# MATERNAL VITAMIN D SUPPLEMENTATION DURING PREGNANCY AND LACTATION TO PROMOTE INFANT GROWTH IN DHAKA, BANGLADESH (MDIG TRIAL): A RANDOMIZED CONTROLLED TRIAL

(¹)Roth, Daniel; (²)Mahmud, Abdullah Al; (³)Morris, Shaun; (⁴)Zlotkin, Stanley; (⁵)Gernand, Alison; (⁶)Tahmeed, Ahmed; (⁷)Islam, M Munirul; (⁸)Papp, Eszter; (⁹)Korsiak, Jill; (¹⁰)Willan, Andrew.

(¹)MD. PhD. Clinician Scientist. Centre for Global Child Health. The Hospital for Sick Children. Canada; (²)MSc. MPH. Scientist. Nutrition and Clinical Services Division. International Center for Diarrheal Disease Research. Bangladesh. Bangladesh; (³)MD. MPH. Clinician Scientist. Division of Infectious Diseases. The Hospital for Sick Children. Canada; (⁴)MD. PhD. Senior Scientist. Centre for Global Child Health. The Hospital for Sick Children. Canada; (⁵)PhD. MPH. Nutritional Scientist. Department of Nutrition. Pennsylvania State University. USA; (⁶)MD. PhD. Senior scientist. Centre for Nutrition and Food Security. International Center for Diarrheal Disease Research. Bangladesh. Bangladesh; (⁷)MBBS. PhD. Scientist. Nutrition and Clinical Services Division. International Center for Diarrheal Disease Research, Bangladesh. Bangladesh; (⁸)MSc. PhD. Research Manager. Centre for Global Health. The Hospital for Sick Children. Canada; (⁹)MSc. Data Analyst. Centre for Global Health. The Hospital for Sick Children. Canada; (¹⁰)PhD. Clinical Trials Methodologist. Ontario Child Health Support Unit. The Hospital for Sick Children. Canada.

**Background and objectives:** Infant linear growth faltering is a significant public health problem in South Asia. Low length-for-age z-scores (LAZ) are associated with adverse physical and neurocognitive outcomes in childhood. Linear growth faltering often begins early in infancy, suggesting that prenatal factors have a significant impact on postnatal growth. Vitamin D regulates bone mineral homeostasis and growth plate activity and is, therefore, a key candidate nutrient involved in fetal and infant linear growth.

**Methods:** In a randomized controlled dose-ranging maternal vitamin D supplementation trial in Dhaka, Bangladesh, 1300 women were enrolled in mid-pregnancy (17-24 weeks gestation) and allocated into one of five treatment arms, receiving 1) placebo, 2) 4,200 IU/week, 3) 16,800 IU/week, or 4) 28,000 IU/week vitamin D in the prenatal period and placebo in the postpartum period, or, 5) 28,000 IU/week vitamin D in the prenatal and 28,000 IU/week vitamin D in the postpartum period. Infants underwent weekly morbidity evaluation until 6 months of age and anthropometric and clinical evaluation at 3-month intervals until 1 year of age. Laboratory analyses were performed at enrollment, 30-weeks gestation, delivery, and 3 and 6 months of age. The primary outcome was mean length-for-age Z score (LAZ) at 1 year of age. Secondary outcomes included pregnancy/birth outcomes and infant morbidity.

**Results:** Of 1300 women enrolled, 64% were vitamin D deficient (25-hydroxyvitamin D<30 nmol/L) at baseline. There were 20 stillbirths, 29 infant deaths, and 86 other losses to follow-up, such that 1165 (90%) infants completed anthropometric follow-up

at 1 year of age. The effects of maternal vitamin D supplementation during pregnancy and lactation on infant LAZ, other anthropometric indices, and various clinical outcomes will be presented.

**Conclusions:** The impact of the current findings on maternal vitamin D supplementation on infant length and maternal and infant health outcomes in Bangladesh will be discussed. The significance of the findings for current maternal vitamin D supplementation guidelines will be discussed.

**Keywords:** vitamin D, pregnancy, nutrition, infant health, bone growth

**Further collaborators**

Farhana Khanam Keya, Minhaz Mohsin, Kelly Murphy, Lisa Pell, Prakesh Shah, Shaila Sharmeen Shanta, Joy Shi, Rosanna Weksberg.

# FREQUENCY OF VITAMIN D DEFICIENCY IN OUR OBESE PATIENTS

Vera, Matilde Elizabeth.

MSc. Nutrition. Argentina.

**Background and objectives:** The objective of the present study is to determine the frequency of vitamin D deficiency in obese patients

**Methods:** Methodology: A cross-sectional observational, descriptive study with an analytical component, performed in 40 patients of the Integral Management Unit of the Obese Patient of the Hospital de Clínicas from June 2015 to May 2016. Variables: socio-demographic, clinical data, 25- Hydroxy-Vitamin D and relation between them. The data collected were loaded in Microsoft Excel® version 2007 and analyzed using Epiinfo 7 version February 2011

**Results:** The mean age was 40 ± 11 years (19-59), mostly women (88%), who work Office (30%), residents of the Central area (68%). The medical diagnosis was predominantly Hypertension (62%) and Type 2 Diabetes (29%), with predominance of obese type II and III with 40% and 38%, respectively. 40% have vitamin D deficiency (≤20ng / ml) and 40% deficiency (21-29 ng / ml) and 20% adequate. The environment, 9 miles, being higher in women. The most frequent risk factor was 55% of the non-exposed subjects with the lowest vitamin D value (μ18 ± 9). Of those with deficiency, 50% had grade II obesity and in those with good results, 75% were grade III.

**Conclusions:** Almost half of the obese studied had vitamin D deficiency, more affecting those with type II obesity

**Keywords:** obesity, vitamin D, vitamin D deficiency, Paraguay.

**Further collaborators:** Dr. Rafael Figueredo
WHO GUIDELINES ON FEEDING COMPLEMENTARY FOODS TO 6-24 MONTH OLD CHILDREN: DEMOGRAPHIC & HEALTH SURVEY (DHS) DATA FROM CAMEROON, EGYPT, INDONESIA AND THE PHILIPPINES

(1)Marriott, Bernadette P.; (2)Nasarre, Patrick; (3)Lee, Fu-Shing; (4)Poole, Ann; (5)Boan, Andrea D.; (6)Wallingford, John C.

(1)PhD. Director. Nutriton Section. Division of Gastroenterology. Department of Medicine. Medical University of South Carolina. Charleston. SC. USA.; (2)PhD. Medical University of South Carolina. Charleston. SC. USA; (3)PhD. Statistician. Nutrition Section. Department of Medicine. Medical University of South Carolina. Charleston. SC. USA; (4)MSc. Nutrition Section. Department of Medicine. Medical University of South Carolina. Charleston. SC. USA; (5)PhD. Department of Pediatrics. Medical University of South Carolina. Charleston. SC. USA; (6)PhD. Nutrition Scientist. President. Nutrispectives Inc. Seattle. WA. USA.

**Background and objectives:** The World Health Organization (WHO) recommends complementary foods with sufficient diversity to meet nutritional needs that are measured by four solid food feeding indicators (FI). Earlier studies have reported associations between meeting the FI and economic status or maternal education. Our purpose was to determine if meeting the WHO FI was associated with country economic status measured by Gross Domestic Product (GDP).

**Methods:** We assessed complementary feeding practices of children 6-24 months of age and their family socio-demographics and lifestyle factors using comparable Demographic and Health Survey (DHS) data and the WHO FI, among four countries of dissimilar economic status: Egypt, Indonesia, Philippines, and Cameroon (World Bank: GDP= 6,600; 5,200; 4,700; 2,400 USD/capita, respectively).

**Results:** The percent of children meeting the WHO guidelines did not parallel GDP. Cameroon had significantly fewer children meeting all four of the solid food FI (p<0.01) than the other countries, yet children in Cameroon were significantly more likely to be fed with meat, vitamin A rich foods, and fruits than children in Egypt (p<0.01). While Philippines had a lower GDP than Egypt and Indonesia, it had a higher percentage of children meeting all four FI's (p<0.01) and mothers completing secondary school or higher education. In terms of food groups overall, more than 80% of the children in all 4 countries received grain-based foods with between 45% and 70% of children having been fed with fruit. Higher maternal education was a significant predictor of meeting the FI specifically for food diversity in Egypt, Indonesia and Cameroon, while working outside the home was a significant predictor of meeting this FI only for women in the Philippines and Indonesia (p<0.01). Overall, a higher family asset index was associated with meeting the FI for food diversity alone among all countries (p<0.01).

**Conclusions:** Among these four countries, maternal educational achievement appears to be a better predictor of general complementary feeding practices than country GDP.

**Keywords:** complementary feeding, WHO guidelines, DHS

ENERGETIC CONTRIBUTION OF ULTRA-PROCESSED PRODUCTS TO THE FOOD LISTFROM DE DIET OF ADULTS IN NORTHEAST OF BRAZIL

(1)de Oliveira Lyra, Clélia; (2)de Lima Motta, Virginia Williane; (3)Vale, Diógo; (4)Pereira Santos, Camila Dayze; (3)Freitas Da Silva Pereira, Ingrid; (2)Garcia Germoglio, Rebecca; (3)De Araujo Cabral, Natalia Louise; (3)Freire Pequeno, Nila Patrícia; (5)Viana Bagni, Ursula; (5)Vieira Cunha Lima, Severina Carla.

(1)PhD Professor. Nutrition Departament. Federal University of Rio Grande do Norte. Brazil; (2)BSc. Post-Graduation Program of Nutrition. Federal University of Rio Grande do Norte. Natal. Brazil; (3)MSc. Post-Graduation Program of Public Health. Federal University of Rio Grande do Norte. Natal. Brazil; (4)BSc. Post-Graduation Program of Public Health. Federal University of Rio Grande do Norte. Natal. Brazil; (5)PhD. Professor. Nutrition Department. Federal University of Rio Grande do Norte. Natal. Brazil.

**Background and objectives:** The ultra-processed products are formulations of industrial sources of dietary energy and nutrients, likefree sugars and salt, saturated fat or trans fats, plus additives including those designed to intensify sensory impact. They typically contain little or even no intact food. Recent studies have shown significant associations between the food consumption of ultra-processed food products with non-communicable diseases (NCDs), in all ages.

The aim of this study was to verify the energetic contribution of ultra-processed food products on a food list in adults, in Northeast of Brazil.

**Methods:** The food list was obtained by food records using data from a nationwide survey, the Pesquisa de Orçamentos Familiares 2008-2009 (POF), in a population sample of Northeast of Brazil in age between 20 and 59 years. Data on pregnant and lactating women have not been included. To construct the list was opted for the methodology of relative percentage of contribution of each food item from Block et al. The foods classifications based on the extent and purpose of their processing, was used the NOVA system of food classification.

**Results:** The list was constituted by 97 foods that contributed up to 90% of the energy consumption. Ultra-processed (n=30) food products contributed together with 11,4% of the energy from the list of food consumed. The food that most contributed to energy was margarine (n = 15;% = 1,23), followed by the crackers (n = 19;% = 1,03%). Were part of the contributions, foods like cookies and stuffed, soft drinks and fast foods.

**Conclusions:** The ultra-processed food products have an important contribution in the energetic consumption of adults in the northeast of Brazil. This results demonstrated the need for public policies aimed at the promotion of healthy eating. For these public policies aimed at the promotion of healthy eatingbe successful, it is important to recognise the conflict of interests between the ultra-processed products food market and public health. To tackle the NCDsit is necessary that there should be a strengthening of the regulatory capacity of the State in the production and marketing of food.

**Keywords:** food list; food processing; noncommunicable diseases;nutrition; feeding behaviour.
(1)Zonis, Luciana Noemi; (2)Indart Rougier, Paula; (2)Favieri, Andrea Lorena; (3)De Gregorio, Maria Jose; (4)Rausch Herscovici, Cecile; (5)Kovalskys, Irina.

(1)BSc. Nutritionist. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Argentina; (2)BSc. Nutritionist. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina; (3)BSc. Sociologist. Department of Anthropological Sciences. University of Buenos Aires. Argentina; (4)PhD. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina; (5)MD. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.

**Background and objectives:** Overweight (OW) at early ages is a vulnerable condition due to the effect of tracking adiposity during infancy and adolescence. The goal of this study was to identify the main determinants in a sample of first grade children attending at public schools in Buenos Aires.

**Methods:** This analysis includes the baseline assessment of the MiniSALTEN Study (obesity prevention program developed in 12 Public Schools in Bs As, Argentina). Data was collected from June to November 2015. All first grade children and their mothers were invited to participate. Data of intake was collected face to face with a 24 h recall for both mother and child, for the last one, the information was completed by the research team, at school. Weight and Height was measured and BMI calculated. Socio demographic information, including socioeconomic level (SEL) was collected. Time of sleep (in hours) was collected during one week. Intake data was analyzed with a software (NDS-R, Nutrition Data System). All analyses were performed with SPSS for Windows. Multivariate logistic regression model was used to find the most predictive variables associated with overweight and obesity. The final models are reported using odds ratios (ORs) and their 95% confidence intervals (CI) and p-value.

**Results:** Final sample was composed by 205 dyads. Children's mean age was 6.68 y. The prevalence of overweight was 26,3 % and obesity 22 %. Significant factors associated with overweight and obesity were Mother's BMI (OR: 1.09, CI 1.03-1.153, p-value: 0.003) and low SEL (OR: 2.279, CI: 1.224-4.242, p-value: 0.009). Were also analyzed energy (OR:1.00, CI: 1.00-1.001, p-value: 0.160), added sugars (OR: 0.983, CI: 0.95-1.018, p-value: 0.345), average daily time of sleep (OR: 1.071, CI: 0.7-1.639, p-value: 0.752), birth weight (OR: 1.183, CI: 0.712-1.965, p-value: 0.517) and exclusive breastfeeding up to 6 months (OR: 1.319, CI:0.730-2.385, p-value:0.359). Non of them shawed association with children's BMI.

**Conclusions:** Argentina is a developing country with one of the highest prevalences of children's overweight in Latin America. Both mother's adiposity and poverty (main determinants) are environmental preventable conditions to tackle obesity at early ages.

**Keywords:** Childhood obesity, Diet, Risk factors, Multivariate analysis.

**Conflict of Interest Disclosure:** The source of funding for the research is the Coca-Cola Foundation. The authors declare that

they have no competing interests. The funding source had no role in study design, data collection and analysis, decision to publish, or preparation of manuscripts.

**Further collaborators:** On behalf of the MiniSALTEN Study Group

(1)Della Líbera, Beatriz; (2)Baião, Mirian; (3)Barros, Denise; (2)Santos, Marta; (4)Araújo, Roberta; (5)Saunders, Cláudia.

(1)PhD. Nutritionist. Curso de graduação em Nutrição. Faculdade Redentor. Brazil.; (2)PhD. Nutritionist. Departamento de Nutrição Social e Aplicada. Universidade Federal do Rio de Janeiro. Brazil.; (3)PhD. Nutritionist. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Brazil.; (4)MSc. Nutritionist. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Brazil.; (5)PhD. Nutritionist. Departamento de Nutrição e Dietética. Universidade Federal do Rio de Janeiro. Brazil.

**Background and objectives:** Maternal morbidity is strongly associated with neonatal mortality. Adequate prenatal care, with early detection and intervention during risk situations, as well as good quality care during labour, are key health indicators related to mother and child, with the potential to further reduce the effects of the main causes of maternal and neonatal mortality. The aim of the study was to assess the impact of a prenatal nutritional care programme on perinatal outcome in the context of primary health care.

**Methods:** That's a non-randomized controlled clinical trial developed in a unit care in Rio de Janeiro, Brazil. 284 pregnant women were allocated into one of two groups: an intervention group (IG; n = 122), comprising pregnant women who received the intervention of nutritional care through collective consultations with a nutritionist, and a control group (CG, n = 162) consisting of pregnant women who did not receive the intervention.

**Results:** There was a higher proportion of pregnancy complications (p=0.000) and abnormal total gestational weight gain (p=0.031) in the CG. In the final model, it was found that belonging to the CG (adjusted OR=4.721; CI 95%=1.009-22.090) and living with four or more people in the household (adjusted OR=2.692; CI 95%=1.021-7.101) were predictors of pregnancy complications, while belonging to the CG (adjusted OR=2.354; CI 95%=1.063-5.213) and starting prenatal care after 16 weeks (adjusted OR =8.509; CI 95%=1.023-70.784) were determinants of abnormal pregnancy weight gain.

**Conclusions:** These findings reinforce that the prenatal nutritional care programme contributed to improving the health of pregnant women.

**Keywords:** Pregnancy. Nutrition programmes. Prenatal nutrition.
# EXPERIENCING A PROPOSAL OF NUTRITIONAL ANTENATAL CARE AMONG PREGNANT WOMEN ATTENDED IN A FAMILY CLINIC IN RIO DE JANEIRO, BRAZIL

**Background and objectives:** Scientific evidence suggests the effectiveness of prenatal and nutritional care on the improvement of perinatal outcomes. The research aimed at analyzing the meanings attributed by mothers to prenatal nutritional care developed in a family clinic in the city of Rio de Janeiro, using Depth Hermeneutics as the methodological framework.

**Methods:** Pregnant women received nutritional care offered in three collective appointments during the prenatal, characterized as “conversation circles” (CC), structured as follows: evaluation of medical records; nutritional assessment; development of educational activities related to health and nutrition; delivery of educational material. Nutritional assessment and medical records provided subsidies for the development of nutritional care developed at CC, in which we applied the nutritional and dietary counselling techniques, taking into account what the woman thinks, how she lives, her daily life, her social representations of “being pregnant” and her eating habits. Participant observations and 15 semi-structured interviews were performed with mothers who participated in the conversation circles (CC).

**Results:** It is possible that pregnant women have realized the CC as a form of emotional support for their concerns, when they could display their behaviours, as well as get information and guidance concerning their new status as pregnant. CC were considered as an opportunity for sharing experiences among pregnant women and professionals, and a significant involvement of both parties in the care production process was observed. It was also recognized as a welcoming environment for enabling dialogue, allowing free expression of doubts, feelings, and expectations, strengthening the bond between the team and the pregnant woman and among pregnant women.

**Conclusions:** The CC represented an important strategy for promoting health in the period of pregnancy, being an environment of humanization, citizenship and social inclusion.

**Keywords:** Pregnancy. Prenatal nutrition. Primary health care. Food and nutrition education. Qualitative research.

# SOCIAL DISPARITIES AND THE NUTRITIONAL STATUS OF CHILDREN UNDER FIVE AND CHILD BEARING WOMEN IN PERU

**Background and objectives:** Social disparities are the root of inequalities in health for both communicable and chronic diseases. Understanding the social determinants of nutritional status in Peru can contribute to promote broader and structural interventions. This work examines associations between socioeconomic status (SES), education and ethnicity with overweight (OW), stunting and anemia in children under 5 y and women of 20-49 y.

**Methods:** We analyzed the Peruvian 2015 National Demographic and Family Health Survey. We used multivariate log-binomial regression model to obtain the prevalence ratio (PR) and assess the independent associations between (SES), education and ethnicity with stunting in children and with overweight and obesity combined (OW) and anemia in both children and women. Low levels of SES, education and non-indigenous were used as reference of prevalence comparison. We used a confidence level of 95%.

**Results:** The prevalence of OW, stunting and anemia in children was 9.1% (8.5-9.8), 14.1% (13.4-14.9) and 32% (31.0-33.0), respectively. Independently and compared with their respective reference, it was found that the prevalence of stunting and anemia was higher in indigenous children [PR=1.35 (1.21-1.50)]; [PR=1.29 (1.2-1.4)], and lower in children with high SES [PR=0.25 (0.21-0.31)]; [RP=0.64 (0.58-0.70)]. Children with high mother education had less prevalence of stunting [PR=0.4 (0.3-0.5)]. For OW only SES was independently associated, its prevalence was higher in high SES children [PR=3.1 (2.5-3.9)]. In women the prevalence of OW and anemia was 65.2% (64.3-66.2) and 21.7 (20.8-22.6) respectively. The prevalence of OW was higher in high SES women [PR=1.27 (1.2-1.3)] and less in indigenous and high educated women [PR=0.64 (0.6-0.7)]; [PR=0.84 (0.8-0.9)]. For anemia, only being indigenous was independently associated; indigenous had more prevalence than non-indigenous [PR=1.18 (1.0-1.3)].

**Conclusions:** Social disparities were associated to the nutritional status of children and women. In general, undernutrition is negatively associated to SES, education and being indigenous, whereas OW is positively associated to SES.

