Society. Argentina.; (3)PhDs. Hypertension Committee. Argentine Diabetes Society. Argentina.

**Background and objectives:** The Triglycerides/High Density Lipoprotein cholesterol (TG/HDL-C ratio) is considered a clinical indicator of insulin resistance. The aims is to assess the relationship of a high TG/HDL-C ratio in T1DM with parameters of insulin resistance, habits and diabetes complications

**Methods:** T1DM patients over 18 years old assisted by 26 Argentinian doctors specialized in Diabetes, year 2011. Evaluation: anthropometric measures, laboratory, habits, treatment and chronic complications. Obesity (WHO criteria), physical activity at least 150 min/week, glycemic control A1c<7%, TG/HDL-C ratio>3, intensive insulin treatment (IIT) three or more daily injections. Statistical analysis: Chi2, Student t, Spearman correlation, Multiple Logistic Regression (CSS/Statistical)

**Results:** 514 patients were included (age: 40.6± 14.6 years), T1DM duration: 17.4 ±12.0 years, females: 55.1%, BMI 25.1±4.3 kg/m2; A1c 8.0 ± 1.5%, Fasting blood glucose 147.1±69.1 (mg/dl). Waist circumference in men 90.5±11.4 cm, women 80.6±12.2 cm. Physical activity 45%.

Overweight 34.4%, obesity 11.9%. Intensive insulin treatment: 75.1%. Metabolic syndrome (IDF criteria) 34.7%. LDLc 110.3±31.7 mg/dl (>100 mg/dl: 60,8%), TG 107.6±61mg/dl (>150 mg/dl: 18.2%) and HDLc 50.4±13mg/dl in men (>40 mg/dl in 81.7%) and 57.8±15.2mg/dl in women(>50 mg/dl: 68.3%). The TG/HDL ratio was >3 in 20.1% and Coronary Heart Disease (CHD)4.6%.

It was found association with high TG/HDL-C ratio with glucose fasting elevated (p<0.0009), men (p<0.03), obesity (p<0.00001), high waist circumference (p<0.0001). IIT (p=0.005)

and physical activity (p<0.009) were found as protective factors. No association with A1c and age were found. Despite the low frequency of CHD, TG/HDL ratio correlation significantly with CHD(p<0.0001)

In multivariate analysis the high TG/HDL ratio was associated with: glucose fasting elevated(OR 1.004, IC 1.001-1.008; p< 0.008) , male(OR 1.82,IC1.12-2.96; p<0.016) , obesity(OR 2.83,IC1.51-5.28; p<0.001) and high waist circumference(OR 2.98, IC 1.74-5.1; p<0.0001) It was found as protective factor the Intensive Insulin treatment(OR 0.55, IC0.02-0.33; p<0.02)

**Conclusions:** The elevated TG/HDLc ratio had significance correlation with metabolic syndrome as high waist circumference, obesity and fasting blood glucose elevated. This ratio may be a surrogate marker for insulin resistance in T1DM and to identify persons with high risk of cardiovascular disease. Further studies must be made.

**Keywords:** TG/HDL ratio, Type 1 Diabetes, Insulin-resistance.

**Further collaborators:**

Alejandra Alcaya. Barbara Arinovich. Guillermo Burlando. Teresa Bensuzan. Alejandro Chertkoff. Angelica Gayarre. Carolina Gomez Martin. Claudio González. Cristina Grosso. Helga Kohl. Marina Khoury. Maria Amelia Linari. Lorena Mariño, Julieta Méndez. Estrella Menéndez. Cecilia Preiti. Virginia Prieto. Silvia Saavedra. Fabiana Vázquez. Beatriz Villarroel Parra.

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MEASUREMENT OF REST ENERGY EXPENDITURE IN PEDIATRIC ONCOLOGICAL PATIENTS: CONCORDANCE BETWEEN INDIRECT CALORIMETRY AND PREDICTIVE EQUATIONS

(1)Muñoz, Eliana; (2)Cordero, María Luisa; (3)Castro, Magdalena;

(4)Derado, Macarena.

(1)MD. Department of Pediatrics. Division of Nutrition. Clinica Las Condes. Santiago.Chile.; (2)MD. Department of Pediatrics. Division of Nutrition. Hospital Dr. Sótero del Río. Santiago.Chile.;

(3)MSc，请registered Nurse. Master in epidemiology. Research Unit. Academic Department. Clinica Las Condes. Santiago.Chile.;

(4)MD. Pediatrician. Emergency Department. Clinica Las Condes. Santiago.Chile.

**Background and objectives:** Cancer in pediatric patients impacts resting energy expenditure (REE) in a way that is not estimable by predictive equations.

The aim of this study is to determine the concordance between the measurement of resting energy expenditure (REE) by indirect calorimetry (IC) in pediatric oncological patients versus World Health Organization (WHO) and Schofield predictive equations.

**Methods:** Cross - sectional study in children, aged 5-15 years old, receiving chemotherapy, in outpatient from Clinica Las Condes and Hospital Dr. Sótero del Río, between July 2013 to July 2015.

REE measurement was performed by indirect calorimetry and WHO and Schofield equations.
Concordance analysis was performed, with a clinically relevant cut-off point of 90% concordance coefficient of Lin (CCI).

**Results:** 27 indirect calorimetry in 27 children were performed. 66% (18) were diagnosed with leukemia, 15% (4) brain tumor. 81% (22) in the maintenance stage of their treatment and 33% (9) eutrophic.

There was no significant difference between indirect calorimetry measurement versus WHO (p 0.18) or Schofield (p 0.07), nor when stratifying by nutritional status, age range or type of cancer diagnosis.

Concordance was calculated between IC and Schofield, with a CCI = 79.4% (CI 65.2 -93.6%) and IC and WHO, CCI = 78% (CI 62.9 -93.2%).

**Conclusions:** Conclusion: This level of agreement, less than 80% in both cases, is insufficient.

With both equations for estimating REE, there is more than 20% of cases who was an overestimation or underestimation of the energy requirements.

There was no agreement between the measurement of REE, measured with indirect calorimetry versus its estimation with Schofield's equations and WHO, so the use of indirect calorimetry for the determination of energy requirements in pediatric patients with oncological pathology should be considered.

**Keywords:** Childhood cancer, Indirect calorimetry, Resting energy expenditure, Pediatric oncological patients.

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# ALCOHOL IN ADULTS WITH TYPE 1 DIABETES MELLITUS: IMPACT ON METABOLIC SYNDROME

(1)Alicia Beatriz, García; (2)Alicia Beatriz, García; (2)López González, Eva; (2)Houssay, Solange; (2)Milrad, Silvana; (2)Ruiz Morosini, María Lidia; (2)Luongo, Ángela; (2)Varela, María Cristina; (2)FRADYC-DM1, Group; (2)González, Claudio D.

(1)PhD. Servicio de Nutricion. Hospital General de Agudos Enrique Tornu. Buenos Aires. Argentina.; (2)PhD. Hypertension Committe. Diabetes Argentine Society. Argentina.

**Background and objectives:** The international guidelines give limits in terms of alcohol quantity consume. The amount of alcohol consumed impacts health differently. Risks associated with excessive alcohol consumption in Diabetes include weight gain, hypoglycemia and hiperglycemia.

To assess the frequency of moderate alcohol consumption in Type 1 Diabetes Mellitus (T1DM), its relationship to habits, glycemic control and the presence of metabolic syndrome.

**Methods:** Patients with T1DM older than 18 years old, assisted by 26 Argentinian doctors specialized in Diabetes, year 2011. Evaluation: anthropometric measures, laboratory, habits, treatment and chronic complications. Obesity (WHO criteria) and metabolic syndrome(IDF criteria), physical activity at least 150 min/week, alcohol consumption: drinking more than 15 standards drinks a week for men or 10 a week for women (Canada: Guidelines for Low-Risk Drinking), Smoking (current smokers),

glycemic control A1C<7%, hyper trygliceridemia TG>150 mg/dl, Hypertension: systolic blood pressure (SBP) >140 and/or diastolic blood pressure(DBP) >90 mmHg. Statistical analysis: Chi2, Student t, Spearman correlation, Multiple Logistic Regression (CSS/ Statistica).

**Results:** 514 T1DM patients were included, 40.6±14.6 years old, T1DM duration 17.4±12.0 years, Females 55%, A1C 8.0±1.5%, and Fasting blood glucose 147.1±69.1mg/dl. BMI 25.1±4.3 kg/m2 and waist circunference 90.5±11.4cm in men and 80.6±12.2 cm in women. Obesity 11.9% and overweight 34.4%. Physical activity 45%, Smoking 20.2%. LDL-C 110.3±31.7mg/dl, HDL-C 50.4±13mg/dl in men, 57.8±15.2mg/dl in women and TG 107.6±61mg/dl. Metabolic syndrome 34.7%. Hypoglycemia was 67% in the last week and 13% had severe hypoglycemia in the last year. SBP118,8±11,9 mmHg and DBP 73,7±8,4 mmHg, hypertension 22,7%.

The 29.9% of patients consumed alcohol in excess.

The excessive alcohol consumption was in association with: male gender(p<0.0001), smoking(p<0.0001), hypertension(p<0.05), being overweight and obesity(p< 0.0001), hypertrygliceridemia(p<0.041) and metabolic syndrome(p<0.046). There was no association with: age(p=0.2), good glycemic control(p=0.09) and hypoglycemia(p<0.9).

The most frequently consumed beverages were beer, wine, and liquor.

**Conclusions:** In this study, 30% of adults with Type 1 Diabetes consumed alcohol in excess. Has been more frequent in male gender and smoking. They had an increased risk of the metabolic syndrome as overweight, obesity, hyper trygliceridemia and hypertension. Alcohol use still needs to be tackled. The low consume of alcohol supports healthy lifestyles.

**Keywords:** Alcohol, Type 1 Diabetes, Metabolic syndrome.

**Further collaborators:**

Alejandra Alcaya. Barbara Arinovich. Guillermo Burlando. Teresa Bensuzan. Alejandro Chertkoff. Angelica Gayarre. Carolina Gomez Martin. Claudio González. Cristina Grosso. Helga Kohl. Marina Khoury. Maria Amelia Linari. Lorena Mariño, Julieta Méndez. Estrella Menéndez. Cecilia Preiti. Virginia Prieto. Silvia Saavedra. Fabiana Vázquez. Beatriz Villarroel Parra.
ZINC SUPPLEMENTATION IS AN EFFECTIVE AND FEASIBLE STRATEGY TO PREVENT GROWTH RE-TARDATION IN 6 TO 24 MONTH CHILDREN: A PRAGMATIC RANDOMIZED DOUBLE BLIND TRI-AL

(1)Fallahrokni, Atieh; (2)Abdollahi, Morteza; (3)Salehi, Foroozan;

(4)Abdollahi, Zahra; (5)Fozouni, Fereshteh; (6)Kalantari, Naser; (7)Ajami, Marjan.

(1)Nutritionist MSc. National Nutrition and Food Technology Research Institute. School of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (2)MD, MPH, Department of Nutrition Research. National Nutrition and Food Technology Research Institute. School of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (3)MD, MPH, Nutrition Department. Undersecretary of Public Health Ministry of Health & Medical Education. Tehran. Iran.; (4)Nutrition PhD, Nutrition Department. Undersecretary of Public Health Ministry of Health & Medical Education. Tehran. Iran; (5)Nutrition, MSc, Department of Nutrition. Deputy of Health. Shahid Beheshti University of Medical Sciences. Tehran. Iran; (6)Department of Community Nutrition. National Nutrition and Food Technology Research Institute and Faculty of Nutrition Science and Food Technology. Shahid Beheshti University of Medical Sciences. Iran; (7)Department of Food and Nutrition Policy and Planning Research. National Nutrition and Food Technology Research Institute. Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.

**Background and objectives:** Zinc is an essential nutrient that is naturally available in most foods. Deficiency of this micronutrient in particular can cause a number of health complications. Zinc deficiency during infancy is more troublesome as rapid growth and nutrient relied development takes place in this period. Most severe outcomes of zinc deficiency during infancy are considered to be cerebral damage, impaired immunity and growth retardation. This feasibility study assesses the effectiveness of zinc supplementation during infancy in Iran.