**Keywords:** Social disparities, children and women nutritional status.

<footnote>(1)Della Líbera, Beatriz; (2)Saunders, Cláudia; (3)Barros, Denise;</footnote>

<footnote>(4)Santos, Marta; (5)Araújo, Roberta; (4)Baião, Mirian.</footnote>

<footnote>(1)PhD. Nutritionist. Curso de graduação em Nutrição. Faculdade Redentor. Brazil.; (2)PhD. Nutritionist. Departamento de Nutrição e Dietética. Universidade Federal do Rio de Janeiro. Brazil.;</footnote>

<footnote>(3)PhD. Nutritionist. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Brazil.; (4)PhD. Nutritionist. Departamento de Nutrição Social e Aplicada. Universidade Federal do Rio de Janeiro. Brazil.; (5)MSc. Nutritionist. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Brazil.</footnote>

<footnote>(1)Curi Quinto, Katherine; (2)López de Romaña, Daniel.</footnote>

<footnote>(1)MSc. Nutritionist. National Institute of Public Health. Mexico.;</footnote>

<footnote>(2)PhD. Technical Advisor. Micronutrient Initiative. Canada.</footnote>
PRE-INTERVENTION CHARACTERIZATION OF
NUTRITIONAL STATUS TO ESTIMATE BURDEN
AND POTENTIAL TO BENEFIT AMONG MOTH-
ERS AND THEIR CHILDREN LIVING IN URBAN
SLUMS OF MUMBAI, INDIA

(1)Huey, Samantha; (2)Powis, Laura; (3)Venkatramanan, Sudha;

(4)Udipi, Shobha; (5)Finkelstein, Julia; (6)Ghugre, Padmini; (7)Haas, Jere D.; (8)Mehta, Saur.

(1)BS. Ph.D. Candidate. Division of Nutritional Sciences. Cornell University. USA.; (2)BS. Research Assistant. Division of Nutritional Sciences. Cornell University. USA.; (3)PhD. Postdoctoral Fellow. Division of Nutritional Sciences. Cornell University. USA.; (4)PhD. Professor & Head. Department of Food Science and Nutrition. SNDT Women's University. India.; (5)ScD. Assistant Professor. Division of Nutritional Sciences. Cornell University. USA.; (6)PhD. Associate Professor. Department of Food Science and Nutrition. SNDT Women's University. India.; (7)PhD. Emeritus Professor. Division of Nutritional Sciences. Cornell University. USA.; (8)MBBS. ScD. Associate Professor. Division of Nutritional Sciences. Cornell University. USA.

**Background and objectives:** The efficacy of biofortification, which is a promising strategy to tackle widespread micronutrient malnutrition, has not been demonstrated in the first 1,000 days. We are conducting the first randomized efficacy trial of biofortified iron- and zinc-enriched pearl millet in children under two years of age residing in urban slums of Mumbai, India. The objective of this analysis was to examine the pre-intervention nutritional status (including micronutrient biomarkers, anthropometric measures, and body composition) of mothers and their children in the community to inform the potential to benefit and the design and implementation of this randomized intervention trial.

**Methods:** Children (6-24 months) were recruited from urban slums in Mumbai, India after obtaining informed parental consent. Anthropometric measurements were assessed in children and a subset of mothers, including length/height, weight, body circumferences, and skinfold thicknesses using standardized methods and calibrated instruments. Z-scores for length-for-age (LAZ), weight-for-length (WLZ), and weight-for-age (WAZ) were calculated using the World Health Organization Child Growth Standards. Percent fat mass was calculated using the Slaughter equation. Hemoglobin (Hb), serum ferritin, serum zinc, and C-reactive protein (CRP) concentrations were evaluated in children at baseline.

**Results:** The median age of children was 12.1 (10.0-13.2) months and 48% of participants were female. A total of 29% of children were stunted (LAZ<-2); the prevalence of stunting and underweight (WAZ <-2) was higher in boys compared to girls [36% vs. 21% (p<0.05), and 34% vs. 17% (p<0.05), respectively]. Median fat mass was 15.9% (13.7-18.7). In analyses among mothers, 26% were underweight, 54% were of normal weight, and 20% were overweight or obese, based on standard BMI cutoffs. 51% of mothers were less than 150 centimeters tall. A total of 75% of children were anemic (Hb <110 g/L). Approximately 74% of children

were iron deficient (serum ferritin <15 µg/L), and 54% were zinc deficient (serum zinc <70.0 µg/dL).

**Conclusions:** Findings demonstrate a high burden of malnutrition, particularly iron and zinc deficiency, in children in the urban slums of Mumbai and indicate the suitability of this population as the target for the biofortified crops-based intervention (ClinicalTrials.gov ID: NCT02233764).

**Keywords:** Stunting, iron, biofortification, children, India

**Conflict of Interest Disclosure:** Saurabh Mehta is an unpaid board member for a diagnostic start-up company focused on developing point-of-care assays for nutritional status, informed by his research as a faculty member at Cornell University. All other authors report no conflict of interest.

KNOWLEDGE OF HYDRATION PRACTICES OF
AMATEUR RUNNERS FROM THE CITY OF SÃO
PAULO

(1)Guizellini, Gloria Maria; (2)Perim, Pedro; (3)Barrella, Ana Beatriz;

(3)Rodrigues, Tânia; (4)Rossi, Luciana.

(1)Nutrition Student. Universit Center of São Camilo. Sao Paulo. Brazil; (2)Nutrition Student. University Centre of Sao Camilo. Sao Paulo. Brazil; (3)RG Nutri Nutrition Consulting. Sao Paulo. Brazil; (4)Faculty of Pharmaceutical Sciences. University of Sao Paulo. USP. Sao Paulo. Brazil.

**Background and objectives:** Street racing is a sport of easy execution that has great health benefits. Thermoregulation is a physiological process in modalities that require physical effort as in street races. This process can affect the hydration of the runner, as increased body temperature will result in excessive production of sweat assisting in dehydration.

**Methods:** A total of 18 male (n = 4) and female (n = 14) between the ages of 31 to 53 years old belonging to a race office in the city of São Paulo were evaluated. The methodology used was of the exploratory type, through a descriptive research using a questionnaire composed of 12 objective self-management questions. The study was approved by ethics committee number 97/06.

**Results:** The results indicated that individuals didn't adequately perform hydration procedures, since the most consumed solution was water and they practice more than 90 minutes of physical exercise. It was also found that there is a greater concern of the runners in hydrating only during and after training and competitions, neglecting hydration before exercise. The main symptoms associated with dehydration were: pallor, sensation of loss of strength and headache.

**Conclusions:** It is concluded that individuals have prior knowledge about the importance of hydration. However, they didn't perform correctly, requiring more specific guidelines to reduce the effects of dehydration on the performance and health of runners.

**Keywords:** Hydration; Runners; dehydration; Performance.
# PROMOTING NUTRITION AND HYGIENE FOR ORPHANS AND VULNERABLE CHILDREN IN THROUGHOUT CHILDHOOD IN NIGERIA

(1)Cunningham, Andrew; (2)Granger, Kristina; (3)Mburu-de-wagt, Anne; (4)Rogers, Bridget; (5)Koniz-Booher, Peggy.

(1)MPH. SBCC Project Officer. SPRING Project. JSI. United States.;

(2)MPH. SBCC Manager. SPRING Project. Manoff Group. United States.; (3)PhD. Independent consultant. India.; (4)MPH. Senior Project Officer. SPRING Project. JSI. United States.; (5)MPS. SBCC Team Lead. SPRING Project. JSI. United States.

**Background and objectives:** Out of Nigeria's 69 million children, an estimated 17.5 million are considered orphans and vulnerable children (OVCs), of which 7.3 million are orphaned by HIV/AIDS. Communities often face challenges when trying to feed and care for these children and meet particular needs due to their OVC status. In 2015, The USAID-funded Strengthening Partnerships, Results: **Methods:** SPRING conducted a landscape analysis to identify priority nutrition practices, existing nutrition materials and curricula, and other interventions across Nigeria for the early childhood (2-5), middle childhood (6-11), and adolescent (13-17) age groups. Data were collected via a combination of desk review and surveys conducted with 63 civil society organizations (CSOs) working with OVCs. SPRING used the findings to design a training package with key nutrition information for use by CSOs associated with Kids' Clubs and early child development (ECD) centers. SPRING concept tested selected activities from the package in four communities in the Federal Capital Territory with teachers and children from each age group.

**Results:** The resulting training package builds the nutrition capacity of CSO staff and volunteers working with OVCs. It includes four modules that use highly engaging and participatory activities for all three age groups and colorful graphic training aids to highlight nutrition concepts. In September 2016, SPRING conducted a training of trainers (implementing partners and donors) to build a pool of 26 master trainers. Each of the five OVC partners is now able to cascade the trainings across CSOs and communities in which they work; one partner has already adopted this package for use in northern Nigeria.

**Conclusions:** This package incorporates developmentally appropriate lessons about food and nutrition using language, concepts, and instruction techniques tailored to each age group. In addition to OVC partners in Nigeria who are cascading this curriculum for their communities, Ministry of Education representatives were specifically included in the TOT to facilitate the incorporation of activities from this package into their existing curricula.

**Keywords:** ECD, OVC, training, curriculum, education

# BACK TO BASICS FOR BETTER BREASTFEEDING: FINDINGS FROM THREE REGIONS OF THE WORLD

(1)Galloway, Rae; (2)Assabri, Ali Mohamed; (3)Cooper, Chelsea;

(4)Creed-Kanashiro, Hilary; (5)Picado, Irene.

(1)M.S. Nutritionist. Consultant. USA.; (2)M.D. Department of Community Medicine. University of Sana'a. Sana'a. Republic of Yemen; (3)MPH. Maternal and Child Survival Program.

Washington D.C. USA.; (4)Lead Investigator. Institute of Investigation in Nutrition. Lima. Peru; (5)Nutrition Consultant. Tegucigalpa. Honduras.

**Background and objectives:** Given its benefits, exclusive breastfeeding (EBF) remains low in many countries. Studies in three in countries in Africa, Asia, and the Middle East were conducted to determine coverage of EBF in the first 6 months and the reasons for non-EBF.

**Methods:** In-depth interviews (IDIs) about breastfeeding were conducted with mothers of children<2 years in Lao People's Democratic Republic (PDR) in 2001 (67 mothers), Malawi in 2009 (100 mothers), and in Yemen in 2013-14 (32 mothers). Breastfeeding practices also were observed in homes. IDIs with key informants (KIs) (fathers, grandmothers, health workers) also identified barriers to EBF.

**Results:** In Yemen, only one child<2 years had been exclusively breastfed. In Malawi, nearly half of babies<6 months were exclusively breastfed while in Lao PDR, one-third of babies had been exclusively breastfed until 4-6 months. EBF varied by region and ethnic group only in Lao PDR.

The major reasons for non-EBF, reported by mothers and KIs, was that breastmilk was insufficient or mothers had to return to work. While there was knowledge about the benefits of EBF in all countries, there was less knowledge about (and fewer observations of) optimal breastfeeding practices. The perception about breastmilk insufficiency, triggered by babies crying after breastfeeding or too much, led to the introduction of breastmilk substitutes and/or food. Inadequate practices co-existed with perceptions of insufficiency and included late initiation of breastfeeding; giving pre-lacteal feeds; withholding colostrum; incorrect positioning; breastfeeding for short durations or infrequently; breastfeeding from only one breast per feed; mothers returning to work; and lack of knowledge about how to increase breastmilk production. A few mothers and key informants said the cause of insufficiency was that mothers' diets were inadequate.

**Conclusions:** To successfully breastfeed in the first six months, nutrition programs need to get back to basics and give mothers adequate information about and support and time to breastfeed. Detailed information is needed by mothers and their families about all the practices required to ensure optimal breastfeeding. Agricultural and income-generating programs need to be nutrition-sensitive by giving mothers the time and support to breastfeed.

**Keywords:** breastfeeding, breastmilk, practices, barriers, education
# IDENTIFICATION OF FACTORS ASSOCIATED WITH NUTRITIONAL RISK AND MALNUTRITION FOR USE IN COMPREHENSIVE GERIATRIC ASSESSMENT - CGA BY CORRESPONDENCE ANALYSIS

**Background and objectives:** Background: Comprehensive Geriatric Assessment (CGA) is a tool used to early identify health problems (medical, psychosocial, and functional limitations) of a frail older person. Nutritional screening is an important component of the CGA that can provides an indication of a patient's nutritional risk. Objective: The study aimed to identify the factors associated with nutritional risk and malnutrition, using the Comprehensive Geriatric Assessment.

**Methods:** This is a cross-sectional study with systematic random sample. A total of 233 older adults patients (aged 60 years or older) attending the Rehabilitation Screening of the Center for the Elderly Reference in the north area of São Paulo (CRI-Norte) (Centro de Referência do Idoso da Zona Norte). Initially, Chi-square and Fisher's exact tests were performed to identify variables associated with nutritional risk and malnutrition, treated as a single variable. For these analysis, it was adopted a level of significance of 5%. Multiple Correspondence Analysis (MCA) were used to identify the association between nutritional risk and malnutrition and the co-variables of the study: weight loss, altered appetite, decrease intake, physical difficulty to buy food, self-health assessment and nutritional self-assessment. MCA is a technique used to analyze the pattern of relationships of several categorical dependent variables, aiming to reduce large sets of variables into smaller sets of components that summarize the information contained in the data.

**Results:** Based on the Multiple Correspondence Analysis, nutritional risk and malnutrition were correlated with unintentional weight loss, decrease appetite, decrease food intake, receiving physical help for to buy food, poor and regular self-health assessment, and nutritional self-assessment low-weight.

**Conclusion:** Through the joint relationship between nutritional risk and malnutrition and the identified variables, it is suggested the development and validation of a nutritional screening tool for the early identification of risks. This instrument will be important for the optimization of the time and appropriate referral of the elderly to the nutritional attention essential for the recovery and maintenance of the health and quality of life of this population.

**Keywords:** nutritional risks, aging, malnutrition, nutrition-assessment.

# EPIDEMIOLOGY OF ANEMIA IN CHILDREN, ADOLESCENT GIRLS AND WOMEN OF REPRODUCTIVE AGE IN BHUTAN

**Background and objectives:** In Bhutan, anemia has declined but remains a public health concern. Globally, causes include iron or other micronutrient deficiencies, helminths or genetic disorders. We estimated prevalence and identify risk factors of anemia in children, adolescent girls and women in Bhutan.

**Methods:** In a 2015 national survey, hemoglobin was measured in 1,083 children 6-59 months, 1,103 adolescent girls 10-19 years, 118 gravida and 3,234 non-pregnant women 15-49 years. We calculated anemia prevalence adjusted for altitude and survey design using life-stage-specific cutoffs. Predictors of hemoglobin and anemia were evaluated in unadjusted and survey-adjusted multivariable regression models.

**Results:** Anemia affected 42%, 32%, 36% and 28% in children, adolescents, non-pregnant and pregnant women, respectively. Children 24-59 mo were at lower risk [OR (95% CI): 0.4 (0.3-0.7) than 6-11 mo olds, as were girls [0.7 (0.5-0.9)] versus boys. Stunted and overweight children were at higher risk [1.5 (1.1-2.1) and 3.7 (1.4-9.5), respectively] than normal height/weight children. Child feeding practices were not associated with anemia. Adolescent and adult women's risk was lower in the East [0.7 (0.5-1.0) and 0.7 (0.5-0.8)] than West region. Older adolescents (15-19 yrs) were at higher risk than 10-14 yr olds [1.5 (1.1-2.2)]. A protective odds was observed for adolescents in households consuming animal foods 1-6 versus zero, but also, paradoxically, ≥7 times per week. Among non-pregnant women, risk was higher at 30-39 and 40-49 years [1.2 (1.0-1.6) and 1.4 (1.0-1.8), respectively], versus 20-29 yrs. Primary versus no schooling was protective [0.7 (0.6-0.9)], as was being married [0.4 (0.3-0.6)] versus unmarried and having a child <5 yr [0.8 (0.6-1.0)] versus not. Beginning antenatal care (ANC) in the first trimester may have put pregnant women at lower risk [0.4 (0.1-1.1)]. In survey design-adjusted regressions, point estimates were unchanged but most CIs contained 1.

**Conclusions:** Age, region, socioeconomic status and possibly diet pose diverse risk associations with anemia in Bhutanese children and women. National ANC coverage including IFA supplementation may have reduced anemia among pregnant women.

<footnote>(1)Marques de Sousa, Mariana Izabel; (2)de Aquino, Rita de Cássia;</footnote>

<footnote>(2)Nogueira Previdelli, Agatha; (3)Império de Freitas, Tatiana; (4)de Jesus dos Santos, Amanda.</footnote>

<footnote>(1)MSc. Nutritionist. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil;</footnote>

<footnote>(2)PhD. Professor. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil.; (3)MSc.</footnote>

<footnote>Professor. Universidade Cruzeiro do Sul. São Paulo. Brazil.; (4)MSc Student. Nutritionist. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil.</footnote>

<footnote>(1)Campbell, Rebecca; (2)Aguayo, Victor; (3)Kang, Yunhee; (4)Dzed, Laigden; (5)Joshi, Vandana; (6)Waid, Jillian; (7)Haselow, Nancy; (8)West, Jr., Keith.</footnote>

<footnote>(1)PhD. Postdoctoral Fellow. Johns Hopkins Bloomberg School of Public Health. USA.; (2)PhD. Associate Director. Chief Nutrition Program Division. UNICEF. USA.; (3)PhD. International Health. Johns Hopkins Bloomberg School of Public Health. USA.;</footnote>

<footnote>(4)Ministry of Health. Government of Bhutan. Bhutan.; (5)MBBS. MPH. Chief Health Nutrition and WASH section. UNICEF Bhutan. Bhutan.; (6)Director. Research, Learning, and Evaluation. Helen Keller International. Bangladesh.; (7)Vice President. Asia-Pacific. Helen Keller International. Cambodia.; (8)DrPH. Professor.</footnote>

<footnote>International Health. Johns Hopkins Bloomberg School of Public Health. USA.</footnote>
en; scaling supplementation for other demographic groups may reduce anemia further, though other potential causes (e.g., thalassemias) should also be investigated.

**Keywords:** Anemia, risk factors, Bhutan

(1)Kimani-Murage, Elizabeth; (2)Wanjohi, Milka; (3)Kamande, Eva;

(2)Macharia, Teresa; (4)Muiruri, Juliana; (5)Samburu, Betty; (6)Kiige, Laura;

(7)Musoke, Rachel; (8)Amundson, Kimberly; (9)Israel-Ballard, Kiersten.

(1)PhD. Research Scientist.African Population and Health Research Center. Kenya; (2)BSc. Research Officer. Health Program. African Population and Health Research Center. Kenya.; (3)MSc. Research Officer. Health Program. African Population and Health Research Center. Kenya.; (4)BSc. Human Milk Banks Coordinator. Maternal and Child Health and Nutrition Program. PATH. Kenya.; (5)MSc. Program Manager.Maternal Infant and Young Child Nutrition. Nutrition and Dietetics Unit. Ministry of Health. Kenya.; (6)MSc. Nutrition Specialist. Maternal Infant and Young Child Nutrition and HIV/Aids. UNICEF. Kenya.; (7)PhD. Pediatrician. Departments of Pediatric. University of Nairobi. Nairobi. Kenya.; (8)MSc.Program officer. Maternal and Child Health and Nutrition. PATH. USA.; (9)PhD. Technical Officer. Maternal and Child Health and Nutrition Global program. PATH. USA.

**Background and objectives:** Kenya has a high burden of neonatal deaths (22/1,000 live births). Breastfeeding is among the most effective interventions for reducing infant mortality but some babies lack access to breastmilk due to mother's sickness, unavailability, or death. World Health Organization recommends Donor Human Milk (DHM) as the best alternative, for vulnerable infants without access to mother's own milk (MOM). However, Kenya has not implemented the best practice of providing safe DHM from Human Milk Banks (HMB), for children without access to MOM. This study aims to establish the perceptions and acceptability of donating and using DHM and the perceived barriers and facilitators in establishing HMBs.

**Methods:** The study was conducted in Nairobi.Quantitative interviews were conducted in three health facilities with 980 mothers of children under 3 years. Qualitative interviews included 17 focus group discussions, 29 key informant interviews and 25 in-depth interviews, with mothers, fathers, and other community members, health professionals and policy makers. Descriptive analysis of quantitative data was done in STATA 13 software while qualitative interviews were transcribed verbatim, coded using NVIVO and analyzed thematically.

**Results:** HMBs and use of DHM were new concepts to over 70% of the mothers. Majority of the participants had a positive attitude towards donating breastmilk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM on their own children (56%). The main concerns on donating and use of DHM were personal dislike, fear of diseases including HIV, hygiene concerns and cultural beliefs.Testing DHM for contamination, Sterilizing DHM and the processing equipment, enhancing personal hygiene were recommended to ensure DHM safety. Community education and involvement in the establishment of HMBs, multidisciplinary approach and assurance on the safety and quality of the DHM were proposed as important ways of enhancing the acceptability and successful establishment of the HMBs.

**Conclusions:** The Findings show potential feasibility of establishing HMBs in Kenya, and are useful in HMB's guidelines development and informing future actions towards establishment of HMB in Kenya, as a strategy to promote optimal child health and nutrition.

**Further collaborators**

Gladys Mugambi. MSc. Head of Human Human Nutrition and Dietetics Unit.Ministry of Health. Kenya.

Allan Govoga. BSc. Program Officer. Newborn Child and Adolescent Health Unit. Ministry of Health. Kenya.