**Methods:** Randomized double blind controlled trial that compared oral zinc supplementation with placebo in children aged 6 to 24 months. From children contacted by researchers in the beginning of the study (n=839), 580 completed the trial. Subjects were randomly divided in two groups to take 5ml of zinc sulfate suspension containing 5mg elemental zinc or placebo daily for 6 month.

**Results:** Following the intervention, compared with the placebo, zinc supplementation was associated with significant difference in the average height increment (placebo 5.23 cm ±2.19 vs. intervention 5.79 cm±2.18 p=0.02). No significant difference was observed in serum zinc, ferritin and high-sensitivity C-reactive protein (hs-CRP) following the 6 month intervention. The prevalence of zinc deficiency was significantly lower in the intervention

group compared to the placebo. No complications were reported and the compliance was very good.

**Conclusions:** Zinc supplementation for 6 month among children (6-24 months) had beneficial effects on growth parameters including average height.

**Keywords:** Zinc supplementation, Serum zinc, Ferritin.

**Further collaborators:**

National nutrition and food technology research institute.

FOOD INTAKE AND BODY MASS INDEX OF PATIENTS WITH TYPE 2 DIABETES MELLITUS FROM AN OUTPATIENT CLINIC IN SÃO PAULO

(1)Barros Pereira Ferreira, Natália; (1)Parise Polo, Gabriela; (1)Silva Gregório, Amanda; (1)Lekevicius Consolin, Brunna; (1)Fonseca Gonçalves, Daniel; (2)Garcia Peloggia de Castro, Adriana.

(1)Nutrition Student. Centro Universitário São Camilo. Brasil.;

(2)PhD. Nutritionist. Centro Universitário São Camilo. Brasil.

**Background and objectives:** The prevalence of type 2 diabetes mellitus is increasing in all populations worldwide. This increase is accompanied by the rising rates of obesity and overweight observed over the past decade. For this reason, the analysis of the body mass index (BMI) may serve as a powerful tool in the assessment of the risk factor for Diabetes. As overweight is directly related to the lifestyle and eating habits, a better understanding of food intake in patients with type 2 diabetes mellitus is essential in order to correct problems, stimulate healthy habits and foster weight loss of these population. This study objective is to classify the population using the BMI scale and correlate it to food intake.

**Methods:** This is a cross-sectional, descriptive study with primary data collection, sampling done by convenience, approved by the Ethics and Research Committee of Centro Universitário São Camilo, Brazil. A structured questionnaire to characterize food intake was developed for this research and applied to 82 patients with type 2 diabetes mellitus, both male and female, attending an outpatient clinic in São Paulo. BMI was classified according to the World Health Organization. Weight and height were self-reported. Data analyses were performed using descriptive statistic, the Quin square test with a level of significance of p<0.05.

**Results:** Regarding the interviews, the mean age was 63±10.6 years. Mean BMI was 29.6 ± 5 kg/m2 ranging from 28.5 to 30.8 kg/m2 (for a 95% of confidence interval). When BMI was classified as underweight, normal weight and overweight it was possible to find a significant difference (p=0.04) between the groups regarding their eating habits. As for individuals with overweight the most consumed foods were: fruits, vegetables and greens (86%), pasta, breads and biscuits (82%), foods of animal origin (73%) and sweets in general (27%).

**Conclusions:** Most patients with type 2 diabetes mellitus are overweight and there are significant differences in food choices according to their BMI score. This insight may bring possibilities
for dietary changes and may facilitate the translation of findings to public health recommendations.

**Keywords:** Diabetes mellitus. Body mass index. Food intake. Eating habits.

**Keywords:** Diabetes mellitus. Dietary counseling. Food intake. Dietary Patterns.

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# IMPORTANCE OF DIETARY COUNSELING TO PATIENTS WITH DIABETES MELLITUS TYPE 2 FROM AN OUTPATIENT CLINIC IN SÃO PAULO

(1)Barros Pereira Ferreira, Natália; (1)Parise Polo, Gabriela; (1)Silva Gregório, Amanda; (1)Lekevicius Consolin, Brunna; (1)Fonseca Gonçalves, Daniel; (2)Garcia Peloggia de Castro, Adriana.

(1)Nutrition Student. Centro Universitário São Camilo. Brasil;

(2)PhD. Nutritionist. Centro Universitário São Camilo. Brasil.

**Background and objectives:** A healthful eating pattern and regular physical activity are extremely important components of type 2 diabetes mellitus management. For many individuals with type 2 diabetes mellitus, the most difficult part of the dietetic plan is to decide what to eat. Dietary therapy has been recognized as an essencial strategy for helping patients with type 2 diabetes mellitus, improving self-management, developing nutritional education and providing an eating plan. In this context the purpose of this work is to correlate the eating habits of patients who received professional guidance with those who did not receive any guidance.

**Methods:** This is a cross-sectional, descriptive study with primary data collection, sampling done by convenience, approved by the Ethics and Research Committee of Centro Universitário São Camilo, Brazil. A structured questionnaire to characterize food intake was developed for this research and applied to 82 patients with type 2 diabetes mellitus, both male and female, attending an outpatient clinic in São Paulo. Data analyses were performed using descriptive statistic, the Qui-square test with a level of significance of p<0.05.

**Results:** Regarding the interviews, the mean age was 63 ± 10.6 years characterizing an elderly population (64.6%). The majority of respondents (80%) received specific dietary guidance for type 2 diabetes mellitus but only 30% admitted to follow the guidance given by the health professional. It is noteworthy that the main health professionals who carried out dietary counseling were nutritionists (50%) and physicians (46%). People who received guidance showed a slightly more varied diet than those who did not receive guidance. Nevertheless, this result was not statistically significant (p=0.26). The most consumed types of food were: fruits, vegetables and greens (74%), pasta, breads and biscuits (66%) and food of animal origin (59%).

**Conclusions:** Patients who received professional guidance on diet present a more varied food profile in relation to those who did not receive it. Therefore, the professional counseling in this population is extremely important for an adequate management of the disease and quality of life.

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# INTEGRATION OF PREVENTATIVE AND CURATIVE ASPECTS OF NUTRITION INTO INTEGRATED COMMUNITY CASE MANAGEMENT (ICCM) IN DEMOCRATIC REPUBLIC OF CONGO

(1)Kavle, Justine; (2)Pacque, Michel; (3)Mbombeshayi, Evariste;

(4)Anzolo, Jimmy; (5)Bachunguye, Richard; (6)Tosha, Maphie; (7)Mirindi, Janvier; (8)Safari, Octave.

(1)PhD. Senior Nutrition Advisor. Maternal Newborn Child Health and Nutrition Division. Maternal and Child Survival Program (MCSP)/ PATH. USA.; (2)MD. Child Health Team Lead. Maternal and Child Survival Program. John Snow Inc. (JSI). Washington DC. USA.; (3)BA.Nutrition Advisor. Maternal Newborn Child Health and Nutrition Division. Maternal and Child Survival Program. PATH. Kisangani, Democratic Republic of Congo.; (4)MD. Child Health Advisor. Maternal and Child Survival Program. John Snow Inc. (JSI). Kisangani, Democratic Republic of Congo;

(5)BS. Independent Qualitative Consultant. Bukavu. Democratic Republic of Congo.; (6)MD. Independent Qualitative Consultant. Bukavu. Democratic Republic of Congo.; (7)BA. Independent Qualitative Consultant. Bukavu. Democratic Republic of Congo.

**Background and objectives:** Integration of nutrition into iCCM provides an opportunity to improve and strengthen IYCF and care practices, nutritional status, and reduce rates of child morbidity. Global iCCM guidelines focus on the identification, treatment, and referral of children who are sick with diarrhea, pneumonia, and/or malaria, as well as acute malnutrition. Yet, the implementation of iCCM is often not delivered with the intensity, quality, and coverage needed to achieve improvements in child nutritional status. Globally, a gap in evidence exists for integrating nutrition into the iCCM platform. The objectives of this study are to 1) examine how various aspects of nutrition integration into iCCM are currently delivered within the DRC health system 2) identify possible approaches for behavior change communication for infant and young child feeding, and advising families with sick children and 3) identify gaps and areas for strengthening nutrition within iCCM programming through health services, including linkages for identification and referral of acute malnutrition.

**Methods:** In-depth interviews were carried out with mothers (n= 48); grandmothers (n= 20) and fathers (n=21) of children under five years of age, 18 health facility providers and 20 traditional healers in 4 sites in Tshopo, DRC. Eight focus group discussions (FGDs) were carried out with community health workers (CHWs). Following transcriptions of recordings for FGDs and IDIs, key emergent themes were identified and sub-themes were coded.

**Results:** Our findings reveal inadequate infant and young child feeding practices, with minimal counseling by health providers. Cultural beliefs and traditional practices surrounding breast-
milk sufficiency and breastfeeding problems should be addressed by health providers. Complementary feeding practices are suboptimal, in terms of quantity, frequency and diversity. Involvement of traditional healers is key. Addressing care seeking behaviors for child illness, as well as targeting preventative rather than solely curative care for malnutrition within the iCCM platform is needed.

**Conclusions:** These findings will be translated into practical approaches for strengthening integration of nutrition into iCCM programming in DRC.

**Keywords:** Integration, Nutrition, Child health, iCCM

**Conflict of Interest Disclosure:** Richard Bachunguye, Tosha Maphie, Octave Safari and Janvier Mirindi were hired as local consultants to carry out the data collection, and aid with analyses and documentation of findings for this study.

with participants living in North region, the ORs and 95% CIs of depression among participants who lived in East, South-Central, North-West, South-West, and North-East regions were 0.81 (0.71-0.93), 0.95 (0.83-1.08), 1.36 (1.15-1.62), 1.26 (1.09-1.45), and 0.84 (0.70-1.00), respectively.

**Conclusions:** there was about one third of Chinese middle-aged and elderly having depression in 2011. Prior measures should be taken among high-risk middle-aged and elderly with lower education and income levels, older women, living in rural area or west China. Further cohort studies are needed to identify the prospective association between sociodemographic factors, diet and lifestyle factors with depression risk among Chinese populations.

**Keywords:** Depression, Sociodemographic disparity, Middle-aged and elderly, China.

## SOCIODEMOGRAPHIC ROLE IN DEPRESSION PREVALENCE AMONG MIDDLE-AGED AND ELDERLY IN CHINA: FINDINGS FROM THE CHINA HEALTH AND RETIREMENT LONGITUDINAL STUDY

(1)Ding, Gangqiang; (2)Li, Yaru; (3)Zhang, Ronghua.

(1)PhD.National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China; (2)MA. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China.; (3)MD. Zhejiang Center for Disease Control and Prevention. China.

**Background and objectives:** Background and objective: Although several studies explored the prevalence of depression in China, few studies have investigated the sociodemographic impact on depression prevalence. Therefore, this study aimed to examine the association between depression prevalence and sociodemographic factors among Chinese middle-aged and elderly.

**Methods:** Using baseline data of the China Health and Retirement Longitudinal Study (CHARLS), conducted between March 2010 and June 2011, the study performed a cross-sectional analysis about depression prevalence and socioeconomic role among 15,271 middle-aged and elderly participants aged 45 and older. Depression was diagnosed by Center for Epidemiological Studies Depression Scale-10 (CES-D) score. Multivariable logistic regression model was used to analyze the association between sociodemographic factors and depression prevalence by providing odd ratios (ORs) and 95% confidence intervals (CIs).

**Results:** The prevalence of depression in the middle-aged and elderly was 37.1% (30.2% for men and 43.2% for women, respectively) in 2011. Multivariable logistic regression model showed that odds of depression in the women was 1.82 times that in the men (95% CI: 1.68-1.97), while the odds of depression in the rural area was 1.42 times that in the urban area (95% CI: 1.31-1.55). Moreover, the depression prevalence was positively associated with age, and negatively associated body mass index (BMI), education and household income level (P for trend < 0.001). Compared
# OBESITY, DIABETES AND BLOOD PRESSURE INDEPENDENTLY CONTRIBUTE TO WHITE MATTER MICROSTRUCTURAL VARIABILITY IN THE BRAIN

(1)Zhang, Rui; (2)Beyer, Frauke; (3)Lampe, Leonie; (4)Luck, Tobias;

(5)Riedel-Heller, Steffi G.; (6)Stumvoll, Michael; (7)Loeffler, Markus;

(8)Schroeter, Matthias L.; (9)Villringer, Arno; (10)Witte, A. Veronica.

(1)MSc. Department of Neurology. Max Planck Institute for Human Cognitive and Brain Sciences. Leipzig. Germany. Collaborative Research Centre 1052 "Obesity Mechanisms". Faculty of Medicine. University of Leipzig. Leipzig. Germany;

(2)MSc. Department of Neurology. Max Planck Institute for Human Cognitive and Brain Sciences. Leipzig. Germany. Collaborative Research Centre 1052 "Obesity Mechanisms".

Faculty of Medicine. University of Leipzig. Germany.; (3)MD. Department of Neurology. Max Planck Institute for Human Cognitive and Brain Sciences. Leipzig. Germany. Clinic of Cognitive Neurology. University Hospital Leipzig. Germany;

(4)PhD. LIFE-Leipzig Research Centre for Civilization Diseases.

University of Leipzig. Germany. Institute of Social Medicine, Occupational Health and Public Health (ISAP). University of Leipzig. Germany.; (5)MD. PhD. LIFE-Leipzig Research Centre for Civilization Diseases. University of Leipzig. Germany. Institute of Social Medicine, Occupational Health and Public Health (ISAP).

University of Leipzig. Germany.; (6)MD. IFB Adiposity Diseases. Faculty of Medicine. University of Leipzig. Germany. Clinic for Endocrinology and Nephrology. University Hospital Leipzig.

Germany.; (7)MD. LIFE-Leipzig Research Centre for Civilization Diseases. University of Leipzig. Germany. Institute for Medical Informatics, Statistics, and Epidemiology (IMSE). University of Leipzig. Germany.; (8)MD. PhD. Max Planck Institute for Human Cognitive and Brain Sciences. Leipzig. Germany. LIFE-Leipzig Research Centre for Civilization Diseases. University of Leipzig.

Germany. Clinic of Cognitive Neurology. University Hospital Leipzig. Germany.; (9)MD. Department of Neurology. Max Planck Institute for Human Cognitive and Brain Sciences. Leipzig.

Germany. Clinic of Cognitive Neurology. University Hospital Leipzig. Leipzig. Germany.; (10)PhD. Department of Neurology.

Max Planck Institute for Human Cognitive and Brain Sciences. Leipzig. Germany. Collaborative Research Centre 1052 "Obesity Mechanisms". Faculty of Medicine. University of Leipzig. Leipzig. Germany.

Microstructure and its association with diabetes and blood pressure. Therefore we aim to investigate the relation between abdominal obesity, diabetes, blood pressure and WM microstructural variability in a large cohort of community-dwelling healthy adults.

**Methods:** The sample included dementia-free participants (mean age 55 ± 16 years; 50.7% women) of the LIFE cohort with brain MRI scans (n = 1255). WM microstructure was measured with diffusion tensor imaging (DTI). Mean FA was derived from the individual WM skeleton processed by tract-based-spatial-statistic method. Linear regression models were used to assess the relationships between diabetes, blood pressure, waist to hip ratio (WHR) and DTI parameters. Adjustments were made for age, sex, education and Apoe4.

**Results:** The preliminary result indicated diabetes, systolic blood pressure and WHR were independently associated with lower FA, and diabetes explained the most variance besides age. Subgroup analysis revealed both systolic blood pressure and WHR were negatively associated with mean FA in the non-diabetes group (n=1101).

**Conclusions:** The preliminary result of our study indicates that diabetes accelerated brain aging on directional diffusion of WM. Abdominal fat and blood pressure were associated with WM variabilities independently from age, sex and diabetes. With subsequent analysis of additional DTI measures, blood parameters, WM hyperintensity maps and voxel-based microstructural WM "integrity", we aim to further characterize the associations between obesity, diabetes, blood pressure and WM microstructure. This will contribute to the existing literature and help to disentangle the underlying mechanism.

**Keywords:** Abdominal fat, Waist to hip ratio, DTI, Fractional anisotropy.

**Background and objectives:** Obesity has been associated with increased risk of dementia. Grey and white matter (WM) of the brain are commonly used as biomarkers for early detection of dementia. However, considering WM, available neuroimaging studies had mainly small sample size and yielded less conclusive results (Kullmann et al., 2015). Recently, a positive correlation between obesity and fractional anisotropy (FA) in a middle age group was reported (Birdsill et al. 2017). Furthermore, obesity is related to many medical problems such as diabetes and hypertension. Diabetes and hypertension were found to be correlated with brain structures independently (de Leeuw et al., 2002; Weinstein et al., 2015). Yet, studies rarely investigated non-lesion WM mi-
# DIET AND CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) - A PILOT INTERVENTION STUDY FOCUSING ON COMPLIANCE AND SYMPTOMS

(1)Birgisdottir, Bryndis Eva; (2)Lauth, Bertrand; (3)Geirsdottir, Ólöf Guðny; (4)Karlsdottir, Ingibjorg; (5)Hilmarsdottir, Elínborg; (6)Hjalmarsdottir, Freydis; (6)Thorsdottir, Inga; (7)Sigurdardottir, Sigurveig; (6)Halldorsson, Thorhallur.

(1)PhD Nutritionist. Unit for Nutrition Research, Faculty of Food Science and Nutrition, University of Iceland and Landspitali University Hospital; (2)PhD. Physician. Child and Adolescents Psychiatric Department, Landspitali-University Hospital. Iceland and Department of Medicine, University of Iceland.; (3)PhD. Nutritionist. 1Unit for Nutrition Research at Faculty of Food Science and Nutrition. University of Iceland and Landspitali – University Hospital. Iceland; (4)MSc. Sociologist. Child and Adolescents Psychiatric Department, Landspitali-University Hospital. Iceland. (5)MSc. Nutritionist. 1Unit for Nutrition Research at Faculty of Food Science and Nutrition. University of Iceland and Landspitali – University Hospital. Iceland.; (6)Professor. Nutrition. 1Unit for Nutrition Research at Faculty of Food Science and Nutrition. University of Iceland and Landspitali – University Hospital. Iceland; (7)PhD. Physician. Department of Immunology, Landspitali-University Hospital. Iceland.

**Background and objectives:** The potential effect of food on Attention deficit hyperactivity disorder (ADHD) symptoms has long been debated. The aim of this pilot study was primarily to investigate compliance to two diets of interest, the healthy diet and the temporary few foods diet (few allergens) and secondary evaluate their effects on ADHD symptoms.

**Methods:** Participants were children who had been diagnosed with ADHD at the two main psychiatric centers for children in Reykjavik, with 29 children randomized into three groups: healthy diet (n=10), few foods diet (n=10) and a control group (n=9). A three-day food diary and questionnaires for both parents and teachers gave background information and symptoms. The same questionnaires were answered five weeks later as well as questions regarding the participation. A blinded physician interviewed the children and parents before and after the intervention. Compliance checklists were designed for the intervention period. Full participation rate was 68%.

**Results:** Baseline diet was not in line with dietary recommendations. Compliance to the diets was generally good (70-80%), although most children found it hard to follow the few foods diet and four dropped out. Using ADHD rating scale (ARS) the parents' total score decreased similarly on both diets (median from 35 to 27) or by 25% (p<0.05). Teachers found no change on ARS nor on Achenbach's Teacher Rating Form after the healthy diet, but significant improvement of symptoms were observed after the few foods diet (p=.027). No change was seen in the control group. The psychiatrist also found differences between groups (p<0.05).

**Conclusions:** With good support, compliance was generally good. Parents reported a decrease in symptoms on both diets,

while teachers only reported improvements for children on the few foods diet. Diet of children with ADHD can be substantially improved and nutritional status and food sensitivity should be examined at diagnosis. However, further studies are needed.

**Keywords:** ADHD, Healthy Diet, Few foods diet, Compliance, Symptoms.

# POSTPARTUM ABNORMALITIES OF CARBOHYDRATE METABOLISM IN PATIENTS WITH GESTATIONAL DIABETES AND RISK FACTORS INVOLVED

(1)Baran, Jesica Dana; (1)Aranguren, Marcela; (2)Gentile, Maria Belen; (2)Olmedo Sosa, Maria Victoria; (2)Tapper, Maria Ximena; (2)Anselmi, Maria Eugenia; (2)Schwartz, Nadia; (3)Castro, Maria Jose; (4)Calcagno, Maria Lujan; (1)Boquete, Hugo Ruben.

(1)MD. Endocrinology. Endocrinology Unit. Hospital Agudos Doctor Teodoro Alvarez. Argentina.; (2)MD. Endocrinology Unit. Hospital Agudos Doctor Teodoro Alvarez. Argentina.; (3)BSc. Catedra de Matemática. Facultad de Farmacia y Bioquímica de la Universidad de Buenos Aires. Aregentina; (4)Bioch. Catedra de Matemática. Facultad de Farmacia y Bioquímica de la Universidad de Buenos Aires. Aregentina.

**Background and objectives:** Gestational Diabetes Mellitus (GDM) is a highly prevalent clinical entity that identifies a population of young women with a high risk of developing type 2 Diabetes Mellitus (T2D) in the future. The rate of persistent metabolic abnormalities after delivery is highly variable and there are no consistent statistics about risk factors. Objectives: 1) To describe the prevalence of carbohydrate metabolism abnormalities in postpartum reclassification 2) To classify risk factors that predict persistence of such abnormalities

**Methods:** Seventy-eight patients with a diagnosis of GDM within the past 3 years were evaluated and reclassified. Patients with pregestational diabetes, those diagnosed before gestational week 20 and/or with blood glucose levels ≥ 126mg% were excluded. Diagnostic criteria were: fasting plasma glucose (FPG) and blood glucose in OGTT at 120 minutes after a 75-g of glucose, based on the American Diabetes Association and the Sociedad Argentina de Diabetes criteria.

**Results:** Sixty-four patients had normal OGTT (82.1%), while 14 (17.9%) showed blood glucose abnormalities: IGT in 9 patients, IFG in 2, two cases with both abnormalities and 1 patient developed T2D. In patients with abnormal reclassification, 57% were diagnosed based on FPG and only 25% in the group with normal reclassification (p= 0.03). In patients with pathologic reevaluation, 69.23% had a family history of T2D compare to 36.5% in the other group (p=0.03). There was a tendency towards an age ≥ 30 yr, higher BMI, personal history of GDM and macrosomia in the group that persisted with abnormalities of the carbohydrate metabolism.
**Conclusions:** In our analysis, we found a high prevalence of carbohydrate metabolism abnormalities following GDM. We found a higher risk for persistent abnormalities in patients who had been diagnosed with GDM based on FGP and in those with a family history of T2D. We consider it is highly important to classify risk factors in order to institute preventive therapeutic actions, particularly in the population with greater vulnerability.

**Keywords:** Gestational diabetes postpartum reclassification factors.

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KETOGENIC DIET COMPLICATIONS IN CHILDREN WITH REFRACTORY EPILEPSY

(1)Armeno, Marisa; (2)Vierini, Antonella; (2)Araujo, Cecilia; (3)Soto Montesano, Betiana; (4)Caraballo, Roberto Horacio.

(1)MD. Clinical Nutrition. Department of Pediatric Nutrition. Garrahan Hospital. Buenos Aires. Argentina; (2)MD, Clinical Nutrition. Nutrition Department. National Pediatric Hospital J.P.Garrahan. Argentina; (3)MSc, Nutritionist. Food Services Department. National Pediatric Hospital J.P.Garrahan. Argentina; (4)MD, Pediatric Neurologist. Neurology Department. National Pediatric Hospital J.P.Garrahan. Argentina.