Lucy Gathigi.MSc.Monitering and Evaluation Manager.Nutrition and Dietetics Unit.Ministry of Health. Kenya.

Thomas Ngwiri. MD. Head of Clinical Services Program.Gertrude's Children's Hospital. Nairobi.Kenya.

Waithera Mirie. PhD. Lecturer.School of Nursing. University of Nairobi. Kenya.

Paula Griffiths. PhD. Reader in Biosocial Science and Programme Director. Human Biology. Centre for Global Health and Human Development. School of Sport Exercise and Health Sciences. Loughborough University. United Kingdom.

Richard Lilford. PhD. Professor of Public Health. University of Warwick. United Kingdom.

Nyovani Madise.PhD. Associate Dean (Research). Faculty of Social and Human Sciences University of Southampton. United Kingdom.

Stephen McGarvey. PhD. Director. International Health Institute. Brown University. USA.

(1)Sal, Francisco; (2)Salazar Burgos, Ramiro; (3)Lacunza, Betina;

(4)Fernandez, Noelia; (5)Caballero, Valeria; (6)Filgueira, Josefina;

(7)Diaz, Yanina; (8)Ale, Marcelo.

(1)Nutricionist. Saint Tomas of Aquino University of North. Argentina; (2)Nutritionist. Conicet. National University of Tucumán. Argentina.; (3)PhD. Psychology. Conicet. National University of Tucumán. Argentina; (4)Nutritionist. Saint Thomas of Aquino University of North. Argentina; (5)Psychology. National University of Tucumán. Argentina; (6)Nutritionist. Si.Pro.Sa. (Sistema Provincial de Salud). Argentina.; (7)Psychology. Saint Thomas of Aquino University of North. Argentina.

**Background and objectives:** Literature indicates that socioeconomic disparities affect health, due to a reduced presence of physical, ecological and psychosocial protective resources.

The objective was to evaluate the relationship between nutritional status, eating habits and salutogenic environment indicators in rural Tucuman adolescents.
**Methods:** Anthropometric Measurements (Weight, Height, BMI) according to WHO criteria.

Structured questionnaire of Food Habits with descriptive rat-
ing scale of 5 categories (designed for this study).

Structured questionnaire of salugenic environment indicators (presence of tap water, waste collection and presence of sewers). The environment was considered salugenic when the respondent had at least one of these indicators.

Sample: 167 adolescents students of low and medium socioec-
onomic level between 11 and 18 years (57% were women), from
rural schools of the province of Tucumán. It was stratified into 2
subgroups: Clinical group (over weight) and Control group (regu-
lar weight). There is no incidental type probabilistic.

**Results:** The clinical group presented a greater absence of salu-
genic environmental indicators than the control group (24% vs. 21%).

Comparing the clinical and control groups with eating habits, the control group represented a higher consumption in the categories of “always and always” protective foods (fruits, vegetables, dairy products and eggs) and hypercaloric (sweets, ice cream, chocolates). The clinical group had a lower consumption of protective foods.

Relating eating habits and indicators of the salugenic environ-
ment, it was found that in the categories “never and almost never”
the consumption of healthy foods (beef, fish, eggs, fruits, vegeta-
bles and dairy products) the percentages were higher in people
who did not present Indicators of salugenic environment than in
their peers who responded to have at least one indicator (Fish 39%
vs. 29%, vegetables 31% vs. 11% and milk 54% vs. 28%).

Regarding the consumption of hypercaloric foods (sweets, ice cream, chocolates and soft drinks), a greater proportion of “always / almost always” responses were observed among adolescents with not salugenic environment indicators in this food group (81 Vs. 45%, 50% vs. 28%, 61% vs. 35%).

**Conclusions:** Rural adolescents belonging to less salugenic en-
vironments reported higher consumption of hypercaloric foods.
These data are relevant for the design of interdisciplinary intervention
strategies focused on food and surrounding ecological contexts.

**Keywords:** Nutritional status, eating habits indicators of salu-
genic environment

(1)Bedford, Juliet; (2)Johnson, Ginger; (3)Jones, Theresa; (4)Gercama, Ingrid; (5)Vandyke, Hanneke; (6)Halati, Siti; (7)Aburmishan, Dina; (8)Oliva, Maritza; (9)Bose, Indira; (10)Kiess, Lynnda.

(1)DPhil. Anthropologist. Anthrologica. UK.; (2)PhD. Anthropologist. Anthrologica. USA.; (3)ClinicPsyD. Anthrologica. Kenya.; (4)MSc. Anthropologist. Sierra Leone.; (5)MS MALD. Nutritionist. Nutrition Unit. World Food Programme. Cambodia.; (6)MPH. Nutritionist. Programme Unit. World Food Programme. Uganda.; (7)MPH. Nutritionist. Analysis Trends and Innovation Unit. World Food Programme. Kenya.; (8)MPH. Nutritionist. World Food Programme. Guatemala.; (9)MPH. Office of Nutrition. World Good Programme. Italy.; (10)MPH. Office of Nutrition. World Good Programme. USA.

**Background and objectives:** Addressing the nutritional needs of adolescent girls is a key step towards achieving SDG 2, Target 2.2, ending malnutrition by 2030. This formative study provides a landscape analysis of adolescent programming in four high priority countries (Kenya, Uganda, Cambodia and Guatemala) and presents new empirical data on perceptions and experiences of adolescents regarding nutrition and engagement platforms particularly aimed at reaching the most vulnerable.

**Methods:** The collaborative study was conducted in three phases. First, a country landscape analysis of adolescent programming categorized the focus, timeframe and location of interventions, target group (age, ethnicity, gender), modes of engagement, and key programme implementer(s). Second, formative qualitative research using participatory creative methodologies elicited perspectives, experiences and suggestions from adolescents and their communities. Third, data was synthesized to provide evidence to improve the design of nutrition-specific and nutrition-sensitive interventions for adolescents across different contexts. Adolescents participated from a range of communities including food insecure pastoralists, rural agriculturalists, settled refugees, remote ethnic minorities, and urban and slum communities.

**Results:** Final results will be available by June. Initial stakehold-
er mapping indicated a wide range of government, non-governmen-
tal and private sector engagement with adolescents, with different
policy and operational environments influencing the focus of inter-
ventions and modes of engagement. Preliminary analysis highlight-
ed that the concept of 'adolescence' is varied, that nutrition is one
of several key areas of intervention alongside education, sexual re-
productive health, gender-based violence and employment oppor-
tunities. Thematic synthesis across the four countries will identify
points of convergence and divergence in engaging with adolescents
in different contexts and operational environments.

**Conclusions:** Increasing the visibility, priority and engage-
ment of adolescents is critical. Evidence can be operationalized
to develop adolescent friendly, context specific interventions and
appropriate modes of engagement that can positively influence
health- and nutrition-related behavior, and encourage the timely
utilization of services by adolescents.
**Keywords:** Adolescents
Girls
Formative research
Qualitative
Participatory

Gloria Aguilar
Ximena Rose Marie Zayas Cáceres
Lourdes Maria Regina Elizeche Serra
Eliana Araceli Cantero Grissetti
Tamara Elizabeth Vidal Britos
Andrea Patricia Reyes García

144/1936

VALUATION OF NUTRITIONAL STATUS BY AN-
THROPOMETRIC METHODS AND BIOELECTRIC
IMPEDANCE IN SCHOOLCHILDREN'S AND AD-
OLESCENTS OF PUBLIC AND PRIVATE SCHOOLS
IN THE CENTRAL DEPARTMENT

(1)Torres Giménez, María Elida; (2)Sanabria, Marta; (3)Meza Miranda, Eliana.

(1)Nutritionist. Paraguay.; (2)MSc. Doctor. Cathedra and Pediatric service. Faculty of Medical Sciences. National University of Asuncion. Paraguay; (3)PhD. Nutritionist. Teaching researcher. Multidisciplinary Center for Technological Research. National University of Asuncion. Paraguay.

**Background and objectives:** The nutritional status allows to focus groups of risk that present deficiencies and excesses. Child malnutrition is a public health problem in Paraguay. There are few national publications on body composition therefore a descriptive observational research with analytical component was designed to determine the nutritional status and body composition in schoolchildren and adolescents attending Public and Private Educational Institutions of the Central Department.

**Methods:** A Sampling probabilistic, stratified, random study was conducted on 494 school children and adolescents between 6 to 17 years old attended public and private educational institutions in the Central Department during 2016. Anthropometric indicators were evaluated according to the current WHO growth curves.

**Results:** 50% of the sample was male. It was found 22.3% of Overweight malnutrition and 13.2% of overweight and obesity, 88% of normal height. There is a positive correlation between BMI and waist circumference (WC). As for the muscular area of the arm, 21% of the female population is with low protein reserve, 60% with normal protein reserve and 19% with high protein reserve. On the other hand, in the men, 32.4% had low protein reserves, 44.1% had normal protein reserves and 23.5% had high protein reserves. In reference to the women fat area, 90.6% showed a normal energy reserve, while 9% showed a high energy reserve. As for males, 74.5% showed a normal energy reserve and 25.1% high energy reserve.

**Conclusions:** Overweigh malnutrition is high among school-
children in the Central Department. The percentage of fat mass
measured by impedanciometry does not exceed the limit that is
25% for men and 30% for women. There is a positive correlation
between BMI and WC.

**Keywords:** nutritional Valuation, body composition,
schoolschildren's, adolescents, malnutrition.

**Further collaborators**

Viviana Raquel Salomon de Torres

144/1938

DIETARY INTAKE AND BIOCHEMICAL PARAM-
ETERS RELATED TO BONE HEALTH IN WOMEN
OVER 65 YEARS OLD IN THE BUENOS AIRES
CITY, ARGENTINA

(1)Brito, Graciela Mabel; (2)Somoza, Julia; (3)Oliveri, Beatriz; (4)López, Laura Beatriz.

(1)BSc. Nutritionist. Escuela de Nutrición. Universidad de Buenos Aires. Argentina. Laboratorio de Enfermedades Metabólicas Óseas. Instituto de Inmunología Genética y Metabolismo (INIGEM) CONICET-UBA. Argentina.; (2)Laboratory Technician. Laboratorio de Enfermedades Metabólicas Óseas. Instituto de Inmunología Genética y Metabolismo (INIGEM) CONICET-UBA. Argentina.; (3)PhD. Medicine. Laboratorio de Enfermedades Metabólicas Óseas. Instituto de Inmunología Genética y Metabolismo (INIGEM) CONICET-UBA. Argentina.; (4)PhD. Nutritionist. Escuela de Nutrición. Universidad de Buenos Aires. Argentina.

**Background and objectives:** Both nutritional status and bone health influence elderly's health and quality of life. The aim of this study was to evaluate: the relationship between the nutritional status of vitamin D (VD) and biochemical markers of bone turnover; the relationship between the intake of Calcium (Ca), protein, VD and vitamin K (VK) and bone formation and resorption markers; the relationship between total osteocalcin (OC) and undercarboxylated osteocalcin (uOC) to VK intake and bone remodeling parameters.

**Methods:** 102 healthy women were evaluated, with age: (X±SD) 71±5 years, BMI 28.7±3.8 kg/m2. A validated food frequency questionnaire was used to asses' dietary intake. Serum 25 hydroxyvitamin D (25OHD), crossslaps (sCTX), bone alkaline phosphatase (BAP), calcium (sCas), phosphorus (sP), OC y unOC were determined in blood samples and calcium/creatinine ratio (uCa/uCr) in 24-hour urine samples.

Data were analyzed applying descriptive statistics, Kolmogorov-Smirnov, Mann-Whitney and Pearson or Spearman correlation. Linear regression models were used to analyze the relationship between numerical variables.

**Results:** Calcium, VK and VD intakes were lower than the rec-
ommended doses 79%, 33.7% and 100% of population respectively.
Median protein intake was 1.03 g/kg body weight/d, with 100% re-
porting intakes higher than the recommended. Vitamin D insuffi-
ciency affected 32.7% of women and deficiency 55.9%, higher levels
of sCTX were observed in those women with lower 25OHD levels.
There were significant (p<0.02) correlations between 25OHD and
sCa, sP, uCa/uCr and Ca intake. OC correlated directly with the
bone resorption marker: sCTX (p<0.0001), but not with the for-
mation parameters. In contrast, the unOC showed an inverse cor-
relation with BAP, no correlation with sCTX and was related with VK intake (p<0.0001). OC levels were lower in the deficiency and insufficient VD groups and were related to sCTX levels (p<0.0001).

**Conclusions:** The intake pattern was high in protein, and deficient in calcium, VD and VK. Poor vitamin D status affected 93% of women, with an increase in bone remodeling observed in severe deficiency. The ucOC was related to VK intake, so it could be considered an adequate indicator of its nutritional status, while OC and its relation to sCTX would reflect the increase in bone remodeling.

**Keywords:** Elderly, bone health, intake, nutritional status

144/1957

A BABY FRIENDLY COMMUNITY INITIATIVE IN KENYA: HARNESSING THE POTENTIAL OF THE COMMUNITY HEALTH STRATEGY IN ENHANCING MATERNAL AND CHILD NUTRITIONAL AND HEALTH STATUS IN RURAL KENYA

(1)Gatheru, Peter; (2)Kimani-Murage, Elizabeth; (3)Kimiywe, Judith;

(4)Wekesah, Frederick; (5)Muhia, Nelson; (6)Wanjohi, Milka; (7)Samburu, Betty.

(1)BA. Research Officer. Health Challenges and Systems. African Population and Health Research Center. Kenya.; (2)PhD. Research Scientist. Health Program. African Population and Health Research Center. Kenya.; (3)PhD. Nutrition. Assistant Professor. Department of Food, Nutrition and Dietetics. Kenyatta University. Kenya.; (4)MSc. Epidemiologist. Health Challenges and Systems Program. African Population & Health Research Center. Kenya.; (5)BA. Economist. Health Challenges and Systems Program. African Population & Health Research Center. Kenya.; (6)BSc. Research Officer. Health Challenges and Systems Program. African Population and Health Research Center. Kenya.; (7)MSc. Program Manager. Maternal Infant and Young Child Nutrition. Nutrition and Dietetics Unit. Ministry of Health. Kenya.

**Background and objectives:** Background:The Baby Friendly Community Initiative (BFCI) is a multifaceted program for the promotion of optimal breastfeeding and maternal, infant and young child nutrition practices in the community. BFCI extends the care provided at the health facility through the Baby Friendly Hospital Initiative (BFHI) to the community, while providing the mothers and their babies a comprehensive support system to improve breastfeeding practices and other maternal, infant and young child nutrition practices at the community level thereby bridging the gap between health facilities and the community.

**Objectives:** We present the design and implementation of the BFCI in rural Kenya, while highlighting its contribution to the improvement of maternal and child nutritional and health status. BFCI leverages on the community health strategy, a program established by the government of Kenya in 2007, and one that uses the vast network of community health volunteers to promote health care at the community level.

**Methods:** The BFCI is implemented within the community health strategy. The community units, which includes the com-

munity health volunteers (CHVs) and the community health committees (CHC) are sensitized on appropriate and optimal maternal, infant and young child nutrition practices. The CHVs are empowered and facilitated by knowledge and materials to provide home based counselling to pregnant women and breastfeeding mothers on maternal, infant and young child nutrition practices.

**Results:** The BFCI program in the rural community in Koibatek sub County, Baringo County engages about 260 CHVs, in 13 community units. From August 2015 to December 2016, CHVs have been actively involved in home visits and counselling of pregnant and breastfeeding women and their families in the community. BFCI also includes introduction of sustainable income generating activities, formation of community mother support groups which includes men and other community members as they influence feeding practices at household level.

**Conclusions:** Ultimately, we hope that the BFCI will: (i) strengthen the capacity for CHVs and the community members regarding MIYCN at community level; (ii) improve nutrition, health and survival of children substantially; and (iii) inform the design and implementation of ongoing and future interventions while advancing knowledge among the research community locally and internationally.

**Keywords:** Baby Friendly Community Initiative, breastfeeding

**Further collaborators:** Koibatek Sub County Health Management Team

144/1960

RELATIONSHIP BETWEEN CHOLINE METABOLITES AND DEVELOPMENTAL OUTCOMES IN HEALTHY TODDLERS AT 24 MONTHS-OF-AGE

(1)Wiedeman, Alejandra Wiedeman; (2)Chau, Cecil; (3)Grunau, Ruth;

(4)McCarthy, Deanna; (5)Yurko-Mauro, Karin; (3)Innis, Sheila; (3)Devlin, Angela M.

(1)PhD candidate. Department of Pediatrics. University of British Columbia and BC Children's Hospital Research Institute. Vancouver. Canada.; (2)MSc. Department of Pediatrics. University of British Columbia and BC Children's Hospital Research Institute. Vancouver. Canada.; (3)PhD. Department of Pediatrics. University of British Columbia and BC Children's Hospital Research Institute. Vancouver. Canada.; (4)RD. DSM Nutritional Products. Columbia. MD. USA.; (5)PhD. DSM Nutritional Products. Columbia. MD. USA.

**Background and objectives:** Choline is an essential nutrient that plays an important role in growth and development and is the precursor of acetylcholine, phosphatidylcholine, and the methyl donor betaine. There is limited data on choline status of infants and toddlers and the potential relationship to neurodevelopmental outcomes. The objective of this study was to assess choline status in healthy toddlers at 12 and 24 months-of-age and to determine relationships to neurodevelopment.

**Methods:** Participants were part of a prospective longitudinal double blind controlled study of arachidonic acid (ARA) and docosahexaenoic acid (DHA) supplementation of toddlers between 12 and 24 months-of-age (24 months). Plasma free cho-
line, betaine, and dimethylglycine concentrations were quantified by liquid chromatography tandem mass spectrometry at baseline (13.4±0.9 months-of-age; mean±SD) and 24 months; developmental outcomes were assessed by the Bayley Scales of Infant and Toddler Development 3rd Ed (Bayley-III) Cognitive and Language composites, and Beery-Buktenica Developmental Test of Visual-Motor Integration (5th Edition) (Beery) at 24 months. Relationships between choline metabolites and developmental outcomes at 24 months were determined by separate general linear models adjusted for sex, supplement group, maternal nonverbal intelligence (TONI-3), and baseline concentrations.

**Results:** At baseline (n=122) plasma free choline, betaine, and dimethylglycine concentrations [median (IQR)] were 9.8 (8.1-12.3), 36.2 (30.8-47.7), and 3.7 (2.9-2.8) µmol/L, respectively. Plasma free choline, betaine, and dimethylglycine concentrations at 24 months (n=103) were 8.1 (6.9-9.5), 37.5 (31.2-45.0), and 2.9 (2.3-3.6) µmol/L, respectively. The DHA/ARA supplement had no effect on plasma choline metabolites at 24 months but plasma free choline and dimethylglycine concentrations were lower (P<0.001) at 24 months compared to baseline. Plasma betaine concentrations were positively associated with Bayley III Language composite scores (B=59.4, P=0.002) at 24 months but no relationships were found with the Bayley III Cognitive or Beery scores. No associations between plasma free choline or dimethylglycine and neurodevelopment tests were observed.

**Conclusions:** This finding suggests a positive relationship between plasma betaine concentrations and language development in healthy toddlers at 24 months-of-age. Additional work is required to investigate this relationship further and to delineate choline metabolism in toddlers and its role in neurodevelopment.

**Keywords:** Choline, betaine, development, toddlers, long chain polyunsaturated fatty acids

obesity, as dietary patterns and eating habits are often formed in childhood, and persist through adolescence into adulthood. Parents can be seen as 'agents of change' in the recognition and treatment of childhood obesity. However, they usually fail to recognize their child excessive weight. The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated to underestimation.

**Methods:** Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of two-to-eight-year-old children (n=976) completed a self-reported questionnaire about their perception of child weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, we estimated the Kappa coefficient, and to investigate associations between parental underestimation and independent variables, we calculated chi-square tests, followed by multiple logistic regression model, considering p≤0.05 for statistical significance.

**Results:** Overall, 48.05% of the parents incorrectly classified their child's weight; more particularly, 45.08% underestimated their child's weight status. Logistic regression demonstrated that children with higher body mass index (OR=2.03; p<0.001) and boys (OR=1.70; p<0.001) were more likely to have their weight status underestimated by parents. The poor agreement of parent's perception and child's weight status was also confirmed by the Kappa coefficient (0.038).

**Conclusions:** Clinical practitioners should focus their interventions on these children to assist parents to correctly evaluate their child weight status. The awareness of parents about a weight problem in children is essential towards the prevention and treatment of childhood obesity, and healthy lifestyles.

**Keywords:** Weight perception; pediatric obesity; parent-child relations; overweight; child.

## FACTORS ASSOCIATED WITH PARENT'S UNDERESTIMATION OF CHILD'S WEIGHT STATUS: A STUDY IN BRAZIL

(1)Amaral Mais, Laís; (2)Warkentin, Sarah; (3)Dias de Oliveira Latorre, Maria do Rosário; (4)Carnell, Susan; (5)de Aguiar Carrazono Taddei, José Augusto.

(1)MSc. Nutritionist. Discipline of Nutrology. Department of Pediatrics. Federal University of São Paulo. Brazil; (2)MSc. Nutritionist. Discipline of Nutrology. Department of Pediatrics. Federal University of São Paulo. Brazil.; (3)PhD. Statistician. School of Public Health. Department of Epidemiology. University of São Paulo. Brazil.; (4)PhD. Psychologist. Division of Child & Adolescent Psychiatry. Department of Psychiatry and Behavioral Sciences. Johns Hopkins University School of Medicine. United States of America.; (5)PhD. Epidemiologist. Discipline of Nutrology. Federal University of São Paulo (UNIFESP). Department of Pediatrics. Brazil.

**Background and objectives:** Childhood overweight is a recognized public health problem, including in Brazil. Early intervention is critical in the prevention and treatment of overweight and

## STRENGTHENING OF THE ESSENTIAL NUTRITION ACTIONS (ENA), AT THE PRIMARY LEVEL HEALTH SERVICES ON 30 MUNICIPALITIES OF THE WESTERN HIGHLANDS FROM GUATEMALA

(1)Alfaro, Norma; (2)Corado, Ana; (3)Arroyo, Gustavo; (3)Perez, Wilton.

(1)MSc. Department of Development of Human Resources. Institute of Nutrition of Central America and Panama. Guatemala.;

(2)Nutritionist. Department of Development of Human Resources. Institute of Nutrition of Central America and Panama. Guatemala;

(3)PhD. Department of Monitoring and Evaluation. Institute of Nutrition of Central America and Panama. Guatemala.

**Background and objectives:** Guatemala is ranked as the sixth country worldwide and the first in Latin America with the highest prevalence of stunting in children less than five years old. Data shows a national prevalence of 46.5% in 2014-2015, mostly focused on the population located at the western highlands of the country. In order to contribute to the Government's efforts to battle this
problem a project based on interventions to address mother-child
health and nutrition during the first 1,000-day window of oppor-
tunity, which efficacy has been widely recognized, and also based
on the Normative Framework of the Ministry of Health (MOH)
for the primary level of attention was promoted. This study aims to
strengthen the capabilities of the primary level health workers at 30
municipalities of the western highlands from Guatemala, to provide
nutrition actions to reduce stunting in Guatemala.

**Methods:** A project based on the analysis of needs and conditions of the environment was generated, which started with the collaborative work among the international cooperation, INCAP and the MOH on its different levels of organization and implementation, afterwards the curricula of the program supported by the MOH and the methodology of implementation were designed, including the training addressed to trainers. The topics included were: nutrition of the pregnant woman, breastfeeding, complementary feeding and feeding of a sick child, water, hygiene and sanitation, growth monitoring and promotion and effective counseling. The topic of self-esteem was included in order to promote the appreciation of the human resource as an agent of change. A process of monitoring and evaluation was applied.

**Results:** The model was carried out in two cohorts, which trained 97 trainers, 1,163 health workers. An 18% of increase on knowledge acquired was reached. Educational printed and multimedia materials were created. The collaborative work at all levels, favored the positioning of the topic related to the first 1,000-day window of opportunity at the MOH and the transference of the program.

**Conclusions:** The feasibility, realignment and interinstitutional coordination were essential for the achievement of results and will be key for sustainability.

**Keywords:** Forming and training, stunting, 1,000-day window of opportunity, essential nutrition actions.

erature. While accurately assessing adiposity can be expensive and invasive, waist circumference (WC) adjusted for total body weight is a cost-effective and useful maker of body fat distribution. The aim of this study was to determine the association between height trajectories during the preschool years and WC in late childhood.

**Methods:** Study participants were a sub-sample that participated in the 8-10 y follow-up of the POSGRAD study, a double-blind, randomized, placebo-controlled trial of prenatal DHA supplementation. Sex-specific height latent class trajectories were derived from 11 measures of height from birth to 5 years of age. MPlus version 7.3 was used in the derivation of trajectories using latent class growth analysis. At ages 8-10, WC (to the nearest 1 mm) was measured at the smallest horizontal circumference between the costal margin and the iliac crests. Multivariable linear regression models were used to determine the relationship between growth trajectory classes and WC in late childhood. Covariates included in the analysis were current body weight (kg), SES (low, medium and high), parity and maternal schooling. Regression analyses were conducted using STATA 14.

**Results:** We included 281 boys and 255 girls. Two height classes were determined for girls [low (58%), high (42%)] and three for boys [low (17%), medium (51%) and high (32%)]. In boys, relative to the intermediate growth class, the high trajectory class had lower waist circumference in late childhood $\beta$ = -1.15 cm 95% CI (-2.27 - -0.03) after controlling for covariates, while no significant associations were found the low trajectory class. For girls, the high class had lower waist circumference relative to the low class, $\beta$= -1.06 cm, 95%CI (-1.93 - -0.20).

**Conclusions:** In this study, children who followed the higher growth trajectory through 5 years of age, had lower waist circumference in late childhood. This suggests that children with shorter stature during the first 5 years of life are at a higher risk of becoming overweight or obese.

**Keywords:** child nutrition, latent class growth analysis, height, waist circumference, BIA, Anthropometry

**Further collaborators**

Supported by NIH grants HD-043099, HD-058818 and Grant Sectorial CONACYT 202062

144/1982

HEIGHT TRAJECTORIES AND WAIST CIRCUMFERENCE IN LATE CHILDHOOD OF MEXICAN CHILDREN

**Background and objectives:** The relationship between fast early growth and adiposity has been of particular interest in the lit-

<footnote>(1)Barrios, Pamela L.; (2)Rivera, Juan; (3)Garcia-Feregrino, Raquel;</footnote>

<footnote>(4)Barraza-Villarreal, Albino; (4)Romieu, Isabelle; (5)Gonzalez-Casanova, Ines; (5)Stein, Aryeh,; (5)Ramakrishnan, Usha; (6)Hoffman, Daniel J.</footnote>

<footnote>(1)MSc. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.; (2)PhD. Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (3)MSc. Health and Nutrition Research Center. National Institute of Public Health. Mexico.;</footnote>

<footnote>(4)Population Health Research Center. National Institute of Public Health. Mexico.; (5)PhD. Hubert Department of Global Health. Rollins School of Public Health. Emory University. United States.;</footnote>

<footnote>(6)PhD. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.</footnote>
# EFFECTS OF TWO FORMS OF DAILY PREVENTIVE ZINC AND THERAPEUTIC ZINC SUPPLEMENTATION FOR DIARRHEA ON GROWTH AND ACQUISITION OF DEVELOPMENTAL MILESTONES IN RURAL LAOTIAN CHILDREN: A RANDOMIZED TRIAL

(¹)Barffour, Maxwell A; (²)Hinnouho, Guy-Marino; (³)Kounnavong, Sengchanh; (⁴)Wessells, K. Ryan; (³)Ratsavong, Kethmany;

(³)Bounheuang, Bangone; (³)Chanhthavong, Bigphone; (⁴)Arnold, Charles D.; (⁵)Brown, Ken; (¹)Hess, Sonja.

(¹)PhD. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA;

(²)MD-PhD. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA;

(³)MD. National Institute of Public Health. Vientiane. Lao People's Democratic Republic (PDR); (⁴)M.S. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA; (⁵)MD. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA and Bill & Melinda Gates Foundation. Seattle. WA. USA.

**Background and objectives:** Evidence is needed on the optimal strategy for delivering zinc to improve growth and other zinc-related functional health outcomes in children. In this double-blind, placebo-controlled, randomized trial, we determined the impact of providing daily preventive zinc tablets (7 mg/d), daily multiple micronutrient powder sachets (containing 10 mg zinc, 6 mg iron and 13 other micronutrients), therapeutic zinc supplements for diarrhea treatment (20 mg/d for 10 days) or daily placebo powder, on growth and acquisition of motor and language developmental milestones in young children in rural Lao PDR.

**Methods:** 3433 children 6-23 months old at enrollment were randomized to one of four intervention groups and followed weekly for ~9 months. Weight and length were assessed at baseline and endline, 32-40 weeks later. Motor milestones (crawling, sitting without support, standing with assistance, standing alone, walking with assistance, walking alone, running, eating, drinking and waving) and language acquisition were assessed weekly by caregiver report and monthly by observation. We compared final height-for-age, weight-for-age, and weight-for-height z-scores, and stunting, underweight and wasting prevalence, and age of acquisition of developmental milestones among the 4 groups using linear or logistic regression (anthropometric outcomes) and cox proportional hazard models (milestone acquisition), controlling for age and baseline values. Intervention groups are still masked.

**Results:** Groups were comparable regarding age, anthropometric scores and attained milestones at baseline. Mean age at baseline was 14.2 ± 5.1 mo; and there was a high prevalence of stunting (37.9%), underweight (26.0%) and wasting (7.9%). We observed a marginally significant treatment effect on the prevalence of final stunting (34.8-41.2% across the groups), wasting (3.8-6.6%) and underweight (22.3-24.9%). There were no between-group differences in final anthropometric indices. We observed a significant treatment effect on reported or observed onset of crawling, sitting without support, standing with assistance, standing alone and walking with assistance but not on other milestones.

**Conclusions:** Endline stunting, wasting and underweight were marginally different and onset of crawling, sitting without support, standing with assistance, standing alone, and walking with assistance differed significantly by treatment group after ~9 months of supplementation. Specific pairwise differences will be identified when codes are revealed.

**Keywords:** Zinc supplementation strategy, growth, developmental milestones

**Conflict of Interest Disclosure:** KHB works for the Bill & Melinda Gates Foundation, which provided part of the financial support. The spouse of SYH works for the Bill & Melinda Gates Foundation. KRW and SYH received non-monetary support from Nutriset SAS. None of the other authors have a conflict of interest to declare.

**Further collaborators** : Dalaphone Sitthideth (MD. National Institute of Public Health, Vientiane, Lao People's Democratic Republic (PDR))

(Khanpaseuth Sengnam) MD. National Institute of Public Health, Vientiane, Lao People's Democratic Republic (PDR)

# TIMELY COUNSELLING AS A STRATEGY TO IMROVE AGE APPROPRIATE INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES AMONG MOTHERS FROM URBAN SLUMS OF VADODARA

(¹)Chandorkar, Suneeta; (²)Patil, Priyanka.

(¹)PhD. Nutritionist. Department of Foods and Nutrition. The Maharaja Sayjirao University of Baroda. Vadodara; (²)MSc. Department of Foods and Nutrition. The Maharaja Sayjirao University of Baroda. Vadodara.

**Background and objectives:** Good nutrition during first 1000 days of life can give a good head start to a child to achieve his/ her physical and cognitive potential. Therefore, the present study aimed at capacity building of health functionaries to improve Infant and Young Child Feeding (IYCF) practices among mothers of urban slums of Vadodara.

**Methods:** Counselling regarding age appropriate IYCF practices was provided to pregnant women in last trimester and lactating mothers (N=57) by Anganwadi Workers (AWWs; service provider under ICDS government nutrition health program), doctors and nurses for 3 months once every month. The pregnant women formed the intervention group 1, younger lactating women (4-6 months) formed the intervention group 2 and older lactating women (7-9 months) formed the intervention group 3. Perceptions and practices of mothers were assessed at baseline and post intervention.

**Results:** Sixty five percent of the mothers in intervention group 1 initiated breastfeeding within 1 hour after birth and 96% fed colostrum to the child. Intervention group 2- Exclusive breastfeeding practices were good and majority of the mothers knew about correct age of introduction of complementary foods but percep-
tions regarding quality, quantity and frequency of feeding comple-
mentary foods were poor. Post intervention 85% of the mothers
fed solid, semi solid or mushy foods along with breast milk. Inter-
vention group 3- The rates of feeding appropriate quality, quantity
and frequency of complementary foods were average at baseline in
children 7-9 months. Forty three percent of the mothers fed 3 or
more food groups at baseline while the same increased to 86% at
the end of intervention. Forty three percent of the mothers started
feeding adequate quantity of food after intervention. Knowledge
and attendance of mothers at mamta day and annaprashan day
(nutrition days celebrated under ICDS) were poor at baseline and
marginal improvement was observed after intervention.

**Conclusions:** Counselling by AWWs and doctors was found to bring about improvement in age appropriate IYCF practices in intervention group 2 and 3. Timely counselling on age appropriate feeding practices can bring about significant improvement in adoption of age appropriate IYCF practices.

**Keywords:** 1000 days, age appropriate IYCF practices, complementary feeding

144/1997

EFFECT OF MULTIPLE MICRONUTRIENT SUP-
PLEMENTATION IN LACTATING WOMEN ON
INFANT GROWTH AND MORBIDITY: A DOU-
BLE-BLIND RANDOMIZED CONTROLLED TRIAL
IN RURAL BURKINA FASO

(1)Bouckaert, Kimberley; (2)Lanou, Hermann Bienou; (3)Roberfroid, Dominique; (1)Kolsteren, Patrick; (4)Kouanda, Seni; (5)Huybregts, Lieven.

(1)PhD. Department of Food Safety and Food Quality. Ghent University. Belgium.; (2)MD. Département Biomédical et Santé Publique. Institut de Recherche en Sciences de la Santé. Burkina Faso.; (3)PhD. Belgian Health Care Knowledge Centre. Belgium.; (4)PhD. Département Biomédical et Santé Publique. Institut de Recherche en Sciences de la Santé. Burkina Faso.; (5)PhD. Poverty, Health and Nutrition Division. International Food Policy Research Institute. USA.

**Background and objectives:** Micronutrient deficiencies contribute to the vicious cycle of growth restriction in low and middle-income countries. Lactating women and their infants are at risk of inadequate intakes and deficiencies in multiple micronutrients due to the imbalance between their high requirements and a typical low intake of micronutrient-dense foods. Infants born small-for-gestational age (SGA) or preterm may be particularly vulnerable. However, there currently is no evidence on the effect of multiple micronutrient supplementation in lactating women on infant growth and morbidity. The objective of this study is to test the efficacy of supplementation with the UNICEF/WHO/UNU International Multiple Micronutrient Preparation (UNIMMAP) compared to iron and folic acid (IFA) on growth and morbidity of infants, and particularly those born SGA or preterm.

**Methods:** In a randomized controlled trial in rural Burkina Faso, 1426 pregnancies were allocated to daily supplementation

with either UNIMMAP (intervention) or IFA (control) for three
months after delivery. In total, 1296 mothers with live births were
enrolled in the study. Daily tablet intake was directly observed by
trained community workers. Anthropometry, morbidity and he-
moglobin concentration of infants were measured monthly until
the first birthday.

**Results:** Infant linear growth and relative weight gain re-
mained suboptimal despite supplementation of lactating moth-
ers. The linear growth rate of infants in the UNIMMAP group
increased compared to IFA (Beta coef = 0.0117 length-for-age
Z-score/month; 95% CI: -0.0022 - 0.0256; P interaction = 0.099).
Infants who were born SGA had significantly higher linear growth
rates (Beta coef = 0.0217 length-for-age Z-score/month; 95% CI:
-0.0012 - 0.0447; P interaction = 0.063), but did not show signif-
icant reductions in stunting. Preterm infants had increased he-
moglobin concentration rates (Beta coef = 0.1569 g/dL/month;
95% CI: - 0.0208 - 0.3346; P interaction = 0.084). Infants in the
UNIMMAP group had a reduced relative weight gain rate (Beta
coef = -0.0179 weigth-for-length Z-score/month; 95% CI: -0.0355
- 0.0002; P interaction = 0.047).

**Conclusions:** Supplementing UNIMMAP instead of IFA dur-
ing the first three months of lactation promotes overall infant lin-
ear growth, and shows a larger effect in those born SGA. However,
UNIMMAP reduced ponderal growth compared to IFA.

**Keywords:** Infant Health, Iron-Folic Acid, Lactation, Multiple Micronutrients, Small for Gestational Age

144/2001

EARLY LIFE HEIGHT TRAJECTORIES AND LATE
CHILDHOOD ADIPOSITY IN MEXICAN CHILDREN

(1)Barrios, Pamela L.; (2)Rivera, Juan; (3)Garcia-Feregrino, Raquel;

(4)Barraza-Villarreal, Albino; (5)Romieu, Isabelle; (6)Gonzalez-Casanova,

Ines; (6)Stein, Aryeh.; (6)Ramakrishnan, Usha; (7)Hoffman, Daniel J.

(1)MSc. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States;

(2)Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (3)MSc. Health and Nutrition Research Center.

National Institute of Public Health. Mexico.; (4)PhD. Population Health Research Center. National Institute of Public Health.

Mexico.; (5)Population Health Research Center. National Institute of Public Health. Mexico.; (6)PhD. Hubert Department of Global Health.

Rollins School of Public Health. Emory University. United States.;

(7)PhD. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.

**Background and objectives:** In Mexico, childhood obesity is a major public health concern, with a current prevalence of 34.4 % in school-aged children classified as overweight or obese. Previous research suggests that poor growth during early childhood may increase the risk of obesity, but others have reported that the rate of growth is more important than size at birth or early nutritional status. Therefore, the objective of this study was to determine if distinct trajectories of growth are associated with body fat mass (FM) in late childhood.
**Methods:** Study participants were a sub-sample that partic-
ipated in the 8-10 y follow up of the POSGRAD study, a dou-
ble-blind, randomized, placebo-controlled trial of prenatal DHA
supplementation. Sex-specific height latent class trajectories were
derived from 11 measures of height from birth to 5 years of age us-
ing MPlus v.7.3. Body composition and anthropometric measures
were obtained between ages 8-10 years. Body composition was
estimated using validated equations for Mexican children based
on the measures from a tetrapolar bioimpedance analyzer (Imped-
imed DF50). Multivariate linear regression was used to determine
the relationship between growth trajectory classes and FM (kg)
in late childhood, controlling for current body weight (kg), SES
(low, med and high), parity and maternal education. All statistical
analyses were conducted with STATA 14.

**Results:** 255 girls and 281 boys and were included. Two height latent classes were identified in girls [low (58%) and high (42%)] and three classes in boys [low (17%), medium (51%) and high (32%)]. Mean FM in girls (high and low) and boys (high, medium, low) per class were 12.66 kg and 8.99 kg and 10.76 kg, 8.97 kg and 8.39 kg, respectively. In girls, there were no significant associations between classes and FM. In boys, relative to the intermediate growth class, the low class had higher FM $\beta$ = 0.69 kg, 95% CI (0.26 - 1.11) and the high class had lower FM in late childhood $\beta$ = -0.40 kg, (-0.76 - -0.05).

**Conclusions:** Among boys, more rapid growth in early child-
hood is associated with lower adiposity in late childhood com-
pared to children who grew slower.

**Keywords:** child nutrition, latent class growth analysis, height, fat mass, BIA

**Further collaborators:** Supported by NIH grants HD-043099, HD-058818 and Grant Sectorial CONACYT 202062

We aimed to investigate the long-term influence of maternal obe-
sity and gestational diabetes (GD) during pregnancy on their chil-
dren diet up to 6 years of life.

**Methods:** 119 children participating in the PREOBE study, born to overweight (n=16), obese (n=15), GD (n=35), and healthy normal weight pregnant women (n=53) were included in the present analysis. Children dietary intake was recorded using three days 24h dietary record (2 working days and 1 weekend day). Quantification of nutrient intake by each child was performed by using the DIAL nutritional software. MANCOVA were performed using SPSS version 23.0, and the results were adjusted for confounding factors (maternal age, weight gain during pregnancy, maternal education and family status). Bonferroni corrected post hoc comparisons were used to identify significant group differences.

**Results:** Children born to GD mothers showed higher levels of fatty acids and trans- fatty acids intake than those born to normal weight (p=0,013 and p=0,006;respectively) and overweight mothers (p=0,026 and p=0,008;respectively). Children born to GD mothers showed higher levels of monounsaturated fatty acids (MUFA)-cis than those born to normal weight (p=0,034) and MUFA-trans respect to those born to normal weight and overweight mothers (p=0,031 and p=0,013;respectively). The intake of polyunsaturated fatty acids-trans were higher in children born to GD mothers than in those born to normal weight or overweight mothers (p=0,005 and p=0,002;respectively).

**Conclusions:** At 6 years of age, children born to mothers who developed GD show an inadequate dietary intake of trans fatty acids from manufactured foods. Diabetic pregnant women are included by routine in medical and nutritional programs to prevent undesirable problems during pregnancy and on their offspring, and furthermore after this intervention, an improvement of their eating habits is usually expected. However, the present results reflect the turn back to poor eating habits in the diabetic mothers which are translated into their offspring up to school age. The consequences of this fact are unknown. Behavioural programs are needed to maintain healthy eating habits in the mothers and children.

**Keywords:** Gestational diabetes, Diet, trans fatty acids

**Conflict of Interest Disclosure:** Supported by the Andalu-
sian Government, Economy, Science and Innovation Ministry
(PREOBE Excellence Project Ref. P06-CTS-02341), the Span-
ish Ministry of Economy and Competitiveness. Ref. BFU2012-
40254-C03-01and Ref. SAF2015-69265-C2-2-R.MyNewGut, GA:
613979. DynaHEALTH, GA: 633595.