**Background and objectives:** The ketogenic diet (KD) is a non-pharmacological treatment used as an alternative in the management of difficult-to-treat epilepsy since 1921. It is a high-fat, low-carbohydrate diet effective in around 50% of the patients. The KD is an unbalanced diet lacking micronutrients leading to possible deficits in energy, proteins, minerals, and vitamins and excess of lipids with a risk of unwanted early as well as late adverse effects (AE). Our aim is to describe the early and late AE of KD treatment in a prospective cohort of 51 children with difficult-to-treat epilepsy seen at a single center.

**Methods:** We performed a prospective study of children with intractable epilepsy admitted for ketogenic diet initiation at our institution from 2014 to 2016. We studied adverse effects at one and six months after diet initiation.

**Results:** Before starting the diet, constipation and Vitamin D deficiency were the most common nutritional conditions seen in this cohort, and at one month after the most common acute AE were metabolic acidosis (n=20), constipation (n=13), food intolerance (vomits, food refusal) (n=13), hipoglycemia (n=8), hipercholesterolemia (n=7) and hipertriglyceridemia (n=5). Long-term adverse effects were metabolic acidosis (n=7) hypercholesterolemia (n=6), neutropenia (n=1), selenium deficiency (n=10), and growth impairment (n=4). In only two patients the AE were severe enough to discontinue the diet.

**Conclusions:** Some AE are difficult to interpret as they may be manifestations of underlying disorders instead of the diet. It is important to follow the protocol regarding frequency of lab tests to detect and prevent these AE. If managed by an experienced multidisciplinary team, all AE are treatable or preventable.

**Keywords:** Ketogenic diet, Adverse effects, Intractable epilepsy.

144/2785

ASSOCIATION BETWEEN BLOOD VITAMIN D LEVELS AND METABOLIC SYNDROME BIO-MARKERS IN POST MENOPAUSE WOMEN

(1)Netto, Claudia; (2)Maria do Amaral dos Santos, Marta; (3)Figueiredo Marinheiro, Lizanka Paola.

(1)PhD. Nutritionist. Department of Biochemistry. University of Rio de Janeiro. Rio de Janeiro. Brazil.; (2)MSc. Nutritionist. Department of Biochemistry. University of Rio de Janeiro. Rio de Janeiro. Brazil.;

(3)PhD. Doctor. Department of Endocrinology. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente - Fernandes Figueira. Fundação Oswaldo Cruz. Rio de Janeiro. Brazil.

**Background and objectives:** Vitamin D may act in several vital cellular processes, as well as biochemical and physiological disorders in obesity, cardiovascular disease and diabetes mellitus. This study aims to evaluate the association between blood levels of vitamin D and indicators and your relation to metabolic syndrome in postmenopausal women.

**Methods:** A retrospective cross-sectional study was carried with postmenopausal women living the city of Rio de Janeiro - RJ. The women were interviewed between August 2013 and August 2014 (n=177 volunteers) and Clinical and demographic data were obtained by individual oral interview using a structured questionnaire. The metabolites were measured 25(OH)D3: insulin, C-reactive protein, follicle stimulating hormone (FSH), estradiol, progesterone, and parathyroid hormone (PTH) glucose, triglycerides, total cholesterol, HDL-cholesterol and LDL-cholesterol. cut off for vitamin D was 25(OH)D3 ≥ 30 ng/mL (75 nmol/L) = normal, 25(OH)D3 <30 ng/mL (75 nmol/L) = hypovitaminosis (WHO). In the anthropometry was analyzed: weight, height, body mass index (BMI) and waist circumference (WC). Statistical analyzes were performed using Student's t test, Wilcoxon test and Chi-square test for. The significance level was 5%.

**Results:** Of the 177 women evaluated, 87 (49,15%) had vitamin D deficiency, and 90 (50,85%) had normal levels of this vitamin; 88 (49,7%) had metabolic syndrome and 89 (50,3%) had no such syndrome. The average weight, body mass index (BMI), waist circumference, blood pressure, insulin, follicle stimulating hormone (FSH), parathyroid hormone (PTH), C-reactive protein (CRP), fasting glucose and triglycerides were higher (p< 0,05) in patients with the metabolic syndrome, while the HDL-cholesterol average was greater (p<0,05) in the group without metabolic syndrome. In the group with metabolic syndrome, the mean diastolic blood calcium and blood pressure were higher (p<0.05) in the group of women with normal levels of vitamin D. In the group without metabolic syndrome, only blood calcium showed a possible relationship with the level of vitamin D in the blood, but the blood calcium was higher (p<0.05) in the group with hypovitaminosis D. There was no statistical difference (p>0.05) between the groups in relation to ethnicity.

**Conclusions:** The vitamin D showed a possible interference in diastolic blood pressure and blood calcium in metabolic syndrome women.

**Keywords:** Vitamin D, Metabolic syndrome, Post menopause, Aging
ANALYSIS AND DESCRIPTION OF AUDITS PERFORMED ON PATIENTS WHO ATTENDED FOR REFERRAL TO BARIATRIC SURGERY IN GALENO GROUP OFFICES

(1)Garcia, Stella Maris; (2)Perri, Noemi; (3)Leal, Marcela; (2)Rodriguez Fanlo, Eugenia.

(1)PhD. Nutritionist. Service of Nutrition. Sanatorio de la
Trinidad. Argentina.; (2)BSc. Nutritionist. Maimonides University.
Argentina.; (3)MSc. Faculty of Health Sciences. Maimonides
University. Argentina.

**Background and objectives:** Obesity is a chronic, complex, heterogeneous health problem of a growth and epidemic behavior that shortens life expectancy, generates great morbidity and increases socio-health costs. Obesity surgery is safe, presenting low morbidity and mortality, and effective for weight loss and improvement of comorbidities. However, it necessarily implies a change in people's eating habits, it is not curative, nor is it the solution for everyone.

To analyze, describe and interpret a database audits carried out on patients who attended a referral for Bariatric Surgery as a treatment for obesity in the Galeno group Palermo and Barrio Norte clinics from September 2014 to September 2016.

**Methods:** Quantitative, descriptive, observational, transversal, retrospective research. The sample was non-probabilistic, conformed by 1544 patients who attended the consultation for referral to Bariatric Surgery, analyzing the variables Age, Sex, Family History, Weight, Height, BMI, Derivation and Performing Bariatric Surgery. It was used Excel 2016® to analyze database of audits and medical histories.

**Results:** The mean age of the sample was 42 years (DS ± 11), 64% were female, 71.5% had an obese family history of at least one relative, 70% had a BMI ≥40, 26% did not meet the requirements for Bariatric Surgery and did not accept another treatment, 1% was placed intragastric balloon, 37.24% was referred to the Comprehensive Center for the Treatment of Severe Obesity (CITOS) and 35.47% that were authorized to perform the surgery, 72% were performed.

**Conclusions:** Many patients who consult for Bariatric Surgery as a treatment for obesity do not meet the inclusion requirements for it and do not accept another treatment for their disease. Prior audits of referral to appropriate treatment for obesity, personalized according to the history and needs of each patient, can reduce the percentage of failures in the treatment chosen and the economic cost that it represents for health systems.

**Keywords:** Obesity, Bariatric surgery, Treatments, Medical referral.

**Further collaborators:** Micaela Scuri, BSc. Nutritionist. Maimonides University. Argentina.

EFFECTS OF VITAMIN D SUPPLEMENTATION IN DIABETICS RATS METABOLISM

(1)Netto, Claudia; (2)Lourdes Pereira Tavares de Souza, Laise; (3)Finelli Vanço, Kátia; (3)Helena Trigo da Paz, Jéssica; (3)Garcia Rocha, Isabella; (4)Rodrigues Júnior, Luiz Fernando.

(1)PhD. Nutritionist. Department of Biochemistry. University of Rio de Janeiro. Rio de Janeiro. Brazil.; (2)MSc. Nutritionist. Department of Biochemistry. University of Rio de Janeiro. Rio de Janeiro. Brasil.; (3)Biomedical. Department of Biochemistry. University of Rio de Janeiro. Rio de Janeiro. Brazil.; (4)PhD. Physiotherapist. Department of Physiology. University of Rio de Janeiro. Rio de Janeiro. Brazil.

**Background and objectives:** Diabetes mellitus affects about 422 million people worldwide and it is considered one of the major global epidemics of the 21st century. However, vitamin D can act in several vital cellular processes, including the pathology of diabetes mellitus. This study evaluated the effects of vitamin D supplementation in diabetic rats metabolism.

**Methods:** Thirty-two recently weaned rats (21 days of life) were distributed randomly in four groups (n=8 per group): 1-control non-diabetic (C); 2- diabetics control (DC); 3- diabetics treated with 400 IU of vitamin D / day (VD400); 4- diabetics treated with 520 IU of vitamin D / day (VD520), for twenty days. The induction of diabetes was performed by applying streptozotocin intraperitoneally diluted in citrate buffer. The analysis performed were glucose, total cholesterol, HDL-cholesterol, triglycerides, insulin, vitamin D, total protein, albumin and calcium serum.

**Results:** The control non-diabetic group had a lower consumption (p<0.05) compared to the diabetic groups, while the body weight did not present variation (p>0.05). Fasting blood glucose decreased (p<0.05) in the treated animals compared to diabetic control animals. Total cholesterol, HDLc, vitamin D and calcium did not show significant differences (p>0.05) with the supplementation, while triglycerides showed statistical difference (p<0.05) between the groups applying ANOVA, but with the Newman-Keuls test was not possible to observe difference between them. The total protein and albumin presented an increase (p<0.05) in the groups supplemented with vitamin D.

**Conclusions:** Vitamin D supplementation may improve glucose control in diabetic rats and total proteins (albumin and globulin) but did not show a significant beneficial change in lipid and insulin profile, suggesting that it may be acting in an alternative way of independent insulin blood glucose control. Thus, the relationship between vitamin D status, fasting blood glucose and insulin action requires a more depth investigation.

**Keywords:** Diabetes mellitus. Vitamin D. Rats. Metabolism.
PERCEPTION OF BODY IMAGE, KEY FACTOR IN
THE CARE OF NUTRITIONAL STATUS

(1)Riccetto, Paula; (2)Calvo, Soledad; (3)Gambogi, Rosana; (4)Nigro, Sonia.

(1)Nutritionist. National Resources Fund. Uruguay; (2)MSc. Nitrationist. National Resources Fund. Uruguay; (3)MD. National Resources Fund. Uruguay; (4)MSc. Nutritionist. National Resources Fund.

**Background and objectives:** Obesity, particularly abdomi-
nal obesity, is considered a very important risk factor for the met-
abolic syndrome, a situation with a high risk of diabetes and car-
diovascular disease. Knowing how overweight and obese people
perceive their body image (BI) will help define new strategies that
strengthen the need to have a healthy weight.

Objective: To study the perception of the nutritional status of patients attending the Secondary Cardiovascular Prevention Program of the National Resources Fund (NRF) of the city of Montevideo, during the period of May-December 2015.

**Methods:** The study is descriptive of an exploratory, cross-sec-
tional type. 203 patients were studied, who were given a semi-struc-
tured form that contained the Stunkard and Stellard BI test. The
nutritional status was assessed through the body mass index.

**Results:** Two-thirds of the population were men; Six out of ten patients were older adults, and almost nine out of ten had over-nutrition, of which almost half were obese. However, more than half were observed with normal weight, of which 65% were male. However, more than half were observed with normal weight, of which 65% were male. Almost half of the obese were perceived as overweight, 8 out of 10 overweight patients were found normal, of those with normal weight, almost half were observed as thinned and those who were underweight were reflected as they are.

**Conclusions:** Most patients had a severe underestimation of their BI. It was men who underestimated more. Identify the perception of the BI is a key factor in weight control and modification of individual behaviors to improve nutritional status.

**Keywords:** Obesity, Patients, Body image, Perception, Under-
estimation.

**Conflict of Interest Disclosure:** Authors Paula Riccetto, Soledad Calvo, Rosana Gambogi and Sonia Nigro declare to be part of one of the technical teams of the evaluated program, as well as the institution that sends this summary (NRF).

**Further collaborators:** MSc. Biol. Gustavo Fernando Saona. Statical Advisor. National Resorces Fund. Uruguay.

EATING BEHAVIOR AND STRESS PERCEPTION
IN ADULT WOMEN FROM BUENOS AIRES PROV-
INCE, BUENOS AIRES CITY AND CHACO, ARGEN-
TINA

(1)Oliva, María Laura; (2)Janjetic, Mariana; (2)Motta Moreno, Encarnación; (2)Pujol, Mariana; (2)Goldfinger, Mariana; (3)Español, Silvina; (2)Fino, Gabriela; (2)Somoza, María Inés; (2)Grasini, Daniela; (2)Torresani, María Elena.

(1)Especialidad de Nutrición Clínica - Escuela de Nutrición, UBA; (2)Especialidad Nutrición Clinica- UBA; (3)Espacialidad de Nutrición Clinica UBA.

**Background and objectives:** Stress is considered a disease of the XXI century, and can influence eating behavior and consequently body weight. The aim of this study was to evaluate the relationship between stress perception and eating behavior in Argentinean adult women.

**Methods:** An observational, transversal and analytical study was carried out on adult women (30-65 years) attending to nutritional appointment in clinics from Buenos Aires Province, Buenos Aires, Buenos Aires City and Resistencia, Chaco. A sociodemographic and lifestyle survey was carried out (physical activity, smoking). The stress perception was assessed by the Preceived Stress Scale (PSS10) with maximum of 40 points and the eating behaviors were evaluated using the Three-Factor Eating Questionnaire (TFEQ-R18), classified as: emotional eating (EE), uncontrolled eating (UE) and cognitive restraint eating (CRE). Nutritional status was assessed by body mass index (BMI) and abdominal fat by waist circumference (WC). Physical activity was defined considering at least 150 minutes of exercise per week. Statistical analysis was performed with SPSS 19.0 using X2, Mann-Whitney Test and Spearman correlation (statistical significance at p <0.05).

**Results:** A total of 251 women aged 43.3 ± 9.8 years were included. The median values of EE, UE and CRE were: 5.0 (3.0-8.0), 16.0 (12.0-21.0) and 15.0 (10.0-18.0), respectively. The mean values of perceived stress were 15.5 ± 6.0. The stress perception positively correlated with the EE (r = 0.23, p = 0.0003) and the UE (r = 0.24, p = 0.0001); however, it did not correlate with CRE (r=0,08, p=0,19). Meanwhile EE, UE and CRE scores were significantly higher in overweight or obese women, the perception of stress was not associated with BMI.

**Conclusions:** The stress perception correlated with higher EE and UE scores, however, it was not associated to nutritional status. On the other hand, the three eating behaviors evaluated were associated to nutritional status.

**Keywords:** Adult woman, Stress, Eating behaviors.
# ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS, NUTRITIONAL AND CLINICAL ASPECTS OF ELDERLY RESIDENTS OF A CITY OF SÃO PAULO: A POPULATION-BASED STUDY

**Background and objectives:** Depression, or depressive morbidity, is a complex mental disease that includes different phenotypes and symptoms. It has association with different negative results. There are many questions about the association between diet and eating habits with different brain disorders, including depressive symptoms. Eat now is not examined. To investigate the association between depressive symptoms, nutritional and clinical aspects of elderly residents of a city of São Paulo.

**Methods:** The present study is part of a larger thematic project: "Study on the Prevention and Treatment of Depression in the Elderly: A Population-Based Study." A cross-sectional, community-based epidemiological study of 2,643 elderly individuals aged 60 years and over. Considering the following variables: Depressive Symptoms: Center for Epidemiologic Studies Depression Scale (CES-D); Nutritional status: BMI and waist circumference; Habit to consume certain food groups and habit to make meals (Brazil, 2006). Presence of chronic diseases: hypertension, diabetes and hypercholesterolemia; Socio-demographic and economic characteristics: Brazil's Economic Classification Criterion (CCEB) (ABEP, 2011). The variables were analyzed by binary logistic regression. All variables investigated as significant values of p <0.05 (SPSS 22.0 software).

**Results:** We found a high rate of depressive symptoms (38%); Depressive symptoms are associated with the habit of consuming milks and derivatives less than 1 serving per day, olive oil less than 2 times a week, do not consume wine every day, do not often carry out lunch and dinner, possess HAS, be female and be divorced or separated.

**Conclusions:** This study showed that negative association between depressive symptoms and the consumption of some foods. The results remained positive, even after adjustment for socioeconomic, demographic and clinical variables.

**Keywords:** Depression, Depressive symptoms, Elderly, Foods, Nutrition.

# EFFICACY OF A MODIFIED CARBOHYDRATE DIET IN OBESE WOMEN

**Background and objectives:** The dietary management of obesity may consider both: energy intake and macronutrient distribution. The most effective dietary treatment for reducing adiposity seems to be a low carbohydrates (CH) and low glycemic index (GI). Fructose and high fructose corn syrup (HFCS) seems to be related to obesity too. The objective was to compare the efficacy of a modified CH diet vs. a diet with a standard proportion of macronutrients within a program of reduced adiposity in obese women.

**Methods:** A randomized clinical trial was performed. Women in reproductive age diagnosed with obesity (BMI ≥ 30) were included. Dietary intervention was performed for six months. The dietary modification of the intervention group consisted of a hypocaloric diet, with a macronutrient distribution of 45-55% CH, 15-20% proteins and 30% lipids, foods with low or medium GI were recommended and to reduce the intake of industrialized foods with HFCS. In the control group, a hypocaloric diet was also recommended, with a distribution of macronutrients of 60-65% CH, 10-15% proteins and 25% lipids, without restriction of any kind of food. Physical activity recommendations were made equally in both study groups and monthly workshops were implemented to improve adherence to treatment. Measurements of anthropometric (body weight, BMI, fat percentage, arm anthropometry), dietetic (24-hour recalls, food frequency questionnaires), physical activity and adherence to treatment variables were taken at baseline and monthly.

**Results:** Changes in body composition were observed in both study groups. The greatest differences were mainly intra-group variables shown in adiposity. BMI, fat percentage measured by bioelectrical impedance as well as skinfolds, arm fat area (AGB) triceps skinfold thickness (PCT) and subscapularis (PCSE) showed major differences in the intervention group. The arm muscle area (UMA) increased in the intervention group and only significant statistically differences were detected (p=0.032 intervention group vs. p=0.305 control group).

**Conclusions:** The effectiveness of the modified diet in amount and type of CH to reduce adiposity was higher in the intervention group compared with the control group, although both groups were decreased adiposity.

**Keywords:** Low-carbohydrate diet, Low-glycemic index diet, High fructose corn syrup, Adiposity, Obesity.

**Conflict of Interest Disclosure:** The authors whose names are listed certify that they have NO affiliations with or in-

<footnote>(1)Wendeborn, Gisele; (2)Bassoli, Lucas; (3)Alexandrino, Clóvis;</footnote>

<footnote>(4)Bottino, Cássio; (5)Ribeiro, Sandra.</footnote>

<footnote>(1)Nutricionista; Programa de Interunidades em Nutrição</footnote>

<footnote>Humana Aplicada; Universidade de São Paulo; (2)Nutritionist.</footnote>

<footnote>University of São Paulo; (3)Doctor. University of São Paulo; (4)PhD.</footnote>

<footnote>Doctor. University of São Paulo; (5)PhD. Nutritionist. University of
São Paulo.</footnote>

<footnote>(1)Chávez Palencia, Clio; (2)Larrosa Haro, Alfredo; (3)Romero Velarde, Enrique; (4)López-Uriarte, Patricia Josefina.</footnote>

<footnote>(1)PhD. Nutritionist. Human Nutrition Institute. University of Guadalajara. Mexico.; (2)PhD. Gastroenterologist. Human Nutrition Institute. University of Guadalajara. Mexico;</footnote>

<footnote>(3)PhD. Pediatrician. Human Nutrition Institute. University of Guadalajara. Mexico.; (4)PhD. Nutritionist. Center for Research in Food Behavior and Nutrition. University of Guadalajara. Mexico.</footnote>
volvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

144/2823

LONG-TERM MAGNESIUM RESTRICTION MODIFIED THE BODY IRON STORES IN RATS FED A HIGH-FAT DIET

(1)Fragal, Beatriz; (2)Batista da Rocha Romero, Amanda; (3)De Carli, Eduardo; (4)Rodrigues Lobo, Alexandre; (3)Colli, Celia.

(1)Undergraduate student. Department of Food and Experimental Nutrition. University of São Paulo. Brazil; (2)MSc. Department of Food and Experimental Nutrition. University of São Paulo. Brazil.; (3)PhD. Department of Food and Experimental Nutrition. University of São Paulo. Brazil. and 50 [Mg50] mg Mg/kg diet, respectively) for 24 weeks. Diet consumption and body weights were recorded twice a week. At the end of experiment, liver and spleen iron concentrations were analyzed by atomic absorption spectrophotometry (AAS). Moreover, liver total protein homogenates were employed in analysis of ferroportin (Fpn1) abundance by immunoblotting.

**Background and objectives:** Poor iron status described in obese individuals has been attributed either to dietary inadequacies, to increments in body iron requirements or more often to inflammation-induced iron decompartmentalization. Here, we tested the hypothesis that a long-term dietary Mg restriction modifies body iron stores (liver and spleen) in rats fed a high-fat (HF) diet.

**Methods:** Male Wistar rats (n = 24; initial body weight 97-123 g) were fed ad libitum semipurified AIN-93-based control (CT) or high-fat (HF) diets (adequate or Mg-restricted; 500 [Mg500] and 50 [Mg50] mg Mg/kg diet, respectively) for 24 weeks. Diet consumption and body weights were recorded twice a week. At the end of experiment, liver and spleen iron concentrations were analyzed by atomic absorption spectrophotometry (AAS). Moreover, liver total protein homogenates were employed in analysis of ferroportin (Fpn1) abundance by immunoblotting.

**Results:** Compared to CT, HF feeding promoted reduced diet consumption (p <0.05) and enhanced body weight gain (p <0.05), irrespective of Mg restriction. Liver iron concentrations did not differ among groups. However, HF fed animals with Mg restriction (HF[Mg50]), but not those with Mg adequate diet (HF[Mg500]), had lower spleen iron concentrations in comparison to controls (CT[Mg500] and CT[Mg50]) (p <0.05). In this context, ferroportin abundance in the liver was significantly lowered in both HF groups (p <0.05), suggesting that Mg restriction did not modified the efficiency of liver iron exportation in response to the dietary lipid overload.

**Conclusions:** Long-term Mg restriction did not affect weight gain, but modified body iron distribution in rats fed HF diets. Further analysis of serum cytokines and hepcidin concentrations and ferroportin (Fpn1) abundance in duodenum and spleen samples will help to clarify whether these findings are accompanied by changes in the inflammation response, in the intestinal iron absorption or in the mobilization of splenic iron stores for erythropoiesis.

**Keywords:** Obesity, Iron deficiency, Ferroportin, Hepcidin.

144/2852

ENTERAL NUTRITIONAL THERAPY IN HOSPITALIZED PATIENTS: EFFECTIVENESS IN DIET ADMINISTRATION?

(1)Teixeira da Silva Chagas Monteiro, Rafaella; (1)Nunes Novais Calisto, Ariane; (2)Resende de Aguiar, Livia; (3)de Lucena Ferretti, Roberta.

(1)Nutritionist. University of Taubate. University Hospital of Taubate. Sao Paulo. Brazil; (2)Nutritionist. University of Taubate. University Hospital of Taubate. Sao Paulo. Brazil.; (3)PhD Student. MSc. Nutritionist. Federal University of Sao Paulo. University of Taubate. Sao Paulo. Brazil.