**Further collaborators:** PREOBE Research Group.

144/2003

THE DEVELOPMENT OF GESTATIONAL DIABETES
IS LINKED TO HIGHER INTAKE OF TRANS FATTY
ACIDS IN THEIR CHILDREN AT 6 YEARS OLD. A
FOLLOW-UP FROM THE PREOBE COHORT

(1)Torres-Espínola, Francisco José; (2)Arias, Miriam; (2)Escudero Marín, Mireia; (3)Campos, Daniel; (4)Pérez-García, Miguel; (5)Campoy, Cristina.

(1)PhD. Psychologist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (2)MSc. Nutritionist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (3)MSc. Degree in Physical Activity and Sports Science. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (4)PhD. Psychologist. Mind, Brain and Behavior Research Centre (CIMCYC). University of Granada. Spain.; (5)MD. Pediatrician. Department of Paediatrics. University of Granada. Spain.

**Background and objectives:** Maternal diet and nutritional status are powerful determinants of development in utero and the first years of life. Women from disadvantaged groups tend to have the poorest quality diets which are translated into their offspring.
## MAIN SOURCES OF INFORMATION ON INFANT FEEDING, AND THEIR APPRAISAL, AMONG SOMALI AND IRAQI MOTHERS RESIDING IN NORTHERN WAY - A MIXED-METHODS STUDY

(1)Grewal, Navnit Kaur; (1)Terragni, Laura; (2)Torheim, Liv Elin.

(1)PhD. Department of Health, Nutrition and Management.
Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences. Norway.; (2)PhD. Professor. Department of Health, Nutrition and Management. Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences. Norway.

**Background and objectives:** Child health centers have a unique opportunity to support infant nutrition. However, studies suggest there can be communication barriers between health centers and immigrant mothers. The objective of the present study was to describe the main sources of information regarding infant nutrition, and how they have been evaluated, among Somali and Iraqi mothers residing in Norway.

**Methods:** Two rounds of surveys and qualitative interviews were carried out in the Oslo region in 2013-2014 among Somali and Iraqi mothers with infants aged 6 and 12 months. At infant's age 6 month, 187 mothers participated in the questionnaire-based survey and 29 in qualitative, in-depth interviews. At age 12 months, 166 mothers participated in the survey and 30 in qualitative interviews.

**Results:** Both in the 6- and 12-month surveys, the main source of information on infant nutrition was the child health center, received by more than 90% of the mothers. At infant's age 6 months, more Somali (97%) than Iraqi mothers (86%) evaluated the information received at the health center as useful. Information received from family members was the second most important source of information, at both 6 and 12 months. At 12 months, slightly more mothers (83%) rated the information from the family as useful, as compared with information received from the health station (80%). Qualitative interviews revealed that the mothers trusted the public health nurses. Some found it challenging to balance the information from the different sources. The mothers missed information that was adapted to their language and culture. Around 60% of the mothers wanted more information on infant and child nutrition.

**Conclusions:** The child health center is the main source for information on infant nutrition among Somali and Iraqi mothers in Norway. The information should be culturally adapted and more informative about feeding of toddlers.

**Keywords:** Infant feeding, nutrition information, immigrants, Norway

**Further collaborators:** The study is a collaboration between Fafo Research Foundation; Oslo and Akershus University College; University of Oslo; Norwegian Center for Migration and Minority Health and Oslo University Hospital. The study has been financed by the Norwegian Research Council.

## MATERNAL DIET WITH ELEVATED FOLIC ACID AND LOW VITAMIN B12 CONCENTRATIONS INCREASES THE METABOLIC RISK IN MICE (C57BL/6)

Castaño, Erika; Ronco, Ana María.

Professor. Institute of Nutrition and Food Technology Doctor
Fernando Monckeberg Barros. INTA. University of Chile. Chile.

**Background and objectives:** Folates and vitamin B12 (B12) are essential during pregnancy to ensure adequate fetal and placental development. Several countries have implemented public policies of food fortification and supplementation with folic acid (FA), but not with B12. Potential side effects for the mother and offspring of high FA/ low B12 consumption during pregnancy are unknown. The aim of this work was to determine whether maternal diets containing high levels of FA and low B12 increase oxidative stress markers in maternal livers and placentas.

**Methods:** Female mice (C57BL/6, age 8 weeks) were fed with diets containing high FA (8mg/Kg) and low B12 (0.5mg/Kg) diet (T) and with normal diet (C) 60 days before, during (20 days) and 21 days after pregnancy. A group (n=13) was scheduled for caesarean and another group (n=8) grew up until 60 days of age with same prenatal diet. Oxidative stress was assessed measuring TBARS in maternal livers and in placentas. Offspring weight was registered after weaning (21 days of age) and fasting glycemia was determined at 60 days of age.

**Results:** TBARS (MDA equivalents µM/mg protein) in T were higher in both, livers (10.5±2.4 vs 6.38±1.3, p=0.0082) and placenta (20.2±5.2 vs 14.2±2.4; p=0.0275) compared to C. Offspring weight at weaning was higher in T compared to C, in both, males (13±3 vs 8±1, p=0.0188) and females (12±2 vs 9±2, p=0.0227). Fasting blood glucose levels (mg/dL) at 60 days of age were higher in T vs. C only in males (153 ± 23 vs 116 ±30).

**Conclusions:** Maternal diets containing high levels of FA and low B12 before, during and after gestation may increase the risk of metabolic alterations in mothers and their offspring, in the short and long term; as evidenced by an increase in oxidative stress in the liver and placenta, in weaning weight, and in fasting blood glucose levels at 60 days of age.

**Keywords:** Folic acid, vitamin b12, oxidative stress, placenta, fetal programming.

**Further collaborators**

Funding: Fondo Nacional de Ciencia y Tecnología (FONDECYT N° 1130188) Gobierno de Chile.

Beca Stekel, INTA, U de Chile.
CONTRIBUTION OF COMPLEMENTARY FOODS
TO ENERGY AND NUTRIENT INTAKES AMONG
CHILDREN LIVING IN THE URBAN SLUMS OF
MUMBAI, INDIA

(1)Venkatramanan, Sudha; (2)Udipi, Shobha A; (3)Ghugre, Padmini;

(4)Huey, Samantha; (5)Powis, Laura; (6)Finkelstein, Julia; (7)Haas, Jere D.; (8)Mehta, Saur.

(1)PhD. Postdoctoral Research Associate. Division of Nutritional Sciences. Cornell University. United States; (2)PhD. Professor and Head. Department of Food Science and Nutrition. SNDT Women's University. India.; (3)PhD. Associate Professor. Department of Food Science and Nutrition. SNDT Women's University. India.; (4)BSc. Doctoral Candidate. Division of Nutritional Sciences. Cornell University. United States.; (5)BS. Research Assistant. Division of Nutritional Sciences. Cornell University. United States.; (6)ScD. Assistant Professor. Division of Nutritional Sciences. Cornell University. United States.; (7)PhD. Emeritus Professor. Division of Nutritional Sciences. Cornell University. United States.; (8)MBBS. ScD. Associate Professor. Division of Nutritional Sciences. Cornell University. United States.

**Background and objectives:** This cross-sectional study was conducted in preparation for a randomized controlled feeding trial assessing the efficacy of iron-biofortified pearl millet based complementary foods in improving child health outcomes. The main objective of the present study was to characterize dietary intake and their appropriateness based on the Indian recommended dietary allowances (RDAs) in urban slums of Mumbai, India.

**Methods:** Study participants were children aged eight to 22 months (n=106). Children's dietary data was collected using 24-hour dietary recall (administered to mothers). Nutrient intakes were calculated using CS Dietary System and compared with the Indian RDAs per day for children.

**Results:** Mean intake of complementary foods was 260 ± 231 g per day. Daily energy intake was less than the RDA for complementary foods in 53% (6 to 12 months, RDA=276 kcal/d) and 89% (12 to 24 months, RDA=714 kcal/d) of children. Protein intake from complementary foods accounted for 81% (6-12 months, RDA=14 g/d) and 88% (12-24 months, RDA=16 g/d) of the total RDA. Iron, zinc, vitamin B-12, and vitamin A intakes were inadequate in more than 90% of children. Dietary iron intake from complementary foods was 24% (6 to 12 months, RDA=5 g/d) and 17% (12 to 24 months, RDA=9g/d) of the Indian RDA. Zinc intake from complementary foods contributed to 10% of the RDA (12 to 24 months, RDA=5 g/d). Vitamin B-12 intake contributed to only 1% of the total RDA (12 to 24 months, RDA=0.2-1 g/d). Vitamin A intake provided 4% and 5% of RDA in the children from both the age groups. Seventy-two percent (n=76) of children consumed animal source foods including whole milk, eggs, yogurt, and chicken.

**Conclusions:** Our results demonstrate the widespread prevalence of inadequate energy and nutrient intake from complementary foods among children in Mumbai. Implementation of effective and sustainable nutritional interventions is essential to

ameliorate nutritional deficiencies in such vulnerable populations
(ClinicalTrials.gov ID: NCT02233764).

**Keywords:** Energy intake, complementary foods, nutritional status, iron, zinc

**Conflict of Interest Disclosure:** Saurabh Mehta is an unpaid board member for a diagnostic start-up company focused on developing point-of-care assays for nutritional status, informed by his research as a faculty member at Cornell University. All other authors report no conflict of interest.

GESTATIONAL WEIGHT GAIN AND NUTRITION-
AL STATUS AT MID-PREGNANCY IN BRAZILIAN
AMAZON

(1)Barreto Malta, Maíra; (2)Barreto Malta, Maíra; (3)Campos, Chiara Alzineth Silva; (4)Neves, Paulo Augusto Ribeiro; (5)Lourenço, Bárbara Hatzlhoffer; (6)Castro, Marcia; (2)Cardoso, Marly Augusto; (7)MINA-Brazil Working Group

(1)PhD. Nutritionist. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil;

(2)PhD. Nutritionist. Departmento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil;

(3)Nutritionist. Departmento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil; (4)MS.

Nutritionist. Departmento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil; (5)PhD.

Nutritionist. Departmento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo. Brazil; (6)PhD. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston.

MA. United States; (7)Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil.

**Background and objectives:** Weight gain during pregnancy is a prognostic factor for maternal and child health and its inadequacy is associated with undesirable outcomes for both. The present study aims to evaluate the relation between gestational weight gain and anemia, vitamin A insufficiency, and blood pressure in the third trimester of pregnancy.

**Methods:** Prospective study in the urban area of Cruzeiro do Sul, Acre state, Western Brazilian Amazon. Women up to 20 weeks of pregnancy (by last menstrual period) attending primary health care units were enrolled in this study (n = 457). Weight gain between the second and third trimesters was classified as insufficient, adequate and excessive according to pre-pregnancy body mass index, using the guidelines of Instituto de Medicine (2009). Outcomes of interest in the third gestational trimester were: anemia (Hb <110 g/dL), vitamin A insufficiency (retinol <1.05 µmol/L) and blood pressure levels (continuous variable, in mmHg). Multiple Poisson regression models with robust variance adjusted for age, schooling and use of micronutrient supplements were performed using Stata software 14.0, p <0.05.
**Results:** Prevalence ratios (PR, 95% CI) for anemia among pregnant women with insufficient (n=85) weight gain was 0.41 (0.18, 0.93) when compared to those with adequate weight gain (n=102). For vitamin A insufficiency, PR was higher among pregnant women with insufficient weight gain (2.85, 95% CI: 1.55, 5.24) and excessive (1.53; 95% CI: 0.84, 2.74) when compared to those with adequate weight gain. Pregnant women with excessive weight gain presented higher mean systolic blood pressure (111.1, 95% CI: 109.9, 112.2) than those with insufficient weight gain (107.5, 95% CI: 105.4, 109.6) and adequate weight gain (106.2; 95% CI: 104.3, 108.2).

**Conclusions:** This is the first study in the Western Brazilian Amazon to evaluate the association between inadequate gestational weight gain and nutritional status and blood pressure levels during pregnancy. Insufficient gestational weight gain was associated with poorer vitamin A nutritional status, while excessive weight gain was associated with higher blood pressure levels. Findings highlight the importance of promoting adequate gestational weight to improve maternal nutritional status and maintain blood pressure in appropriate levels.

**Keywords:** vitamin A; anemia; pregnancy; nutritional status; epidemiologic factors

**Further collaborators**

Funding: Maria Cecília Souto Vidigal Foundation, National Council of Scientific and Technological Development – CNPq, and São Paulo Research Foundation – FAPESP (2016/00270-6).

144/2031

WOMEN'S EMPOWERMENT: PATHWAYS TO-
WARDS MATERNAL AND CHILD NUTRITIONAL
OUTCOMES

**Background and objectives:** Women's empowerment (WE) is a key determinant of nutritional status of women and children. In this paper we examine the role of several domains of WE and the pathways by which they influence child nutritional status (CNS).

**Methods:** We used nationally representative data from the Demographic and Health Survey (2011-2015) for married women with children under five in East Africa (Ethiopia, Kenya, Rwanda, Tanzania, and Uganda) (n=42,721). Our key outcome, CNS was operationalized through anemia, height-for-age-z score (HAZ), and body mass index (BMI). Based on our previous work, we used three domains of WE as our primary exposure variable: human/ social assets, justification of wife-beating, and household deci- sion-making. We used measured variable path analysis to estimate

the strength of a priori hypothesized biological and behavioral pathways from WE to CNS. For the biological pathway, the medi-ating variable was women's nutritional status (WNS) including anemia, underweight, and BMI. The behavioral pathway includ- ed infant and young child feeding (IYCF) practices measured by breastfeeding and timely introduction of complementary foods. Analysis reported with standardized coefficients and was further adjusted for maternal and household characteristics.

**Results:** In Ethiopia, the direct association of WE and CNS was significant for the household decision-making domain, with higher empowerment being positively associated with better CNS (beta=0.64; p<0.001). For the biological pathway, higher WE was positively related to WNS for each domain of empowerment (assets: beta=0.40; p<0.005; beatings: beta=0.12; p<0.001; decision-mak- ing: beta=0.38; p<0.001). Improved WNS was related to improved CNS (beta=0.54; p<0.001). Along the behavioral pathway, the as- sets domain was related to appropriate IYCF practices (beta=0.09; p<0.005). Improved IYCF was related to CNS (beta=0.10; p<0.005). Further examination of these relationships and pathways including analysis of data from the other four countries is ongoing.

**Conclusions:** These findings indicate that the direct and bio- logical pathways are more strongly associated with CNS than the behavioral pathway in Ethiopia. Further analysis will help deter- mine if these observations are generalizable across East Africa. Based on the relative contribution of the specific components of WE and pathways by which they influence CNS, appropriate in- terventions and programs that improve WE could be developed to improve CNS.

**Keywords:** Women's Empowerment; Nutritional Status; Mat- ernal & Child Health; East Africa

144/2066

LIFE-COURSE HEIGHT AND WEIGHT TRAJECTO-
RIES IN MEXICAN CHILDREN

**Background and objectives:** Growth during infancy is im-
portant for future health and overall well-being and rapid weight

<footnote>(1)Jones, Rebecca; (2)Ramakrishnan, Usha; (3)Yount, Kathryn M.;</footnote>

<footnote>(4)Miedema, Stephanie; (5)Haardoerfer, Regine; (2)Webb Girard, Aimee.</footnote>

<footnote>(1)MSPH. Doctoral Student. Nutrition and Health Sciences. Emory University. USA.; (2)PhD. Nutritionist. Hubert Department of Global Health. Emory University. USA.; (3)PhD. Sociologist. Hubert Department of Global Health. USA; (4)MA. Doctoral Student. Department of Sociology. Emory University. USA.;</footnote>

<footnote>(5)PhD. Statistician. Department of Behavioral Sciences and Health Education. Emory University. USA.</footnote>

<footnote>(1)Barrios, Pamela L.; (2)Rivera, Juan; (3)Garcia-Feregrino, Raquel;</footnote>

<footnote>(4)Barraza-Villarreal, Albino; (5)Romieu, Isabelle; (6)Gonzalez-Casanova, Ines; (6)Stein, Aryeh.; (6)Ramakrishnan, Usha; (7)Hoffman, Daniel J.</footnote>

<footnote>(1)MSc. Department of Nutritional Sciences, New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.; (2)PhD. Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (3)MSc. Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (4)PhD. Population Health Research Center. National Institute of Public Health. Mexico.; (5)MD. Population Health Research Center. National Institute of Public Health. Mexico.; (6)PhD. Hubert Department of Global Health, Rollins School of Public Health. Emory University. United States.; (7)PhD. Department of Nutritional Sciences, New Jersey Institute for Food, Nutrition, and Health, Rutgers University. United States.</footnote>
gain during childhood has been associated with adverse health effects in adulthood. Latent class growth analysis (LCGA) identifies heterogeneity of growth patterns in cohort subgroups whereas other modeling techniques assume a single underlying trajectory per population. In LCGA, similar individuals are grouped together on the basis of their growth characteristics. The aim of this study was to derive height and weight growth trajectories from birth to 5 years of age in Mexican children.

**Methods:** Study participants were a sub-sample that participated in the 8-10 y follow-up of the POSGRAD study, a double-blind, randomized, placebo-controlled trial designed to assess the effect of prenatal supplementation with DHA on offspring growth and development (281 boys, 255 girls). Sex-specific height and weight latent class trajectories were derived from 11 measures of height and weight from birth to 5 years of age. Analyses were conducted by using MPlus version 7.3 (Muthen &Muthen). Tests of class membership association between the latent classes formed by sex were carried out using Pearson's Chi Squared in STATA 14 and p<0.05 was considered significant.

**Results:** Two weight and height latent classes were identified in girls [height: low (58%) and high (42%), weight: low (67%) and high (33%)] and three classes in boys [height: low (17%), medium (51%) and high (32%), weight: low (30%), medium (52%) and high (19%)]. The 2-class models for girls and the 3-class models for boys had the highest entropy (sign of successful convergence), they were all above 0.79. Classes also had the highest posterior probabilities of candidate models suggesting high class separation, all above ~0.92. For both sexes, height latent class membership was associated to weight latent class membership (p<0.000).

**Conclusions:** Based on these results, distinct height and weight trajectories separate within the first months of life, suggesting that early life factors may play a role in this separation. There is also a high correlation of latent class membership in height and weight trajectories.

**Keywords:** child nutrition, latent class growth analysis, height, weight

**Further collaborators:** Supported by NIH grants HD-043099, HD-058818 and Grant Sectorial CONACYT 202062

**Background and objectives:** Interventions promoting optimal infant and young child nutrition could prevent a fifth of under five deaths in countries with high mortality. Effective strategies to improve infant and young child feeding practices are needed. This study aims to pilot implementation of the baby friendly community initiative (BFCI), a global initiative recommended by the WHO that is aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to exclusive breastfeeding in a rural setting in Kenya.

**Methods:** The study, employing a cluster-randomized trial design, was conducted in rural Kenya between 2014 and 2016. A total of 13 clusters, constituting community units within the government's community health strategy were randomized with six allocated to the intervention and seven to the control arm. A total of ~800 pregnant women and their respective children were recruited into the study. The mother-child pairs were followed up until the child was at least six months. The intervention involved regular counseling and support of mothers by trained community health volunteers and health professionals on maternal, infant and young child nutrition. Regular quantitative assessment of knowledge, attitudes, and practices on maternal, infant and young child nutrition was done. A qualitative exploration of the effect of the intervention was also done. The analysis involves assessment of the effectiveness of the intervention on the primary outcome (exclusive breastfeeding for six months).

**Results:** Preliminary results indicate potential effectiveness of the intervention on exclusive breastfeeding. Narratives indicate that the counseling of women enhanced their skills and competencies in breastfeeding including with regards to breast positioning and attachment which led to better breastfeeding practices. The analysis is ongoing.

<footnote>(1)Kimani-Murage, Elizabeth; (2)Kimiywe, Judith; (3)Wekesah, Frederick;</footnote>

<footnote>(4)Muriuki, Peter; (5)Wanjohi, Milka; (6)Samburu, Betty; (7)Kabue, Mark;</footnote>

<footnote>(8)Griffiths, Paula; (9)Madise, Nyovani; (10)McGarvey, Stephen.</footnote>

<footnote>(1)African Population and Health Research Center. Kenya;</footnote>

<footnote>(2)Professor. Department of Foods Nutrition and Dietetics. Kenyatta University Nutrition. Nairobi. Kenya; (3)Epidemiologist. Health Challenges and Systems. African Population and Health Research Center. Nairobi. Kenya; (4)Research Assistant Health Challenges and Systems. African Population and Health Research Center. Nairobi. Kenya; (5)Nutritionist. Health Challenges and Systems. African Population and Health Research Center. Nairobi. Kenya; (6)Nutritionist. Unit of Nutrition and Dietetics. Ministry of Health,. Nairobi. Kenya; (7)Epidemiologist. JHPIEGO. USA; (8)Professor. Centre for Global Health and Human Development; Loughborough University. Loughborough. UK; (9)Professor. Centre for Global Health. Population, Poverty, and Policy University of Southampton. Southampton. UK; (10)Professor. International Health Institute. Brown University. Providence. Rhode Island. USA.</footnote>
# THE ASSOCIATION BETWEEN ACTIVE TOBACCO USE DURING PREGNANCY AND GROWTH OUTCOMES OF CHILDREN UNDER FIVE YEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS

**Background and objectives:** Current research on infant and young child growth faltering, manifesting in the form of stunting, primarily focuses on nutrition-specific risk factors. However, less is known about the nutrition-sensitive risk factors of growth faltering, including exposures to harmful substances, such as tobacco use during pregnancy. The objective of the study is to investigate the relationship between active tobacco use among pregnant women and growth outcomes of children under five years globally through a systematic review and meta-analysis.

**Methods:** CABI Global Health, CINAHL, Embase, Global Index Medicus, PubMed, and Web of Science databases were searched to identify studies from 1980 to present on the association between active tobacco use during pregnancy and child growth. Studies that collected data on active tobacco use as either a binary measure, quantity, or frequency at any time during pregnancy based on self-reporting or biomarker assessment were included in the review. At least one of the following child growth outcomes was considered: small for gestational age (SGA), length/height, and head circumference. A meta-analysis using a random effects model was conducted for the association between active tobacco use and SGA.

**Results:** Of the 13,189 citations identified by the search strategy, 406 studies were included in the full text review and 213 studies were eligible for inclusion in the analysis: 42 cross-sectional, 77 prospective cohort, 41 retrospective cohort, 29 case-control, and 24 unclear study design. In total, 25,168,224 mother-child pairs were included measuring for SGA (121 studies), length/height (84 studies), and head circumference (75 studies). These studies were conducted in 43 countries, including low-, middle-, and high-income countries. Most commonly, tobacco use was defined by cigarette smoking measured by self reporting and/or cotinine levels. Active tobacco use during pregnancy is associated with significantly higher rates of SGA (pooled adjusted OR=1.96; 95% CI 1.71 to 2.23).

**Conclusions:** Active tobacco use during pregnancy is associated with impaired child growth among certain outcomes. Nutrition-sensitive risk factors such as tobacco use during pregnancy should be considered when implementing interventions to reduce child stunting.

**Keywords:** tobacco, pregnancy, stunting, growth, nutrition-sensitive

# THE NEED OF FOOD SUBSIDY PROGRAMS TO FULFILL NUTRIENT ADEQUACIES: THE CASE OF INDONESIA

**Background and objectives:** The Indonesian family-based conditional cash transfer (CCT) program or locally known as PKH/Program Keluarga Harapan) started in 2007, which target the bottom poorest 10 percent households. The program demanded pregnant and lactating mothers, as well as children under the age of five years attend health check-ups and school age children go to school. In addition, these families are entitled to a cash or 15 kg rice subsidy monthly. However, the two programs have had less effect on the improvement of the quantity and quality of food consumed.

**Methods:** The authors exercised calculation on the potential macronutrient adequacy of the cash received from both programs, which is amounting to approximately USD 12.00 per month.

**Results:** Assuming all the money is used to purchase rice, the money is not enough to provide 100% adequacy of energy and protein for pregnant and lactating women. There is still a gap of 6% for energy and 26% for protein for a pregnant woman or equivalent to one small plate of rice and two eggs daily. The gap for a lactating mother and her child age 7 to 11 month is 23% for energy and 40% for protein or equivalent to 2.5 plate rice and three eggs daily. The money, however, should be enough to provide food for a child age 4 to 6 years. The amount of money or food equivalent given to a family with a pregnant woman should be USD 13.00 monthly and for a lactating mother and her child USD 19.00.

**Conclusions:** Improvement of the programs should be made to guarantee nutritional need for the important first 1000-days-period.

**Keywords:** conditional cash transfer, nutrient adequacy, food subsidy, Indonesia

<footnote>(1)Quelhas, Diana; (2)Kompala, Chytanya; (3)Wittenbrink, Brittney;</footnote>

<footnote>(4)Han, Zhen; (5)Downs, Shauna; (6)Shapiro, Myra; (7)Parker, Megan;</footnote>

<footnote>(3)Kreis, Katharine; (8)Kraemer, Klaus; (9)Fanzo, Jessica.</footnote>

<footnote>(1)BSc. MPH. PhD. Nutrition Innovation. PATH. USA.; (2)BSc. MSPH. Nutrition Innovation. PATH. USA.; (3)BSc. MPH. Nutrition Innovation. PATH. USA.; (4)BSc. PhD. Nutrition Innovation. PATH. USA.; (5)BSc. MSc. PhD. Berman Institute of Bioethics. Johns Hopkins Bloomberg School of Public Health. USA.; (6)BA. MHS. PhD. Center for Human Nutrition. Department of International Health. Johns Hopkins Bloomberg School of Public Health. USA.; (7)BScH. MSc. PhD. Nutrition Innovation. PATH. USA.; (8)BSc. PhD. Johns Hopkins Bloomberg School of Public Health. USA. Sight and Life. Switzerland.; (9)BSc. PhD. Berman Institute of Bioethics. Johns Hopkins Bloomberg School of Public Health. USA.</footnote>

<footnote>(1)Usfar, Avita; (2)Catharina, Maria.</footnote>

<footnote>(1)Dr. Avita A. Usfar. Nutritionist. Sakanti Consulting. Jakarta. Indonesia.; (2)Maria Catharina, MSc. Nutritionist. Sakanti Consulting. Jakarta. Indonesia.</footnote>
# INTAKE OF DAIRY PRODUCTS REPORTED BY ELDERLY PEOPLE AND SOCIODEMOGRAPHIC AND CULTURAL VARIABLES - SABE SURVEY: HEALTH, WELLBEING AND AGING

**Background and objectives:** The feeding behavior may be related to sociodemographic and cultural variables. The elderly intake of dairy products has been considered unsatisfactory by some researchers and this behavior may be related to the living conditions influenced by sociodemographic and cultural variables. The aim of this study was to verify the association among elderly intake of dairy products and sociodemographic and cultural variables.

**Methods:** Cross-sectional study with elderly people (≥60 years), of both sex, from the SABE Survey: Health, Wellbeing and Aging, performed in 2000, in São Paulo/SP city. The variables were self-reported: intake of dairy products (<1x/day); sociodemographic: schooling by years (zero, 1-4, >4), sex (male or female), age group (60-74 or ≥75 years), marital status (married, single, divorced or widower) and company at home (accompanied and living alone); cultural (life in rural area during childhood or adolescence-yes/no); nationality (brazilian or foreign); religion (catholic, evangelical, others). It was used univariate logistic regression, Rao & Scott test (CI=95%;p<0,05) and Stata Version10.1 program.

**Results:** This research studied 2142 elderly people; 82% reported intake of dairy products ≥1x/day (60% female sex). It was verified positive association between the intake of dairy products <1x/day and: schooling = zero (OR=2,85;CI=1,85-4,40;p=0,000), schooling = 1-4 (OR=1,76;CI=1,17-2,66;p=0,007), life in rural area (OR=1,76;CI=1,27-2,44;p=0,001), male sex (OR=1,50;CI=1,16-1,93;p=0,002) and negative association with: age group ≥75 years (OR=0,63;CI=0,50-0,79;p=0,000) and foreign nationality (OR=0,35;CI=0,19-0,66;p=0,002).

**Conclusions:** The intake of dairy products was associated with sociodemographic and cultural variables such as schooling, life in rural area, sex, age group and nationality in this brazilian elderly population.

**Keywords:** Dairy products, feeding behavior, aged, aging

# EFFECT OF MATERNAL VITAMIN D SUPPLEMENTATION ON VITAMIN D METABOLITES AND MARKERS OF IMMUNE FUNCTION IN UMBILICAL CORD SERUM

**Background and objectives:** Low maternal vitamin D status has been associated with increased risk for asthma and autoimmune disease in the offspring. The hormone 1,25-dihydroxyvitamin D (1,25(OH)2D) regulates many inflammatory processes, but the pathways by which insufficient vitamin D during gestation may impact the developing immune system have not been elucidated. The aim of this study was to test the effects of maternal vitamin D supplementation on concentrations of vitamin D metabolites, inflammatory cytokines, and IgE in umbilical cord serum (UCS).

**Methods:** Pregnant adolescents (n=79) living in Rochester, NY received 200 IU or 2,000 IU of vitamin D3 daily (in addition to a standard prenatal supplement with 400 IU of vitamin D3) from (mean ± SD) 18 ± 5 weeks of gestation until delivery. Maternal serum and UCS were analyzed for 25(OH)D, 1,25(OH)2D, and 24,25(OH)2D using LC-MS/MS. UCS cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, TGF-β1, and TNF-α), IgE, and IgA (the negative control) were measured by immunoassays. Linear regression was used to test the effect of supplement group assignment on UCS vitamin D metabolites, cytokines, and IgE.

**Results:** The mothers were 17 ± 1 yrs of age at study entry. The majority (60%) identified as Black race, and 35% had serum 25(OH)D <20 ng/mL at delivery. UCS was obtained from 56 neonates at birth (39.5 ± 1.7 wks' gestation). The prevalence of UCS 25(OH)D <12 ng/mL was 39%. The 2,000 IU group had greater mean UCS 25(OH)D (β=4.6; p=0.02) and 24,25(OH)2D (β=0.42; p<0.01), but there was no effect of treatment group on UCS 1,25(OH)2D. Cytokines and IgE have been measured in 34 UCS samples. IL-6, IL-10, TGF-β1, TNF-α and IgE were detectable in the majority of UCS samples. The mean concentrations of these cytokines and IgE in UCS did not differ by supplement group.

**Conclusions:** Risk of vitamin D deficiency was prevalent in term neonates born to adolescents living at latitude 43°N. Daily supplementation with 2,000 IU compared with 200 IU of vitamin D3 increased UCS 25(OH)D and 24,25(OH)2D but had no effect on either UCS 1,25(OH)2D or (based on data available to date) select markers of immune function.

**Keywords:** perinatal nutrition, vitamin D, developmental origins, asthma, allergy

**Conflict of Interest Disclosure:** This work was supported by a Grant from The Gerber Foundation, the United States De-

<footnote>(1)Souza, Cláudia; (2)Marucci, Maria De Fátima; (3)Roediger, Manuela;</footnote>

<footnote>(3)França, Ana Paula; (4)Duarte, Yeda.</footnote>

<footnote>(1)MSc. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (2)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (3)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (4)PhD. Department of Nursing Medical-Surgical. School of Nursing. University of São Paulo. Brazil.</footnote>

<footnote>(1)Best, Cora; (2)Mehta, Saur; (3)Pressman, Eva; (3)Queenan, Ruth Anne;</footnote>

<footnote>(4)Cooper, Elizabeth; (5)O'Brien, Kimberly.</footnote>

<footnote>(1)MHS. PhD Candidate. Division of Nutritional Sciences. Cornell University. USA.; (2)MBBS. ScD. Division of Nutritional Sciences. Cornell University. USA.; (3)MD. Department of Obstetrics and Gynecology. University of Rochester School of Medicine. USA.; (4)CNM. EdD. Department of Obstetrics and Gynecology. University of Rochester School of Medicine. USA.; (5)PhD. Division of Nutritional Sciences. Cornell University. USA.</footnote>
partment of Agriculture under award 2011-03424, and the United States National Institutes of Health under award T32-DK007158. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health. SM is an unpaid board member for a diagnostic start up focused on measurement of nutritional biomarkers at the point-of-care utilizing the results from his research. The authors report no conflicts of interest.

(1)Gebara, Telma; (2)Delfino, Bianca; (3)Tarzia, Andréa; (4)Mastella, Paula; (5)Santos, Silvana; (2)Thomaz, Ana Cláudia.

(1)BSc. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (2)BSc. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (3)PhD. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (4)PhD. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (5)MSc. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.

**Background and objectives:** Breastfeeding is the best natural strategy for bonding, affection, protection and nutrition for a child, as well as an important intervention to reduce infant morbidity and mortality. Exclusive breastfeeding is recommended by World Health Organization up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Some of the benefits that make breastfeeding feasible are the families engagement to support the mother during the breastfeeding period, the low cost, and the quality of life for mothers and their babies. Nevertheless, many mothers are not knowledgeable on the benefits of breastfeeding. The aim of this research was to analyze the perception of mothers regarding breastfeeding of inpatient newborns on a neonatal intensive care unit (NICU) in the city of Curitiba, Brazil.

**Methods:** A cross-sectional study (descriptive and observational) was conducted on a group of 10 mothers of newborns, during the months of August and September 2016. A questionnaire was applied and answered individually by each mother, without interference. Furthermore, the research project was approved by the Ethics Research Committee.

**Results:** Average age of mothers was 31.7 (± 4.71) years, and 60% were graduate or post-graduated. All the mothers (100%) answered that they received information about maternal education through various media, nurses and doctors, as well as family and friends. Half of them (50%) answered that mother can offer the milk to the baby in the first hour postpartum. Cultural level of the mothers is related to breastfeeding in a positive way, breastfeeding in the first hour after the birth of the baby is important for effective

breastfeeding, in addition to providing the strengthening of the affective bonds between mothers and their babies.

**Conclusions:** It is important to recognize that knowledge building about the importance of exclusive breastfeeding is the result of a collective struggle, where quality health professionals should, besides providing adequate guidance, give greater safety to the mothers during breastfeeding.

**Keywords:** breastfeeding, nursing, breastfeeding promotion.

(1)Kowalski, Alysse; (2)Georgiadis, Andreas; (3)Stein, Aryeh.

(1)PhD Student. Laney Graduate School. Emory University. Atlanta. USA.; (2)PhD. Brunel Business School. College of Business, Arts and Social Sciences. Brunel University London. London. UK.; (3)PhD. Hubert Department of Global Health. Rollins School of Public Health. Emory University. Atlanta. USA.

**Background and objectives:** Linear growth failure in the first 1000 days is associated with impaired child cognitive development. Using longitudinal data from four low and middle income countries we examined the strength of the pathways by which growth throughout childhood is associated with measures of cognitive performance.

**Methods:** Data come from the Young Lives study in Ethiopia (N=1275), India (N=1350), Peru (N=1402), and Vietnam (N=1594). Height was measured at participant age 1, 5, 8, and 12 y; height-for-age z-scores (HAZ) were calculated. Cognitive performance was assessed at age 12 y by the Peabody Picture Vocabulary Test and a mathematics test, which were adapted and standardized in each country. We used path analysis to examine associations between HAZ at each age and each test. We adjusted for covariates at the child, parent, household, and community levels.

**Results:** In all four countries, the total effect of HAZ at each age was positively associated with cognitive performance; 12 of 16 and 10 of 16 associations were statistically significant for vocabulary and mathematics scores, respectively. Collectively, total effects of HAZ explained modest proportions of the total variation in test scores; across countries, partial r2 ranged from 1.8% to 4.0% for vocabulary and 1.1% to 2.5% for mathematics. Across countries, the total effect of HAZ 1 y explained 0.1% to 1.3% and 0.1% to 0.9% of the total variation in vocabulary and mathematics scores, respectively, while HAZ 5, 8, and 12 y combined explained 1.0% to 3.9% and 0.9% to 2.0%, respectively. The relative magnitude of the HAZ associations with cognitive performance were comparable to those of maternal and paternal education, household expenditures, and ethnicity. The proportion of the total effect of HAZ at 1 y mediated through HAZ at older ages ranged from 55% to 100% across countries for vocabulary and 42% to 100% for mathematics.
**Conclusions:** HAZ was associated with increased cognitive performance at age 12 y, but the proportion of the total variation in test scores explained was modest. While the primary drivers of cognitive performance may not be mediated through growth, increased child growth may confer modest benefits for cognitive performance.

**Keywords:** growth, height-for-age, cognitive development

**Conclusions:** Effort to ensure that appropriate IYCF key messages reach Penan mothers should be strengthened, to further improve the overall nutritional status and feeding practices of this vulnerable group.

**Keywords:** nutritional status, infant young child feeding, Penan

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## MALNUTRITION AND INFANT/YOUNG CHILD FEEDING PRACTICES AMONG PENAN COMMUNITY IN SARAWAK, MALAYSIA

(1)Noor, Mohd Ismail; (2)Bong, Mee Wan; (3)A Karim, Norimah.

(1)Wife. Malaysia.; (2)BSc. Nutritionist. Nutrition Section. Sarawak State Health Department. Kuching. Sarawak. Malaysia; (3)PhD. Nutritionist. Nutritional Sciences Programme. Faculty of Health Sciences. Universiti Kebangsaan Malaysia. Kuala Lumpur. Malaysia.

**Background and objectives:** The tribal Penan estimated around 16,000 largely settled in rural and remote areas of Sarawak. The objective of this study was to determine the nutritional status and infant young child feeding (IYCF) practices in Penan children, using indicators of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD).

**Methods:** Data collection was carried out in 14 Penan villages in Sarawak from August to December 2016. Subjects consisted of 71 young children, aged below 24 months. Malnutrition was assessed using anthropometric measurements of children and categorized according to WHO Growth Standards (2006). Mothers were interviewed using a pre-tested questionnaire based on WHO IYCF Indicators.

**Results:** Majority (88.7%) of mothers interviewed were below 35 years, with 29.6% having attended primary school and 15.5% secondary school with a household income of less than MYR600 (USD 135) per month. The prevalence of underweight was 33.8%; stunting 49.3% and wasting 9.8%. Prevalence of exclusive breastfeeding under 6 months was 50% while continued breastfeeding up to 1 year was 72.2% and 41.2% at 2 years. Proportion of children aged between 6 to 23 months achieving MDD was 83.1%. Among children of different age groups, MDD achievement was low (71.4%) for those aged 6 to 11 months. For those achieving MDD, 71.2% of children received food from 4 to 5 food groups whilst 11.9% received food from 6 to 7 food groups. Majority of children received food from grain, roots and tubers group (96.6%). Other food groups given were flesh foods and Vitamin-A rich fruits and vegetables. Almost half (49.2%) of the children consumed dairy products and eggs; and MMF achieved was 83.1%. The study also revealed only 59.3% of children aged 6 to 23 months achieved minimum acceptable diet. Overall, the compliance to minimum acceptable diet indicator was low. Consumption of iron-rich foods was satisfactory at 79.7%, however only 57.1% was achieved amongst infants aged 6 to 11 months.

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## NUTRITION RECOMMENDATIONS FOR IMPROVING ADOLESCENT GIRLS' HEALTH AND WELLBEING

(1)Koniz-Booher, Peggy; (2)Ramage, Abigail Kaplan; (3)Rayco-Solon, Pura; (4)Alvey, Jeniece; (5)Lamstein, Sascha; (6)Grey, Elaine S.; (7)Lutter, Chessa; (8)Cunningham, Sarah.

(1)MPS. SPRING/USAID Project. JSI Research & Training Institute Inc. USA.; (2)MS. MA. Independent Nutrition Consultant. United Kingdom.; (3)MD. MSc. PhD. Evidence and Programme Guidance Unit. Department of Nutrition for Health and Development. World Health Organization. Switzerland.; (4)MPH. IBCLC. Global Health Fellows Program II/USAID. Public Health Institute. USA.; (5)PhD. SPRING/USAID Project. JSI Research & Training Institute, Inc. USA.; (6)MS. MPH. Global Health Fellows Program II/USAID. Public Health Institute. USA.; (7)PhD. Visiting Research Professor. School of Public Health. University of Maryland. United States.; (8)BS. SPRING/USAID Project. JSI Research and Training Institute, Inc. USA.

**Background and objectives:** Over half a billion adolescent girls between the ages of 10 and 19 live in low- and middle-income countries (LMIC), making up nearly ten percent of their populations (UNDESA 2008). The challenge of developing appropriate policies, social and behavior change strategies, effective nutrition education programs, and targeted communication tools to reach adolescent girls is complicated by the lack of specific nutrition guidance for this critical population. While guidelines exist for some adolescent interventions, adolescent girls might also benefit from nutrition interventions that target wider age groups, such as iron supplementation for women of reproductive age. In many cases, however, these interventions have not been prioritized or adapted for adolescent programming. To help provide better guidance, the USAID Strengthening Partnerships, Results: **Methods:** Building on recommendations from the 2015 technical expert meeting on adolescent and women's nutrition, co-hosted by PAHO/WHO and SPRING/USAID, a framework reflecting the determinants of and interventions for adolescent girls' nutrition, health and wellbeing was developed through a consultative, interagency process. This framework guided the selection of relevant evidence-informed recommendations from existing WHO guidelines for inclusion in the document.

**Results:** This product – Nutrition Recommendations for Improving Adolescent Girls' Health and Wellbeing – will provide global guidance for achieving optimal adolescent girls' nutrition in a user-friendly format. It organizes key interventions and related recommendations under categories, including healthy diets;
micronutrient deficiencies; undernutrition management; antenatal nutrition; water, hygiene and sanitation; physical activity; and sexual and reproductive health.