**Background and objectives:** Hospital malnutrition is very prevalent, especially in patients receiving Enteral Nutritional Therapy (ENT), due to several factors such as inadequate and ineffective diet administration, lack of monitoring by the team, among others, which may complicate the Clinical picture of the patient, increasing the hospitalization time. The objectives of this study were to evaluate the nutritional status and the effectiveness in the administration of enteral diets in hospitalized patients.

**Methods:** A cross-sectional study with adults and elderly individuals over 20 years old in a hospital in Taubate, Sao Paulo, between August 2015 and April 2016. All patients under ENT were selected. It was considered as effective dietary administration when the prescribed diet was completely infused, reaching 100% of the nutritional needs of the patient. To evaluate the effectiveness of diet administration, the dietary prescription, the volume of diet programmed in the infusion pump as a function of time, as well as information obtained by the patient's chart, nursing professionals, physicians and the multidisciplinary team for nutritional therapy. The mean time attributed to interrupting the diet was also verified. For nutritional status assessment, arm circumference was measured, and compared to the reference values demonstrated by Fritsancho (1990), and adequate according to Blackburn and Thomton (1979). Descriptive statistics were performed for data analysis.

**Results:** Among the 135 patients evaluated, 56.3% (n = 76) were males, while the median age for this sex was 76.5 ± 12.3 years and for females 68.5 ± 10.2 years old. Regarding the nutritional status, 72% of the evaluated patients presented some degree of malnutrition. Regarding the diet administration, it was effective in 78% of the sample. Regarding the 22% of the patients who did not receive the prescribed diet, it was observed that there was interruption of diet for at least 2 hours. Among the patients who did not receive the diet effectively, 80% were malnourished.

**Conclusions:** It is concluded that the majority of the sample was found to be malnourished, and the enteral diet infusion was not effective for all patients. Therefore intervention measures should be adopted and implemented, helping to prevent hospital malnutrition.

**Keywords:** Enteral Nutritional Therapy. Enteral Nutrition. Hospital Malnutrition. Diet Management. Diet Infusion.

**Further collaborators:**

Rafella Teixeira da Silva Chagas Monteiro, Ariane Nunes Novais Calisto and Livia Resende de Aguiar helped to implement the
study and data collection. Roberta de Lucena Ferretti conceived, designed, and implemented the study, collected and interpreted data, wrote and revised the text was responsible for coordinating original study and contributed to the intellectual content. All authors have sufficiently contributed to the development of this study.

(1)Nutricionist. Institution of Nutrition and Food Technology. University of Chile; (2)Pediatric Neurologist. Institution of Nutrition and Food Technology. University of Chile; (3)M.Sc. Nutricionist. Institution of Nutrition and Food Technology. University of Chile; (4)Biochemist. Institution of Nutrition and Food Technology. University of Chile; (5)Medical Technologist. Institution of Nutrition and Food Technology. University of Chile; (6)Psychologist. Institution of Nutrition and Food Technology. University of Chile.

**Background and objectives:** Phenylketonuria (PKU) is a metabolic disease characterized by increased plasma levels of phenylalanine (Phe) which causes mental retardation. Through the National Neonatal Screening Programme for PKU; 248 cases are diagnosed with classical PKU, 46% of the patients are older than 10 years old, which poses important challenges regarding adherence to treatment and PKU Maternal Syndrome prevention.

**Methods:** The treatment consists in restricting Phe intake, providing Phe-free formula, medical and nutritional assessments, psychometric (Weschler Bayley Scale) and biochemical evaluations (MS/MS).

**Results:** Average age of diagnosis: 17.6 ± 9.5 days, with initial values of Phe: 18.5 ± 8.9 mg / dl and Tyrosine: 1.2 ± 0.7 mg/dl. Current age range (1 month to 24 years). The average diet provides 15.5 ± 10 mg Phe/kg/day, 2.1 ± 0.7 g protein/kg/day (80% of the formula), 1330 ± 441 kcals/ ay. 71% of the PKU patients maintains blood FA values under 6 mg/dl (good metabolic control), there was a significant correlation (p <0.01) with IQ. The 89% of PKU have normal IQ, 9% borderline and 2% boundary slight delay. The 61% have normal nutritional status, 19% are overweight, 15% are obese and 5% is underweight.

**Conclusions:** The PKU population may show normal growth and development because of neonatal diagnosis and strict long-term follow-up.

**Keywords:** Phenylketonuria, Metabolic control, Treatment.

(1)Baeta, Danielli; (2)Mendonça, Beatriz Morales; (3)Kawagoe, Eric Kazuo; (3)Garcia, Letícia Colavite; (3)Neto, Júlio Mariano; (4)Muraoka, Juliano Yudi; (5)Souza, Marcos Barros; (6)Araújo, Maria Lúcia Gonsales da Costa; (7)Alves, Maria José Queiroz de Freitas; (8)Oliveira, Olga Maria Mascarenhas de Faria.

(1)MSc. Biotechnology. Department of Biochemistry and Chemical Technology. Institute of Chemistry. São Paulo State University (UNESP). Brazil.; (2)Nutrition's student. Bioscience Institute. São Paulo State University (UNESP). Brazil.;
(3)Biomedical Sciences Student. Bioscience Institute. São Paulo State University (UNESP). Brazil.; (4)Department of Physiology. Bioscience Institute. São Paulo State University (UNESP). Brazil.;
(5)Department of Physical Therapy. Faculty of Science and Technology. São Paulo State University (UNESP). Brazil.; (6)PhD. Department of Biotechnology and Chemical Technology. Institute of Chemistry. São Paulo State University (UNESP). Brazil.;
(7)PhD. Department of Physiology. Bioscience Institute. São Paulo State University (UNESP). Brazil.

**Background and objectives:** The passion fruit (Passiflora edulis f. flavicarpa Degener) has been studied and several researches works the pharmacological and therapeutic properties both for its calming action and its action in hyperlipidemias. Thus, this work verified the possible relation of passion fruit to a caloric diet and the cholesterol level in rabbits with induced hypercholesterolemia.

**Methods:** The experiment was carried out in rabbits divided into three groups: G1 (without treatment), G2 (commercial passion fruit treatment) and G3 (remedy treatment - simvastatin). The experimental protocol was divided in three phases: 1) was offered normal ration to evaluate the basal level of cholesterol; 2) was offered supplemented ration with egg yolk to obtain hypercholesterolemia; and 3) continued with supplemented feed and daily G2 and G3 rabbits were treated with pulp and passion fruit seed (30g) and medicine (10g), respectively.

**Results:** The data indicate a decrease in the average feed intake in the animals of the 3 groups, analyzed during the experiment: G1 was 35.77%, G2 was 38.25% and G3 was 31.01%, but without altering the growth and weight of animals. The results of analyzes of total cholesterol level of the animals showed that in phase 1 it was approximately 80.00mg.dL-1; a significant increase in phase 2 (for 151.2mg.dL-1 in G1, 105,9mg.dL-1 in G2 and 116,1mg.dL-1 in G3); and in stage 3 a reduction to 84.5mg.dL-1 in G2 and to 82.2mg.dL-1 in G3 with treatment, while G1 continued with elevation to 182.7mg.dL-1. The increase in cholesterol level in phase 2 proves that the egg yolk diet was efficient in developing hypercholesterolemia and in phase 3 (in G2 and G3 animals), it is clear that the treatment with passion fruit and with the allopathic medicine reduced plasma cholesterol (21% and 29%, respectively).
**Conclusions:** Passion fruit intake did not change the weight of the animals as it increased progressively and in the same proportion throughout the experimental phases and may be an alternative in the treatment of high cholesterol compared to conventional treatment.

**Keywords:** Passion fruit. Hypercholesterolemia. Simvastatin. Rabbits.

(1)Di'ósady, Levente László; (2)Mannar, M.G. Venkatesh.

(1)University of Toronto. Canada; (2)Honourary Doctor of Science, Adjunct Professor. Department of Chemical Engineering and Applied Chemistry. University of Toronto. Canada

**Background and objectives:** Deficiency of micronutrients in the diet is a major contributor to maternal and infant mortality, birth defects and development problems. These widespread deficiencies can be readily addressed through food fortification. Unfortunately a very large proportion of rural poor do not participate in the purchase of processed foods, and are not reached by basic fortification programs for flour, bread etc. Salt is an ideal carrier for micronutrients as it is universally consumed in predictable, uniform quantities. Unfortunately salt cannot be directly fortified with combinations of micronutrients. We developed appropriate technologies for multiple fortification of salt,

**Methods:** Salt has been fortified with different combinations of iodine, iron, zinc, folic acid, and B vitamins. To prevent interactions among the micronutrients, especially iron and iodine, we developed technologies for microencapsulating iron alone and in combination with zinc and vitamin B12 to form a solid premix that can be admixed to salt. We have developed stable spray solutions that contain iodine, folic acid and other B vitamins that can be sprayed onto salt using currently installed iodization equipment.

Premixes and spray solutions as well as salt prepared with them were stored at elevated temperatures for up to a year.

**Results:** Stable solid premixes were prepared by extruding ferrous fumarate, colour masking it with titanium dioxide, alone or in combination with zinc oxide, and overcoated with a moisture resistant edible coating. The premix was blended with salt at a ratio of 1:200, and sprayed with the combined spray solutions that were pH adjusted and stabilized

The salts retained <80% of the added iodine and vitamins for at least six months at 45°C, <60% RH.

**Conclusions:** Salt multiple fortified with stable agglomerated and coated premixes and stable spray solutions can provide 30-100% of critical micronutrients at a cost of ≤25US¢ per person per annum, and can reach populations that do not purchase manufactured food products. Salt is a versatile, simple and inexpensive carrier for micronutrients, when combined with appropriate technologies for maintaining organoleptic qualities of food and stability of micronutrients.

**Keywords:** Salt, Micronutrients, Deficiencies, Fortification, Premixes.

**Conflict of Interest Disclosure:** The work was partially funded by GCC, the Micronutrient Initiative and the Bill and Melinda Gates Foundation

**Further collaborators:**

The work was partially funded by GCC, the Micronutrient Initiative and the Bill and Melinda Gates Foundation. Members of the Food Engineering Group included numerous graduate students and post doctoral fellows, including among many others Dr. Olve Yao Li of CalPoly Pomona

(1)Belbraouet, Slimane; (2)Gagnon, Charline; (3)Ouellette, Rodney.

(1)Université de Moncton; (2)MS. Dietitian. Université de Moncton. Canada; (3)PhD. MD. IARC. Moncton. Canada.

**Background and objectives:** This case-control study aims to evaluate the association between dietary fat intake and the risk of breast cancer (BC).

**Methods:** The dietary intake assessed using "Food Processor" in 31 women newly diagnosed with BC and 39 healthy women. A descriptive approach collected relevant data such as nutritional status, sociodemographic and anthropometric characteristics, and lifestyle of subjects. Comparisons between cases and controls carried out by simple t-tests and statistical correlations conducted between lipid intake and dietary parameters.

**Results:** The calorie intake is significantly lower (1699±527 vs. 2221± 799 kcal; p<0.05) in the subject group vs the control group. The same results are observed with the averages in the protein intake (75± 30 vs 99±36 g; p<0.05), carbohydrates (230±73 vs 294±123 g; p<0.05), and dietary fibre (21±11 vs 31±14 g; p<0.05). No significant association between dietary fat intake and the risk of breast cancer is observed: total fatty acids (68 ± 31 vs 77±36 g), saturated fatty acids (19±12 vs 21±11 g), monounsaturated fatty acids (23±13 vs 27±17 g), polyunsaturated fatty acids (12±8 vs 14±9 g), or cholesterol (213±177 vs 225±130 mg).

**Conclusions:** Our results do not support a positive relationship between fat intake and BC.

**Keywords:** Lipid intake, Dietary assessment, Breast cancer.

**Further collaborators:** A Khalil. PhD. Université de Sherbrooke.
# IS THE TIME SPENT FETCHING WATER ASSOCIATED WITH CHILDREN'S ANTHROPOMETRIC INDICATORS STATUS? A COMPARATIVE STUDY OF ETHIOPIAN, MALAWIAN AND ZAMBIAN MOTHERS WITH CHILDREN UNDER 5

Ahmadi, Davod; Sinclair, Kate; Cortbaoui, Patrick; Melgar-Quiñonez, Hugo.