**Conclusions:** Global guidance focused on improved adolescent girls' nutrition is needed to protect gains made in child survival and early childhood development, with a focus on the adolescent period as a "second window of opportunity". This WHO product will provide Member States, donors and implementing partners with recommended evidence-informed guidance for adolescent girls' nutrition interventions and programming. It aims to catalyze and focus future investments for prioritization and development of policies, strategies, programs, and tools.

**Keywords:** Adolescent girls, Adolescent nutrition, Nutrition guidelines, WHO guidelines

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CORRELATION BETWEEN CHRONOTYPE AND THE QUALITY OF DIET IN PREGNANT WOMEN

(1)Cabral, Bruna; (2)Gontijo, Cristiana Araújo; (3)Castro, Isabella;

(2)Balieiro, Laura; (4)Fahmy, Walid; (5)Maia, Yara; (5)Crispim, Cibele.

(1)Nutritionist. Brazil.; (2)Nutritionist. MSc. Medical Faculty. Federal University of Uberlandia. Brazil.; (3)Undergraduate student. Nutrition Course. Medical Faculty. Federal University of Uberlandia. Brazil.; (4)Physician. MSc. Prefeitura Municipal de Uberlandia. Brazil.; (5)UBERLANDIA. Brazil.

**Background and objectives:** The literature shows that chronotype can influence food consumption and individuals with an evening chronotype may consume a lower quality of diet. However, this issue is an unexplored among pregnant women. In this sense, the focus of this study was to correlate chronotype with the quality of diet in pregnant women in the first trimester.

**Methods:** We evaluated 100 pregnant women, with up to 12 gestational weeks, aged 18 to 40 years, attended at the public health service in Uberlandia city, Minas Gerais, Brazil. Properly trained nutritionists collected information about food consumption by means of three 24HR on non-consecutive days, including one day of the weekend, in order to better reflect the eating habits of the participants. The qualitative dietary assessment was performed using the Brazilian Healthy Eating Index Revised (BHEI-R), from the following components and, or food groups: Total Fruits; Whole Fruits; Total Vegetables; Vegetables Dark Green and Orange Vegetables and Legume; Total Grains; Whole Grains; Milk and Dairy Products; Meat, Eggs and Beans; Oils; Saturated Fat; Sodium; and SoFAAS. Chronotype was derived from the time of mid sleep time on free days at the weekend (MSF), with a further correction for calculated sleep debt – calculated as the difference between average sleep duration at the weekends and weekdays correlation was used and p <0.05 with significant statistic. The data were analyzed using the SPSS.21.0. To evaluate correlations between variables, Spearman's correlation coefficients, adjusted for confounders were used. Correlations were considered weak if r <0.30, moderate if r was 0.30-0.70 and strong if r >0.70. Statistical tests with p < 0.05 were accepted as significant.

**Results:** We found a significant correlation between the BHEI-R score for the total Fruit components (r=-0.239; p=0.017), Whole Fruits (r=-0.214; p=0.032) and Saturated Fat (r=-0.211; p=0.035) with chronotype.

**Conclusions:** Our data suggest that pregnant women with an evening chronotype may be more likely to a diet with less fruit and higher saturated fat. Longitudinal studies should be developed to better understand this issue.

**Keywords:** chronotype, food consumption, pregnancy, Quality Of Diet

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CONSUMPTION OF NON-ALCOHOLIC SWEETENED BEVERAGES IN YOUNG ADULTS IN URUGUAY

(1)Elichalt, Marta; (2)Puig, Silvia; (1)Girona, Alejandra; (3)Della Santa, Ana Paula; (1)Britz, Monica; (4)Perdomo, Guillermo.

(1)MSc. Nutritionist. Nutrition School. Republic University. Uruguay.; (2)Nutritionist. Nutrition School. Republic University. Uruguay; (3)Nutritionist. Nutrition School. Republic University. Uruguay.; (4)MSc. Biological Sciences. Nutrition School. Republic University. Uruguay.

**Background and objectives:** Sweetened drinks are one of the ultraprocessed foods that have had the greatest increase in consumption in recent years in Uruguay. A descriptive quantitative study was carried out to determine the consumption of sugar drinks in young adults aged 18 to 35 years and to compare the average amount of sugar from this consumption with the maximum amount of intake recommended by WHO free sugar in the framework of healthy eating (10% of energy needs per day).

**Methods:** The sample was non-probabilistic, a Google form was applied where it was collected: socio-demographic information, types of beverages consumed, frequency and total quantity for different types. To know the association between variables the chi square test p <0.05 was applied.

**Results:** Respond 440 young people, 75% between 18 to 29 years and 75% were women, just over half reside in the capital and have university education; 44% study and work. In relation to the frequency of consumption, tea, coffee and soft drinks predominate with a minimum frequency of 5 times per week. More than 70% exceeds the average consumption / day of 200 mL. 34% exceeds 10% of energy from free sugars only with the intake of beverages. There are no significant differences in the sugar energy intake of the drinks between sexes, ages, places of residence, or types of activity (p <0.05).

**Conclusions:** It is concluded that the habit of young adults to consume tea and coffee with sugar added and the intake of soft drinks, fruit juices and flavored waters contribute to the excessive contribution of free sugars in the study population as a risk factor for the development of diseases prevalent in Uruguay.

**Keywords:** sugar; drinks, intake
# IMPROVING COMPLEMENTARY FEEDING IN RU-RAL BANGLADESH WITH LOCAL FOOD-BASED RECOMMENDATIONS

(1)Wendt, Amanda; (2)Waid, Jillian; (3)Ali, Masum; (4)Gabrysch, Sabine.

(1)Postdoctoral Fellow. Institute of Public Health. University of Heidelberg. Germany.; (2)Director of Research, Learning, and Evaluation. Helen Keller International. Dhaka. Bangladesh.;

(3)Researcher. Helen Keller International. Dhaka. Bangladesh.;

(4)Unit Head, Deputy Institute Head. Unit of Epidemiology and Biostatistics. Institute of Public Health. University of Heidelberg. Germany.

**Background and objectives:** Poor infant and child feeding practices can lead to adverse growth and development outcomes. This is of particular concern in low- and middle-income countries. Nutrition-sensitive agricultural interventions are uniquely positioned to improve child feeding practices through improved household access to nutrient-dense foods as well as providing a platform for nutrition counseling activities.

Our objectives were to describe current food patterns of 6-23 month old children in the Food and Agriculture Approaches to Reduce Malnutrition (FAARM) trial population, identify problem nutrients which are not being fulfilled with normal dietary patterns, and create local food-based recommendations to address these deficiencies.

**Methods:** Food consumption patterns were measured as part of the FAARM cluster-randomized trial in Sylhet, Bangladesh. A 24-hour recall was conducted in 864 households (Children 6-8m: n=43; 9-11m: n=59; 12-23m: n=255) from September 2015 to August 2016, with replication in one-third of the sample. Complementary feeding patterns and food-based recommendations were evaluated using WHO Optifood linear programming software, which evaluated 10 micronutrients: calcium, vitamin C, thiamine, riboflavin, niacin, vitamin B6, folate, vitamin A, iron, and zinc.

**Results:** In all age groups, calcium, riboflavin, folate, iron, and zinc were identified as 'problem nutrients,' defined as not meeting 100% of recommended intake levels with an optimized diet. Thiamine was also identified as a 'problem nutrient' for children 12-23 months of age. Key local foods rich in these micronutrients were identified and included dark green, leafy vegetables (e.g. red amaranth, buffalo spinach), small dried or fermented fish, pulses, and eggs. For 9-11m and 12-23m age groups, increasing dark green, leafy vegetable consumption to two meals per day and consuming fish with eggs or pulses once per day ensured dietary adequacy of 5 and 7 of the 10 nutrients evaluated, respectively. For children 6-8m of age, diets remained inadequate.

**Conclusions:** Promotion of key foods which are locally available and acceptable is an important step for effective nutrition counseling of complementary feeding. **Methods:** **Keywords:** Infant and young child feeding

Complementary feeding

Nutrition

Micronutrients

Optifood

## Further collaborators

This abstract was produced through support provided by PATH, under a grant from UK aid from the UK Government; however, the views expressed do not necessarily reflect the UK government's official policies.

# METABOLIC SYNDROME AND DIETARY PATTERNS OF OLDER ADULTS FROM THE HEALTH, WELL-BEING AND AGING SURVEY (SABE)- BRAZIL

(1)Quintiliano Scarpelli Dourado, Daiana; (2)Roediger, Manuela;

(3)Marucci, Maria de Fátima.

(1)PhD. Nutritionist. Public Health School. University of Sao Paulo;

(2)Post Doctoral Student. Nutritionist. Public Health School. University of Sao Paulo. Sao Paulo. Brazil; (3)PhD. Profesor. Public Health School. University of Sao Paulo. Sao Paulo. Brazil.

**Background and objectives:** Metabolic syndrome (MS) is common in elderly people. The feeding influences its prevalence constituting one of the modifiable risk factor with positive impact on disease control.

To investigate the association between MS and dietary patterns of older adults from São Paulo city.

**Methods:** Cross-sectional study that used data from the SABE survey: epidemiological, cohort based and home-dwelling. The study population included elderlies (≥ 60 years old), both sexes, selected by probability sampling, belonging to three cohorts A/2000 (n = 630), B/2006 (n = 214) and C/2010 (n = 311). The study variables were: gender, age, education, alcohol consumption, smoking, physical activity, number of chronic noncommunicable diseases; MS, identified according to the criteria of the National Cholesterol Education Program-Adult Treatment Panel III. The feeding data were obtained by one food frequency questionnaire with 18 food groups. Dietary patterns were determined by exploratory factor analysis of principal components. Rao & Scott and multiple logistic regression for complex sample were used, with 5% significance level. The statistical software STATA 13.1 was used.

**Results:** 1155 subjects were studied. The prevalence of MS was 57.9%. Four dietary patterns were identified: pattern 1, composed by fried foods, sausages, canned foods, sweets, tubers, spices/ sauces and processed eggs, called inappropriated; pattern 2, composed by low-fat dairy products, whole grain cereals and breads, and light, diet or zero food, called modified; pattern 3, composed by vegetable oils, rice, refined cereals and white bread, meat and legumes, called Brazilian traditional pattern; and pattern 4, fruits, vegetables and tubers, called beneficial. The modified pattern was positively associated to MS. 4th quartile modified pattern older adults had increased in 60% the risk of MS. The beneficial pattern was negatively associated to MS, in the older individuals (≥ 70 y, cohort A). The inappropriated and Brazilian traditional patterns were not significantly associated to MS.

**Conclusions:** The modified and beneficial dietary patterns were associated to MS. Modified individuals pattern showed in-
creased risk of MS. Beneficial pattern reduced the risk to the oldest older individuals. The modified pattern could be due to dietary changes implemented in the older adults daily life after diagnosis of metabolic abnormalities.

**Keywords:** metabolic syndrome; aging; food intake; factorial analysis.

(1)França, Ana Paula; (2)Marucci, Maria de Fátima; (2)Roediger, Manuela; (3)de Souza, Claudia Sebba Tosta.

(1)PhD. Nutritionist. University of São Paulo. Faculdade das Américas. São Paulo. Brazil.; (2)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (3)MSc. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** To investigate the association between abdominal obesity and demographic, clinical and behavioral variables, a cross-sectional study with 469 women (45-65 years) was conducted in two outpatient public clinics in São Paulo, Brazil.

**Methods:** The dependent variables were: abdominal obesity according to waist hip ratio (WHR) and obesity according to waist circumference (WC); the main explanatory variable was: climacteric stage (pre- or post-menopause) and the control variables were age; level of education; parity; use of hormone therapy; physical activity and smoking habit. Was performed multiple regression analysis “glm” (general linear model) using Stata 9.2 software for analysis.

**Results:** According to WHR, abdominal obesity was positively associated with age (PR=1,02; 95% CI = 1,00-1,05), and negatively associated with level of education (PR = 0,76; 95%CI = 0,64-0,92) and physical activity (PR = 0,70; 95% CI = 0,61-0,82). As indicated by WC, abdominal obesity was positively associated with age (PR = 1,02; 95% CI = 1,01-1,03) and parity (PR = 1,21; 95% CI = 1,02-1,45) and negatively with physical activity (PR = 0,70; 95% CI = 0,61-0,82).

**Conclusions:** While physical activity was a protective factor, age, level of education and parity were established as risk factors for the prevalence of abdominal obesity in women of this study group.

**Keywords:** abdominal obesity; parity; physical activity, climacteric; menopause.

(1)Guerendiain, Marcela; (2)Monzón Rodríguez, Allyson Natalie;

(3)Cando Pilatuña, Rosario Isabel; (4)Mayorga Mazón, Clara de las Mercedes; (2)Ligerini Vázquez, Lorena Johana; (2)Menendez Blanco, Cintya Yanella.

(1)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (2)Nutritionist. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)MSc. Psychologist. School of Clinical Psychology. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (4)MSc. Nutritionist. School of Nursing. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.

**Background and objectives:** There is evidence that the polyunsaturated fatty acids may play a key role in brain development, but the studies on monounsaturated and saturated fatty acids are limited. Therefore, the objective of this research was to explore the relationship between fatty acid intake and cognitive development in schoolchildren.

**Methods:** It was studied seventy-three children, from 5 to 11 years old, of the EVANES project, in this case, from San Juan school, Ecuador, located at 3240 meters above sea level. To identify levels of verbal comprehension (VC), perceptual reasoning (PR), working memory (WM), processing speed (PS) and full-scale intelligence quotient (FSIQ) the schoolchildren were evaluated using the Wechsler Intelligence Scale for Children four edition (WISC IV). In the target population, a survey was conducted in order to know the total daily consumption of food, and the fatty acids were calculated. The data were analyzed using general linear model, corrected by Bonferroni, and linear regression tests, both adjusted for age, sex and standard deviation (SD) of height. Inside the cognitive development, the sample was divided in normal (≥80 points) and low (<80 points).

**Results:** The mean and the SD for VC, PR, WM, PS and FSIQ were 79.62 ± 14.33, 81.30 ± 13.90, 86.53 ± 13.73, 89.49 ± 14.90 and 78.66 ± 12.11 points, respectively; for intake of saturated, monounsaturated and polyunsaturated fatty acids were 29.82 ± 18.56, 19.93 ± 9.88 and 7.19 ± 3.03 grams per day, respectively. It was found that children with a low VC had a higher intake of saturated and monounsaturated fatty acids. Besides, it was identified a relationship between lower PS and higher saturated fatty acid consumption, and, when we adjusted the model, the association became stronger.

**Conclusions:** An inverse relationship between the consumption of saturated and monounsaturated fatty acids, and verbal comprehension and processing speed was observed in schoolchildren of Ecuador.

**Keywords:** Cognitive development; fatty acids; monounsaturated fatty acids; saturated fatty acids.
# THE INFLUENCE THAT A LOCAL GOVERNMENT-LED MODEL WALKING PROGRAM GIVES FOR THE CHANGE OF PHYSICAL STRENGTH AND THE FIGURE

(1)Nagaoka, Tatsuki; (2)Omori, Akane; (1)Cho, Chuhwa; (3)Okubo, Mion;

(4)Koizumi, Kayo.

(1)Japan Woman's College of Physical Education Graduate School. Japan.; (2)M.S. Abiko Nikaido High School. Japan.; (3)Japan Woman's College of Physical Education. Japan.; (4)Ph.D. Japan Woman's College of Physical Education. Japan.

**Background and objectives:** The purpose of this study to compare the numerical value of the figure with the physical fitness test before and after the business of this time by the generation and examine an effect to physical training according to the generation.

**Methods:** Participants included 74 individuals ≥60years old-(n=58), ≥70(n=16) that participated in "10,000 steps of walking" in residents. The intervention combined a program to improve a physical function program to prevent declines in cognitive function. This intervention was conducted 9 times for 5 months from September 2014 to January 2017. All participants were measured their body composition, body size, physical fitness tests and steps were made at baseline and after 5 months later, and results were than compered. Body composition were measured by a whole-body bioelectric impedance analysis system (MC-780, Tanita Co.Ltd,Tokyo,Japan).And the International Society for the Advancement of Kinanthropometory(ISAK) protocol was used for measuring 5 body parts as follows ; three skinfolds(abdominals and medial calf) and 3 girths (waist, gluteal and mid-calf) on the right side of the objects'body. The statistical difference was determined by two-sided Student's t test, Difference with P<0.05 was considered significant.

**Results:** As for the steps of 5 months, a man in 70s was 11889±4700 steps of most, 5406±4022 steps of the 70s woman, that there was the least. No significant difference was found for all measurements between 60s and 70s. The long seat body ante flexion, the walking speed significantly increased the man and woman in its 60s, the woman in her 70s in approximately a program, but, as for the man in 70s, a meaningful change was not recognized. A meaningful change was not accepted for the grips between sex generations.

**Conclusions:** This study indicated that necessity of program not just walking, but to improve physical strength and increase of the quantity of muscle for 60s also.

**Keywords:** 10,000 steps of walking, elderly person,physical fitness

# ARE THERE CHANGES IN THE FATTY ACID PROFILE IN BREAST MILK WITH SUPPLEMENTATION OF OMEGA 3 SOURCES? A SYSTEMATIC REVIEW

(1)Amaral, Yasmin; (2)Marano, Daniele; (3)Silva, Leila; (3)Guimarães, Aline; (4)Moreira, Maria Elisabeth.

(1)Msc. Nutritionist. Instituto Fernandes Figueira/ Fiocruz. Brazil.;

(2)Dr. Nutritionist. Instituto Fernandes Figueira/ Fiocruz. Brazil.;

(3)Nutritionist. Instituto Fernandes Figueira/ Fiocruz. Brazil.; (4)Dr. Neonatologist. Instituto Fernandes Figueira/ Fiocruz. Brazil.

**Background and objectives:** Due to the controversies between the studies, as well as to the importance of the theme for the health of the newborn, this systematic review aims to evaluate the studies that verified the effects of Omega 3 supplementation during pregnancy and/or puerperium on the composition of LH. The bibliographical survey with this theme aims to assist the maternal and child population as well as health professionals, in order to establish the importance of supplementation as well as offering subsidies for its practice. Objective: To evaluate the effect of supplementation of Omega 3 sources on the fatty acid composition of human milk.

**Methods:** The review consisted of the search for articles published in PubMed, Virtual Health Library and Web of Science databases using the following keywords: "Fatty acids, Omega-3, Human milk and Supplementation", for which we have used the PRISMA checklist. The following selection criteria were used: articles published in English, Portuguese, Spanish or Italian, published between 2000 and 2015 and carried out in humans, according to the established strategy, resulting in 710 articles.

**Results:** All studies found a positive relationship between the consumption of Omega-3 sources and their concentration in human milk. The differences in the findings are due to the different methods used such as, for example, the specific moment of Omega-3 supplementation, the type of Omega-3 source offered, as well as sample size.

**Conclusions:** Although the studies were different in several methodological aspects, it was possible to observe the importance of Omega-3 supplementation in gestation and/or puerperium.

**Keywords:** Pregnant women; Breastfeeding; Human milk; Omega-3 Fatty Acids; Systematic review.
COMPARISON OF TOTAL LIPID AND FATTY ACID INTAKE ACCORDING TO THEIR DAILY DISTRIBUTION: RELATIONSHIP WITH STUNTING IN CHILDREN FROM ECUADOR

**Background and objectives:** It must be considered that, in childhood, the contribution of fats is essential for correct growth, vigorous physical activity and optimum intellectual development, and therefore it is necessary to maintain an adequate contribution. Our objective was to compare the daily lipid intake in the different meal times and to link the fatty acids consumption with stunting in schoolchildren of Andean region.

**Methods:** The study included 100 middle-aged children, 7.8 ± 2.17 years old, from a rural community school in Chimborazo, Ecuador. A nutritional survey was used for the registration of the food intake. The dietary consumption was evaluated, in each food time, and was calculated from the corresponding standard portion size. The total lipid and fatty acid (FA) consumption was determined transforming these data into food volume/weight (gr or ml), as appropriate, and through the latest available information in food-composition tables from Ecuador. The standard deviation score of height, applying the Child Growth Standards of Word Heath Organization (2006 and 2007) and Anthropplus, was used for nutritional status evaluation. Children were classified in stunting (height for age <-2 SD) and normal (height for age ≥-2 SD). The daily intake was analysed using the general linear model, corrected by Bonferroni, which was adjusted for sex, age and body mass index. The children were divided into two groups, stunting and normal stature.

**Results:** The contribution of fats at breakfast was higher than the other mealtimes, except lunch. The intake of total lipids in the collation at mid-morning (provide by government of Ecuador at school) was greater than middle afternoon, while in the evening collation was lower compared with all meal times. Children also presented a higher contribution of saturated FA in breakfast compared to collation. Regarding nutritional status, the saturated FA intake was higher in schoolchildren who had normal height than these who had stunting.

**Conclusions:** In schoolchildren from rural communities of Chimborazo, the main lipid intake comes from breakfast. Stunting children have a lower contribution of saturated fatty acids in relation to those with normal stature.