McGill University.

**Background and objectives:** Women's access to water and the time they spent carrying water have implications for maternal and child health status; however, little is known about the association between mothers' time fetching water and children anthropometric indicator status. This study aims to fill the existing knowledge gap.

**Methods:** The main objective of this paper is to study the association between the amount of time mothers spent carrying water and children anthropometric indicators such as, wasting, stunting, underweight and BMI for age.

Data from three surveys carried out in Ethiopia on 2016, Malawi and Zambia on 2017 were used in this article.

Different statistical analyses such as, descriptive, bivariate and linear regression analyses were used to examine the association between the time mothers spent fetching water and each of anthropometric indicator status by adjusting children's sex, age, community water supply and mothers' decision making.

**Results:** Findings of unadjusted linear regression analyses showed negative associations between the time spent fetching water and wasting, stunting, and underweight. But, results of adjusted model revealed that time spent of carrying water is not the final determinant of anthropometric indicators, and children's sex, age, and mothers' decision making were significantly associated with stunting, wasting, and underweight.

**Conclusions:** Overall, our study found that children's characteristics and maternal decision making influence the anthropometric indicators.

**Keywords:** Water access, Time fetching water, Children's anthropometric indicators, Ethiopia, Malawi, and Zambia.

# ASSOCIATION OF SALT AND POTASSIUM INTAKE ASSESSED BY URINARY EXCRETION OVER 24-HOUR AND BLOOD PRESSURE: A CROSS-SECTIONAL ANALYSIS FROM A POPULATION COVERED

(1)Moliterno, Paula; (2)Boggia, José; (3)Olascoaga, Alicia; (4)Luzardo, Leonella; (5)Marino Donangelo, Carmen; (6)Noboa, Oscar.

(1)MSc. Nutritionist. Escuela de Nutrición. Universidad de la República. Uruguay.; (2)PhD. MD. Departamento de Fisiopatología. Hospital de Clínicas. Universidad de la República. Uruguay.; (3)MD. Laboratorio de Patología Clínica. Hospital de Clínicas. Universidad de la República. Uruguay.; (4)MSc. MD. Departamento de Fisiopatología. Hospital de Clínicas. Universidad de la República. Uruguay.; (5)PhD. Escuela de Nutrición. Universidad de la República. Uruguay.; (6)MD. Centro de Nefrología. Hospital de Clínicas. Universidad de la República. Uruguay.

**Background and objectives:** Globally, a positive association between sodium consumption and blood pressure has been pointed out. Therefore salt reduction has been recommended as a strategy to reduce population BP levels. Twenty four hour urinary sodium analysis is considered the "gold standard" to estimate sodium consumption, although collection is difficult and cumbersome. In Uruguay, consumption of salt is estimated from national dietary surveys, without considering potassium. The aim of this study is to assess sodium and potassium urinary excretion as surrogate of salt and potassium intake and its main dietary sources in a local population sample, and its relationship with blood pressure.

**Methods:** Participants form GEFA (Genotype Phenotype and Environment of Hypertension in Uruguay) Study recruited until September 2016 were included. Electrolytes excretion was measured from 24-hour urinary collection, and creatinine excretion (mg/Kg/day) used to validate completeness of urine collection (>13 in women, >15 in men). Blood pressure was considered average of 5 consecutive conventional measurements. Dietary sources of electrolytes were assessed using a food frequency questionnaire.

**Results:** Form 394 recruited participants, 350(89%) complete urinary collection. From these, only 176(50%) completed valid urine collection. Table shows principal characteristics.

Sodium intake >2g/day was present in 92% of participants (men: 97%; women: 87%). Main dietary sources of sodium were processed meats (21%), sausages (12%) and bread (24%). Most of participants (93%) had potassium intake below 3.5 g/day, being major sources: mate (ilex paraguariensis) drink (29%), milk (13%) and meats (10%). Multivariable analysis in participants without hypertension treatment (n=137), showed a positive association between sodium intake (adjusted by age, sex) and systolic (r=0.18, P=0.033) or diastolic (r=0.21, P=0.011). Linear regression showed per each gram of sodium intake, an increase in systolic and diastolic blood pressure by 1.6 (R2= 0.22, P=0.032) and 1.2 mmHg (R2= 0.15, P=0.011) respectively. Potassium intake and systolic blood pressure were not associated (r=0.11, P=0.17): a trend was observed for diastolic blood pressure (r=0.17, P=0.05).
**Conclusions:** Less than 50% of participants completed valid urinary collection. Mean salt intake (9.2 g/day) was lower than world estimates (~9.9g/day). Nevertheless, mean sodium intake was over and potassium intake below WHO recommendations. A positive association was found between sodium intake and blood pressure.

**Keywords:** Urinary sodium, Urinary potassium, Intake, Blood pressure.

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DEFINITION AND INDICATORS OF ADHERENCE
TO NUTRITIONAL TREATMENT IN PATIENTS
WITH METABOLIC SYNDROME

(1)Saravia, Luisa; (2)Ibáñez, Ana.

(1)Nutritionist. MSc. School of Nutrition. University of La Republica. Montevideo. Uruguay; (2)Psychologist. MSc. School of Nutrition. University of La República. Montevideo. Uruguay.

**Background and objectives:** Backgrounds and objectives: In recent years, diseases related to lifestyle, especially obesity and associated non-communicable diseases (NCDs), have reached global epidemic levels. Adherence to nutritional treatment, as well as other preventive actions, may help modifications of lifestyle-dependent risk factors that could control these diseases. The aim of the study is to define the adherence to nutritional treatment in patients with metabolic syndrome identifying the indicators that measure adherence to treatment.

**Methods:** Delphi's Method was the investigation technique use for the study. 24 experts in non-chronicle diseases nutritionists begin the process, 16 finish it. Four consultation instances were held. The first one required a definition of the experts of what is nutritional treatment adherence in patients with metabolic syndrome. Based on the answers, the researchers elaborated three definitions and a list of contributions to the topic that were, in a second query, put into experts consideration. In the third query, a consensual definition was created. In addition, a list of indicators was requested. In the fourth query, agreement or suggestions of the indicators list were requested.

**Results:** An adherence to nutritional treatment definition was obtained, including the patient's perspective, the personalized treatment performed by the professional and the indicators that allow adherence to be measured.

**Conclusions:** The obtained definition and the indicators allowing adherence assessment will enable an instrument that facilitate patience adherence to nutritional treatment.

**Keywords:** Nutritional treatment adherence, Metabolic syndrome patients, Delphi's Method.

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HOSPITAL MENU: ASSESSMENT OF NUTRIENT COMPOSITION AND PATIENT SATISFACTION

(1)Garcia, Alicia C; (2)Greig, Susan; (3)Hekmat, Sharareh.

(1)PhD. Registered Dietitian. School of Food and Nutritional Sciences. Brescia University College. Western University. Ontario. Canada; (2)MScFN. HBSc. MBA. RD. School of Food and Nutritional Sciences. Brescia University College. Western University. Ontario. Canada; (3)PhD. Food Scientist. School of Food and Nutritional Sciences. Brescia University College. Western University. Ontario. Canada.

**Background and objectives:** At best, menus fail to be noticed by administrators and ministries when determining overall satisfaction of a patient's hospital experience. Patient satisfaction with hospital food enhances consumption to facilitate adequate intake of nutrients required for recovery. The nutrient content of the menu must balance patient preferences. This study of Ontario hospital foodservice departments determined the prevalence/ frequency and methods of menu analysis, nutrients assessed and criteria to determine and provide amounts required for health or foster recovery from illness/injury, methods and frequency of assessing patient satisfaction.

**Methods:** A review of manuscripts, government documents on hospital services, hospital resources and popular media identified current practices and focused on legislation/standards for menu planning. Survey questions were then developed based on perceived gaps and the researchers' work experiences. Foodservice managers and directors from 57 Ontario hospitals were included in a cross-sectional in-depth telephone survey. Respondents were asked close- and open-ended questions to explore barriers, issues and priorities. Responses to open-ended questions were captured in an Excel spreadsheet and deductive analysis was done to supplement quantitative data.

**Results:** Of the 140 hospital corporations, 45 foodservice managers from academic hospitals, hospitals with <100 beds and hospitals with ≥100 beds participated in the survey together with 12 managers working in hospitals governing long-term care facilities. Findings indicate that more than or almost half of the hospitals assessed regular, therapeutic and texture modified menus for nutritional adequacy. This differed from hospitals governing long term care facilities where 75 % of regular menus were assessed. Most departments obtained patient satisfaction feedback at departmental and corporate levels.

**Conclusions:** Inconsistency in practice disables foodservice leaders to identify trends or compare their results to similar facilities. They are challenged to provide high quality regular, therapeutic and texture modified menus for patient satisfaction and quality nutritional care within available resources and nutritional standards. The study suggests the importance of establishing evidence-based standards for assessing nutritional adequacy and patient preferences in Ontario hospitals to assist foodservice leaders in creating or modifying hospital menus.

**Keywords:** Hospital foodservice, Patient satisfaction, Hospital menu analysis, Long-term care menus, Nutritional adequacy.
# Track 5: Nutrients and Nutritional Assessment

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## PREDICTIVE EQUATIONS FOR INDIAN WOMEN TO CALCULATE BODY FAT PERCENT (BF%)

(1)Sinha, Srishti; (2)Verma, Lalita; (2)Nigam, Shailly.

(1)MSc. Nutritionist. Department of Food and Nutrition. Lady Irwin College. University of Delhi. India; (2)PhD. Assistant Professor. Department of Food and Nutrition. Lady Irwin College. University of Delhi. India.

**Background and objectives:** Obesity is defined as a condition with an excess accumulation of fat in the body. There are various tools and techniques to assess body fat i.e. laboratory methods and anthropometric indices. The latter has benefit over laboratory techniques as they are simple to use in field setting. However, the accuracy of the same in estimating BF% is debatable. Therefore, the objective of present study was to develop predictive equations using anthropometric measurements to calculate BF%.

**Methods:** A cross-sectional study was conducted in South Delhi area on 320 subjects (through purposive sampling). The women who were pregnant, habitual smoker, morbidly obese, suffering from thyroid disorder or any other persistent health problem and having irregular menstrual cycle were excluded from the study. The data was collected on basic descriptives, height, weight, waist circumference (WC), hip circumference (HC) and BF% (assessed using Bioelectrical Impedance Analysis method – BIA) of the subjects. The multiple linear regression analysis was done on 261 subjects using SPSS 23.0 version.

**Results:** The results from Kolmogorov-Smirnov Test showed that the data was normally distributed under the study. The predictive equations were formulated from multiple regression analysis using anthropometric measurements which are highly correlated with BF% (p-value < 0.05). These are:

$$BF\% = (0.444*WC) + (0.065*Age) - 5.204$$

$$BF\% = (0.506*HC) + (0.149*Age) - 20.970$$

$$BF\% = (0.584*Height) + (-0.478*Weight) + 74.299$$

From the regression analysis it was evident that 90.8% variation in BF% was attributed by height and weight of an individual.

**Conclusions:** The study developed predictive equations for Indian women using anthropometric measurements that can provide an estimate of BF% more effectively than anthropometric indices like BMI, FMI etc. The combination of anthropometric measurements and age provides good combinations that are not only easy to measure but also these can be used in clinical and anthropometric studies.

**Keywords:** Body Fat Percent (BF%), Predictive equations

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## IMPLEMENTATION OF NUTRITION-SENSITIVE AGRICULTURE IN THE CENTRAL PROVINCE OF ZAMBIA

(1)Chipili, Given; (2)Msuya, John.

(1)Mukuba University, Department of Nutrition Sciences. Kitwe. Zambia.; (2)Morogoro.

**Background and objectives:** The Central Province of Zambia contains the majority of the nation's malnourished children, despite being the most productive province in terms of Agriculture. Most studies in the province have not paid attention to the linkages between agriculture performance and nutrition outcomes of the population. In light of this knowledge gap, this study focused on the linkage between nutrition and agriculture. In 2010 the Ministry of Agriculture in the Central Province while working with Non-Governmental Organizations (NGOs), the Ministry of Health and the Ministry of Education started a pilot project in Kapiri-Mponshi on Orange fleshed Sweet Potatoes and Orange Maize and educating farmers on the importance of crop diversity.

**Methods:** The study assessed the extent to which the small scale farmers are implementing the best practices of nutrition-sensitive agriculture in the Central Province. This study sought to determine the association of crop diversity and nutritional status of children aged 6-59 months in Kapiri-Mposhi district in the Central Province of Zambia. A cross-sectional descriptive study was conducted using a structured questionnaire. A total of 365 households were randomly sampled and the nutritional status of one child from each household assessed using anthropometric measurements. A total of 100 children were included in the study.

**Results:** Up to 21% of the children were stunted; 2% were wasted; and 9% underweight. There was a significant relationship between crops grown in households (ground nuts, mangoes and orange-fleshed sweet potatoes) and Z-scores for stunting (HAZ) and underweight (WAZ) (p<0.05).

**Conclusions:** This study has established that farmers may not diversify if they have high market demands on the staple.

**Keywords:** Agriculture, Crop diversity, Children, Nutrition.
# CAUSAL ANALYSIS OF UNDER-NUTRITION IN JEJU AND MELKA BELO DISTRICTS OF OROMIA REGION OF ETHIOPIA

(1)Asamo, Feleke Milikias; (2)Kassa, Yohannes Chanyalew; (3)Boltana, Sisay Sinamo; (4)Teshale, Alemshet Aschalew; (5)Dibaba, Asrat.

(1)BSc.MPH.Nutrition specialist. World vision Ethiopia; (2)MSc. MD.Health and Nutrition Manager. World vision Ethiopia; (3)MPH. MD.Health and Nutrition Senior Technical Advisor. World vision East Africa regional office; (4)BSc.MPH. Nutrition specialist. World vision Ethiopia; (5)MPH.MD DIRECTOR OF HEALTH. WORLD VISION INTERNATIONAL EAST AFRICA REGION.

**Background and objectives:** Under-nutrition has been one of the main health problems in Ethiopia. The poor nutritional status in children and women is a consequence of multiple factors. Mainly, inadequate nutrient intake and illness and some underlying conditions being compounded by factors related to socioeconomic conditions. World Vision Ethiopia has been supporting both districts with various emergency relief and development projects. However, the districts faced concurrent malnutrition problems and often classified as hot spot 1 and 2. The current study was, therefore, to assess the magnitude of under nutrition in children 6-59 months and to identify key factors and generate evidence-based responses to address the determinants.

**Methods:** Both quantitative and qualitative data collection methods were applied. For quantitative data, household questionnaire was used in selected 640 households and for qualitative, 20 key informant interviews and 13 Focused Group discussions (FGD) along with secondary data review were carried out. ENA and SPSS softwares were used for cluster selection, data entry and analysis.

**Results:** The result of SMART study showed that the assessed areas had a high prevalence of malnutrition. The prevalence of Global Acute Malnutrition (GAM) was estimated at 16.4%, with Severe Acute Malnutrition (SAM) 4.1% and stunting, 33.2%.

It was found that, 55% of mothers expressed and disposed colostrum thinking that it is not good and over 77% of children were introduced complementary foods late. The mean dietary diversity score was 4.9 and 94% of children never consumed meat and only 30% consumed vegetables and 24% fruits. More than 35% drink water from unprotected sources and 62.5% of them do not treat. About 56% reported that they had less than 1 hectare farmland.

**Conclusions:** Under nutrition is one of the most important public health problem in the study area. Despite the long years intervention, GAM and SAM rate was still at serious stage. The factors significantly related with wasting and stunting include high maternal illiteracy rate, shortage of farmland, poor child care practices, insufficient agricultural production, poor diet diversity, poor hygiene and sanitation practices, which all need to be given due attention to define priorities for action.

**Keywords:** Wasting, Stunting, Complementary feeding, Diet diversity, Severe Acute Malnutrition, Breastfeeding.

# ASSOCIATION BETWEEN MANGANESE INTAKE AND BODY MASS INDEX IN A POPULATION BASED SURVEY IN SÃO PAULO, BRAZIL

(1)Marchioni, Dirce; (2)Macedo Silva, Alexsandro; (3)Gorgulho, Bartira;

(4)Fisberg, Regina.

(1)Professor. Nutritionist. Department of Nutrition. University of São Paulo. Brazil; (2)PhD Student. Pharmacist. Department of Nutrition. University of São Paulo. Brazil; (3)PhD. Nutritionist. Department of Nutrition. University of São Paulo. Brazil;

(4)Professor. Nutritionist. Department of Nutrition. University of São Paulo. Brazil.

**Background and objectives:** Manganese plays an essential role in metabolism, activating mitochondrial enzymes, especially those involved in β-oxidation. The functional impairments of this pathway may lead to incomplete catabolism of amino acids, and promote triglycerides synthesis, consequently, increasing adipose tissue. The aim of this work was to investigate the association between manganese intake and obesity in a population-based study.

**Methods:** The dietary intake data, a 24hR of 832 adolescents and adults, were obtained from the "Health Survey of São Paulo" (ISA-Capital 2008), a population based cross-sectional survey in Brazil. Linear regression was used to verify the relationship between manganese intake and Body Mass Index (BMI), adjusting by energy intake, age, sex, race, and physical activity. In this model, the energy adjusted manganese intake (independent variable) was log-transformed. It was considered the p-value ≤0.05 for statistical significance. The multicollinearity between the predictors variables were verified by the variation inflation factor (VIF).

**Results:** Manganese intake was negatively associated with BMI (β=-1.30; p=0.031, VIF=1.46), suggesting a BMI decrease of 0.013 units for every one percent increase in manganese intake.

**Conclusions:** In conclusion, considering the relationship with manganese and mitochondrial metabolism, the low manganese intake could make changes in the metabolism of carbohydrate, cholesterol, and amino acids, by impairing the manganese metalloenzyme activity. These metabolism changes could reflect the metabolism alteration related to the obesity.

**Keywords:** Manganese intake. Body Mass Index. Obesity. Metabolism.
# SUBJECTIVE GLOBAL ASSESSMENT FOR THE DIAGNOSIS OF PROTEIN-ENERGY WASTING IN PERITONEAL DIALYSIS PATIENTS

(1)Hung-Lien, Wu; (2)Ming-Cheng, Wang; (3)Yu-Wei, Wang; (4)Chin-Chung, Tseng; (2)Junne-Ming, Sung.

(1)PhD. Nutritionist. Department of Nutrition. National Cheng Kung University Hospital. College of Medicine. National Cheng Kung University. Tainan. Taiwan.; (2)MD. Divison of Nephrology. Department of Internal Medicine. National Cheng Kung University Hospital. College of Medicine. National Cheng Kung University. Tainan. Taiwan.; (3)BSc. Nurse. Divison of Nephrology. Department of Internal Medicine. National Cheng Kung University Hospital. College of Medicine. National Cheng Kung University. Tainan. Taiwan.; (4)PhD.MD. Divison of Nephrology. Department of Internal Medicine. National Cheng Kung University Hospital. College of Medicine. National Cheng Kung University. Tainan. Taiwan.

**Background and objectives:** Subjective global assessment (SGA) has been demonstrated to be a reliable method for protein-energy wasting (PEW) in CKD patients. Few data are available on PEW evaluation in chronic peritoneal dialysis (CPD) patients. This study has two purposes, (1) the prevalence of PEW by 7 point SGA; (2) the correlation between SGA and PEW.

**Methods:** This study enrolled 146 patients (71 males and 75 females) from the PD unit of National Cheng Kung University Hospital, Tainan, Taiwan. Patients were divided into a PEW and non-PEW groups. We measured anthropometric, 7-points SGA, biochemical parameters, body composition.

**Results:** PEW was present in 57 (39%) patients, Among the SGA components, the most frequent abnormality in patients with PEW were appetite, GI function, activity, stress, muscle score, and total SGA score (P< 0.0001). Hb, HCT%, serum albumin, potassium, uric acid were lower in PEW (P< 0.05). In body composition, lower fat% and higher water % of total body and lean mass in PEW patients (P< 0.05). 32 patients with severe and mild malnutrition (SGA 2~4 score) had 24 (75%) patients with PEW, 46 patients with SGA 5 score had 21(46%) patients with PEW, 68 patients with SGA 6~7 score had 12 (18%) with PEW.

**Conclusions:** The prevalence of PEW was 39% in our CPD patients, malnutrition from SGA score can reflect the status of PEW in CPD patients.

**Keywords:** Subjective global assessment, Protein-energy wasting, Chronic peritoneal dialysis.

**Conflict of Interest Disclosure:** Subjective global assessment is a very practical method in assessing overall nutrition and protein-energy wasting. It can be fast and easy diagnosis for protein-energy wasting in dialysis patients. Subjective global assessment is promoted and practical method in peritoneal dialysis patients.

**Further collaborators:**

Li-Li Tung BSc. Nutritec Enjoy Inc. Taipei, Taiwan.

# HOW DIFFERENT IS THE DIET OF OBESE PATIENTS COMPARED TO THE NORMAL WEIGHT PEOPLE?

(1)Posea, Mihaela-Cameia; (2)Dragomir, Andreea Diana; (3)Radulian, Gabriela.

(1)Md. Phd. Diabetes Nutrition and Metabolic Diseases. Smart Nutrition Clinic. Bucharest. Romania; (2)MD. 2- MD. Diabetes Nutrition and Metabolic Diseases. University of Medicine and Pharmacy "Carol Davila ". Bucharest. Romania; (3)3- MD. PhD. Diabetes Nutrition and Metabolic Diseases. National Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", Bucharest, Romania.

**Background and objectives:** According to World Obesity Federation, in 2025 there will be 2.7 billion adults suffering from overweight and obesity, up from 2 billion in 2014. We need to see how different is the diet of obese patients compared to normal weight subjects in order to make adequate nutritional advises to obtain or to maintain a healthy weight and diet.

**Methods:** A sample of 199 subjects, 54 normal weight patients and 145 obese people were investigated. Anthropometric and paraclinic data, biological samples and nutritional assessment were made. Using a 7-day food self-recorded questionnaire, we evaluated the nutritional content of food intake: carbohydrates, proteins, lipids, vitamins A, B1, B2, B3, B5, B6, B12, C, D, E, folic acid, and minerals like calcium, iron, magnesium, phosphorus, zinc, copper, manganese, selenium, and sodium. We measured resting metabolic rate using the indirect calorimetry.

**Results:** As we expected, the differences between the two samples were regarding the weight, body mass index, body fat, percent of body fat, the resting metabolic rate, abdominal circumference and blood pressure.

We found plasma HDL cholesterol in normal ranges more frequently in patients with normal body weight compared to obese subjects (78.79% vs 58.47%, p = 0.03). In 3.81% of obese patients we found a small, significant, negative correlation between the HDL cholesterol plasma levels and the intake of iron from diet.

All the patients had a high fat, high protein, low carb diet, without significant differences between the two groups.

Regarding the vitamins, the only significant differences were about the mean intake of B1 (thiamine) and B3 (niacin) vitamins.

Obese subjects consumed higher amounts of phosphorus, iron, copper and selenium.

**Conclusions:** None of the patients, neither normal-weight nor obese, had a balanced diet regarding the intake of macro-nutrients, vitamins and minerals. There are some significant differences between the groups regarding micro-nutrients but not regarding macro-nutrients.

We need to pay more attention to nutritional recommendation in both normal weight and obese people in order to not exceed the recommended daily doses.

**Keywords:** Obese, Diet, Vitamins, Minerals, Normalweight.