**Keywords:** fatty acids; mealtimes; saturated fatty acids; children.

PERCEPTION OF HEALTHY EATING AND DAILY DIETARY INTAKE IN CHILDREN AND ADOLESCENTS OF FACATATIVÁ, COLOMBIA

**Background and objectives:** The perception of healthy eating is a useful tool to identify beliefs, ideas and concepts about this term. In childhood, these factors contribute to eating behaviours and patterns. For this reason, it was analysed the differences in dietary intake according to the perception of healthy eating in children and adolescents.

**Methods:** It was included 33 children and adolescents (8-14 years old) of Facatativá, Colombia. The perception of healthy eating was obtained through a semi-structured questionnaire, based on the model used in previous studies. The narrative responses were codified and grouped into 6 categories "eating fruits and vegetables", "eating all food groups", "foods that help us grow healthy", "foods that give vitamins", "eating vegetables and proteins", "do not eat sweets or junk food". To determine the daily dietary intake, a food frequency questionnaire with 33 item was used.

**Results:** The mean of age of population was 9.8 ± 1.7 years, and for fish, milk and gran intake was 8.24 ± 11.77, 244.67 ± 192.65 and 16.01 ± 16.15 grams, respectively. The participants who reported, as healthy eating, "eating fruits and vegetables" had a lower grain consumption than "do not eat sweets or junk food" group (p=0.032). The daily fish and milk intake was higher in children who responded, "do not eat sweets or junk food" than those who said, "foods that help us grow healthy" (p=0.037) and "eating fruits and vegetables" (p=0.003), respectively.

**Conclusions:** Children and adolescents who consider a healthy eating as "do not eat sweets or junk food" present a higher intake of fish, milk and grain. This suggest that the perception of healthy eating may affect the dietary patterns in these stages of life.

**Keywords:** Perception of healthy eating; daily dietary intake; fish intake; milk intake; grain intake.

<footnote>(1)Guerendiain, Marcela; (2)Ligerini Vázquez, Lorena Johana;</footnote>

<footnote>(3)Mayorga Mazón, Clara de las Mercedes; (2)Monzón Rodríguez, Allyson Natalie; (2)Menendez Blanco, Cintya Yanella.</footnote>

<footnote>(1)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador;</footnote>

<footnote>(2)Nutritionist. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)MSc. Nutritionist. School of Nursing. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>

<footnote>(1)Rojas Infante, Diana Milena; (2)Guerendiain Margni, Marcela Esther.</footnote>

<footnote>(1)Nutritionist. Pontificia Universidad Javeriana. Bogotá. Colombia.; (2)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>
NUTRITIONAL STATUS AND CHILD DEVELOP-
MENT OF PRE-SCHOOL CHILDREN IN BHUTAN

(1) Kang, Yunhee; (2) Aguayo, Victor; (3) Campbell, Rebecca; (4) Dzed, Laigden; (5) Joshi, Vandana; (6) Waid, Jillian; (7) Haselow, Nancy; (8) West, Jr., Keith.

(1)PhD. Postdoctoral fellow. Department of International Health. Johns Hopkins School of Public Health. USA.; (2)PhD. Associate Director. Chief Nutrition. UNICEF. New York. USA.; (3)PhD. Department of International Health. Johns Hopkins School of Public Health. USA.; (4)PhD. Sr.Program officer. Ministry of Health. Royal Government of Bhutan.Thimphu. Bhutan.; (5)PhD. Nutrition Specialist. UNICEF Bhutan. Thimphu. Bhutan.; (6)PhD. Helen Keller International New York. USA.; (7)PhD. Vice President for Asia-Pacific. Helen Keller International. USA.; (8)DrPh. Professor. Department of International Health. Johns Hopkins School of Public Health. USA.

**Background and objectives:** Few nationally representative studies exist reporting on the nutrition and development of Bhutanese pre-school children. Using the National Nutrition Survey (NNS) 2015 and Multiple Indicator Cluster Survey 2010 (MICS-4), we evaluated household-, maternal-, and child-level risk factors for undernutrition among children aged 6 to 59 mo (n=1,506) and examined associations between early development indicators and nutritional status among children aged 36 to 59 mo (n=2,038).

**Methods:** Prevalences of stunting, wasting, underweight (height-for-age, weight-for-height, weight-for-age Z-scores, respectively, <-2) and overweight (weight-for-height Z-score>2) were estimated adjusting for survey design. Ten-item early child development index (ECDI) scores were created using UNICEF guidelines to assess four domains: literacy and numeracy, learning, physical, and socio-emotional. ECDI was defined as "on track" for children with satisfactory scores in 3 or 4 domains. Logistic regression, adjusting for sampling design, was conducted to identify predictors of undernutrition and its association with development indicators.

**Results:** The prevalence of stunting, wasting, underweight and overweight were 21.2%, 2.5%, 7.3% and 2.6%, respectively. In multivariable regressions, risk of stunting increased with age: 5.2% at <6 mo (referent), 17.1% at 6-23 mo (OR=3.59; 95%CI: 0.74, 17.4) and 24.9% at 24-59 mo (OR=6.12; 95%CI: 1.40, 26.9) and was lower among children of university-educated (OR=0.05; 95%CI: 0.00, 0.89) compared to uneducated mothers. No examined variables were significantly associated with wasting or overweight. Percentages of children who met literacy and numeracy, learning, physical, and socio-emotional were 25.5%, 99.6%, 61.4%, and 93.2%, respectively; 66.1% children were found "on track". Literacy and numeracy was negatively associated with stunting (OR=0.64; 95%CI: 0.48, 0.86), severe stunting (OR=0.55; 95%CI: 0.36, 0.83), and severe wasting (OR=0.17; 95%CI: 0.03, 1.08) providing a clear linkage between these aspects of development and chronic undernutrition. ECDI was negatively associated with severe stunting (OR=0.66; 95%CI: 0.47, 0.93). No other associations were found between nutritional status and developmental outcomes.

**Conclusions:** Whereas weight-for-height is superimposed on the WHO referent distribution, one-fifth of Bhutanese preschoolers are stunted, a condition that is negatively associated with children's literacy and numeracy achievement and maternal education. Severely stunted children require remedial care, both nutritionally and to promote catch-up in aspects of their development.

**Keywords:** stunting; risk factors; early child development index; literacy and numeracy; Bhutan

ANALYSIS OF THE ASSOCIATION BETWEEN NU-
TRITIONAL STATUS AND DIETARY INTAKE IN
CHILDREN AND ADOLESCENTS OF FACATATIVÁ,
COLOMBIA

(1) Rojas Infante, Diana Milena; (2) Guerendiain Margni, Marcela Esther.

(1) Nutritionist. Pontificia Universidad Javeriana. Bogotá. Colombia.; (2) PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.

**Background and objectives:** The food intake is one of the most important factors that determines the nutrition and health in childhood. For this reason, it was analysed the relationship between the nutritional status and daily dietary intake in children and adolescents of Facatativá, Colombia.

**Methods:** A descriptive cross-sectional study was conducted, involving 33 children and adolescents (9.8 ± 1.7 years old). The nutritional status was defined according to the standard deviation score of height and body mass index (BMI), using the Child Growth Standards of Word Heath Organization, 2006 and 2007, adapted for the Colombian population in 2016. Taking into account the BMI-for-age, children and adolescents were classified in: thinness (< -2 SD), risk of thinness (≥-2 to <-1 SD), normal (≥-1 to ≤+1 SD), overweight (>+1 to ≤+2 SD) and obesity (>+2 SD). Considering the height, they were divided in: stunting (height-for-age <-2 SD), risk (height-for-age >-2 to <-1 SD) and normal (height-for-age ≥-1 SD). The daily dietary intake was assessed using a food frequency questionnaire with 33 item.

**Results:** The mean of weight was 32.9 ± 9.5 kg and for height 1.3 ± 0.1 m. The 39.4% of children had risk of stunting and 48.5% normal height; the 63.6% presented a normal BMI and 21.2% excess weight. It was found relationship between the standard deviation score of height-for-age and the butter intake (-0.482, p=0.005). The daily intake of tomato had an inverse association with the weight (p=0.043) and positive with the standard deviation score of height-for-age (p=0.032). The BMI presented a negative relationship with daily carrot consumption (p=0.038), and the intake of sugar was positively associated with the height.

**Conclusions:** As expected, it has been found relationship between food intake and nutritional status. Tomato and carrot consumption, could have beneficial effects on the nutritional status
of children and adolescents in rural Colombia. Further studies on
sugar and butter intake are required to support our results.

**Keywords:** Perception of healthy eating, daily dietary intake, fish intake, milk intake, gran intake.

(1)Robalino Flores, Ximena del Rocío; (1)Balladares Saltos, Aida Mercedes; (2)Cando Pilatúna, Rosario Isabel; (3)Guerendiain Margni, Marcela Esther.

(1)MSc. Laboratory Technician. School of Clinical Laboratory. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (2)MSc. Psychologist. School of Clinical Psychology. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.

**Background and objectives:** It is well known that the presence of anemia may affect the development in childhood, including the cognitive functions. However, the evidences on inhabitants of the Andean region are scarce or null. Hence, we studied the association between hematological parameters and cognitive development in children of Ecuador highlands.

**Methods:** Forty-three preschool children, from 5 to 6 years old, of the EVANES study, were recruited. To evaluate verbal, manipulative and full-scale intelligence quotient (IQ), the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) was used. The scores were classified according to the following criteria: extremely low (<70), borderline (70-79), low average (80-89), average (90-109), high average (>110) and superior (>120). Also, the IQ was grouped in low (<80) and normal (≥80). Blood samples were extracted by venipuncture, and hemoglobin and hematocrit concentrations were determined. Children were divided in anemic (hemoglobin <11.5 g/dL) and non-anemic. The data were analyzed using SPSS statistical software, and General linear model, with Bonferroni correction, and Spearman tests were applied.

**Results:** The hematocrit concentration was 43.14 ± 2.73% and the hemoglobin level 14.49 ± 0.94 g/dL. The means of verbal, manipulative and full-scale IQ were 86.46 ± 11.55, 96.39 ± 9.96 and 89.25 ± 10.43 points, respectively. No differences were found in subscales and full-scale IQ between anemic and non-anemic children, nor in hemoglobin and hematocrit concentration between normal and low IQ groups. However, it was observed positive correlation of tertiles of hematocrit level with the classification of manipulative IQ (extremely low, borderline, low average, etc.). In

addition, the manipulative and full-scale IQ were directly related to hemoglobin concentration tertiles.

**Conclusions:** A higher hemoglobin and hematocrit concentration is related to an elevated cognitive performance, in preschool children of Andean region of Ecuador.

**Keywords:** Cognitive development; intelligence quotient; hemoglobin; hematocrit; anemia.

(1)Padilla, Lowela; (2)Melse-Boonstra, Alida; (3)Ferrer, Eldridge; (4)Barba, Corazon; (5)Feskens, Edith.

(1)MSc. PhD Candidate. Division of Human Nutrition and Health. Wageningen University & Research. The Netherlands.; (2)PhD. Assistant Professor. Division of Human Nutrition and Health. Wageningen University & Research. The Netherlands; (3)MSc. Science Research Specialist. Food and Nutrition Research Institute. Philippines.; (4)PhD. Professor Emeritus. Institute of Human Nutrition and Food. University of the Philippines Los Banos. Philippines.; (5)PhD. Professor. Division of Human Nutrition and Health. Wageningen University & Research. The Netherlands.

**Background and objectives:** Adolescence is a period that provides an opportunity to address problems from early life. Yet, available information on adolescents are scarce, usually limited to sexual & reproductive health and often not disaggregated by sex, age, and other factors. This study aimed to establish the association of BMI and HFA Z-scores among male and non-pregnant, non-lactating female Filipino adolescents. Additionally, to characterize the pattern of growth of male and non-pregnant, non-lactating female Filipino adolescents.

**Methods:** This research is a cross-sectional secondary data analysis of the adolescent (10.0-19.0 years; n=33,404) data from the 2011 Updating of Nutritional Status of Filipino Children and other Population Groups conducted by the Food and Nutrition Research Institute (FNRI). Selection of social, economic factors in the dataset for inclusion in the analysis was determined a priori based on empirical data as well as those found associated with HFA and BMI Z-scores during bivariate correlations. Associations with Z-scores were determined through multiple linear regression.

**Results:** Among male and non-pregnant, non-lactating female Filipino adolescents, stunting rates decreased from pre-pubertal to pubertal stage and reverted back to even higher levels before puberty (M:38.5%-36.0%-39.1%; F:35.3%-30.4%-35.0%). An overall decreasing trend was observed for thinness (M:13.5%-9.7%-6.5%; F:15.0%-16.4%-12.6%) and overweight (M:7.2%-5.9%-6.8%; F:9.1%-5.8%-5.0%) as the Filipino adolescent grew older. Wealth index had the highest correlation with HAZ (r=.305, p<.01) as residence locality is for BAZ (r=.125, p<.01) according to bivariate correlations. After controlling for covariates in multiple linear re-
gression, household size showed consistently negative association with z-scores in both physiologic categories. Other strong predictors of z-scores were belonging to the richest quintile and being a widow/widower. Apart from educational attainment of household head and wealth index, there were no other clear trends observed in the associations of the different parameters to the z-scores.

**Conclusions:** The results of this study underscores the need to improve nutritional status prior to the onset of puberty to maximize vertical growth. On the other hand, interventions focused on sustaining nutritional gains during the post-pubertal stage should be similarly implemented without compromising BMI. Providing interventions that lead to improvement in wealth is a good place to begin with.

**Keywords:** Adolescent Nutrition, Filipinos, HAZ, BAZ

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ASSESSMENT OF MALNUTRITION RISK AND NUTRITIONAL STATUS OF OLDER PEOPLE AT HOSPITAL ADMISSION

(¹)Núñez, Iliana; (¹)Gómez, Milagros; (²)Rios, Israel.

(¹)Nutritionist. Nutrition and Dietetic Department. Medicine School. University of Panama. Panama city. Panama.; (²)MSc. Nutritionists. Nutrition and Dietetic Department. Medicine School. University of Panama. Panama city. Panama.

**Background and objectives:** Introduction: Malnutrition in the elderly is of multicausal origin even in hospitals. Objective is to evaluate the nutritional status and risk factors of older adults admitted to the geriatric acute ward of Irma De Lourdes Tzanetatos Hospital (ILTH).

**Methods:** Methodology: Observational, analytical and transverse study in 94 patients admitted to the geriatric ward of Irma De Lourdes Tzanetatos Hospital. Data were collected from January to March 2016. Included anthropometric measurements, nutritional risk screening according to Mini Nutritional Assessment (MNA), clinical and hospital data, Barthel Index and Charlson Comorbidity (CC); Biochemical data and sociodemographic information. Multivariate logistic regression was used to determine risk factors associated with malnutrition.

**Results:** Of the 94 patients, 51 (54%) were female, mean age 77.9 ± 8.2 years; 39.4% had cardiovascular disease admission diagnosis, 35.1% presented severe functional disability, 95.8% severe lean mass, according to the arm muscle area (AMA). According to MNA, 50.0% were malnourished; according to BMI, 54.2% were in the low weight category; And according to the CC, 45.7% with high comorbidity. Barthel's index, schooling, triceps skin fold (TS-Fmm) and arm circumference (ACcm) were significantly associated (R² = 0.61) with an increased risk of malnutrition according to MNA (OR = 46.5, p = 0.001, OR = 13.8, p = 0.009, OR = 0.78, p = 0.005, OR = 0.73, p = 0.046, respectively). For nutritional status according to BMI, Barthel's index and pre-albumin were significantly associated (R² = 0.43) with low weight (BMI <23kg / m2), (OR = 14.3, p = 0.003 and OR = 0, 91, p = 0.024, respectively).

A second model to determine low-weight risk according to BMI showed a significant association (R² = 69) with TS-Fmm, ACcm, pre-albumin and number of drugs in use (OR = 0.78, p = 0.010, OR = 0.51, P = 0.000, OR = 0.92, p = 0.043, OR = 0.65, p = 0.045, respectively).

**Conclusion:** Barthel's Index, schooling level, triceps skin fold and arm circumference were associated with an increased risk of malnutrition. Barthel's index, prealbumin, skin fold of the triceps, arm circumference and number of drugs are associated with low weight according to BMI.

**Keywords:** Older adults, malnutrition, MNA, anthropometry.

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PRO-INFLAMMATORY TRIGGERS IN SCHOLARS: LEPTIN, IL-6, FIBRINOGEN, AND HIGH-SENSITIVITY C-REACTIVE PROTEIN

(¹)Alvarez Cordova, Ludwig Roberto; (²)Santana Porben, Sergio;

(³)Sierra Nieto, Victor Hugo; (⁴)Fonseca Perez, Diana Maria; (⁵)Rojas Criollo, Melina Isabella; (⁶)Escobar Valdivieso, Gustavo Saul;

(⁶)Espinoza Caicedo, Jason Amadeus; (⁷)Moran Zuloaga, Juan Luis.

(¹)Medical doctor. Magister in Clinical Nutrition. Institute of Biomedicine. University Chatolic of Santiago of Guayaquil. Ecuador.; (²)Medical doctor. Magister of Public Health. University of La Habana. Cuba.; (³)Economist. Magister in Sciences. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.; (⁴)Nutritionist. Magister in Clinical Nutrition. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.; (⁵)Nutritionist. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.; (⁶)Biologist. Institute of Biomedicine. University Catholic of Santiago of Guayaquil. Ecuador.; (⁷)Nutritionist. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.

**Background and objectives:** Obesity is a major health problem shown to be associated with a pro-inflammatory state. Adipocyte dysfunction results in the expression of pro-inflammatory mediators which, in turn, contribute to the development of chronic inflammation states. We documented the serum levels of leptin and their association with markers of systemic inflammation in obese children.

**Methods:** Cross-sectional study of 46 scholar children (Boys: 45,7%). BMI, waist circumference and body fat percentages were obtained by means of anthropometric and bioimpedance techniques. Leptin, fibrinogen and C-reactive protein measurements were made by recommended analytical protocols in fasting blood samples.

**Results:** Average BMI was 23,28 ± 4,39 kg/m2. Only 6.5% of the children had elevated CPR values. In sharp contrast with this finding, leptin values were increased in 93,5% of them.

**Conclusions:** Obesity is associated with increased leptin values. This finding confirms the presence of a state of insulin resistance resulting from adipocyte dysfunction. The increase in leptin values precedes the rise of inflammation markers that will eventuate
ally lead to endothelitis and atherosclerosis. Obese children are at
high risk of cardiovascular disease.

**Keywords:** Pediatric Obesity; Body Composition; Inflammation; Leptin; Nutritional Assesment

THE VARIETY AND DIVERSITY OF THE DIET OF BREASTFED INFANTS AND YOUNG CHILDREN FROM THE PROVINCE OF BAJA VERAPAZ IN GUATEMALA IS LOW

**Background and objectives:** The WHO recommends exclusive breastfeeding for 6 months, followed by the progressive introduction of safe, nutritious and appropriate complementary foods (CF). Qualitative research in the province of Baja Verapaz indicates both premature and delayed introduction of CF. We aimed to assess the dietary variety and diversity of CF offered to infants and young children (IYC) aged 6 to 23 months old in this setting.

**Methods:** Convenience samples of IYC aged 6-8 months (n=6), 9-11 months (n=9) and 12-23 months (n=13) were derived from distinct sites and ethnicities across the province of Baja Verapaz. We aim to increase the sample size to 100 in the near future. IYC diets were assessed by means of previous-day dietary recalls collected from mothers. Dietary diversity among breastfed infants was computed using the WHO food groups which include: (i) grains, roots and tubers, (ii) legumes and nuts, (iii) dairy products (milk, yogurt, cheese), (iv) flesh foods (meat, fish, poultry and liver/organ meats), (v) eggs, (vi) vitamin-A rich fruits and vegetables and (vii) other fruits and vegetables. Dietary variety was calculated by adding all food items mentioned within these food groups; non-nutritive beverages and food were not included.

**Results:** Most IYC had been breastfed the day of the interview (n=23, 82%) and all breastfed infants were receiving CF. The most commonly consumed foods were corn-dough tortilla (consumed by 19), banana (n=9), rice (n=8), sweet bread (n=7) and Incaparina® gruel (n=7). IYC consumed a median of 5 food and beverage items, and dietary variety ranged between 2 and 9. Median dietary diversity was 3, and ranged between 1 and 6 food groups. Median dietary diversity was 2, 3 and 3 at for IYC aged 6-8, 9-11 and 12-23 months, respectively. Only 4(14%) of breastfed IYC consumed a minimum dietary diversity, as recommended by the WHO.

**Conclusions:** No instance of protracted EBF was documented in the 6-8 month period. However, the variety and diversity of CF offered to IYC in Baja Verapaz is alarmingly low and unlikely to be nutritionally adequate. Further investigation into the quality of the diet of IYC is merited.

**Keywords:** infant and young child feeding, minimum dietary diversity, dietary variety, human milk, Guatemala

**Further collaborators**

This research was conducted in collaboration with the Global Alliance for Improved Nutrition (GAIN) with funding from the Inter-American Development Bank

BREASTFEEDING AND PRESCHOOL CHILDREN INTELLIGENCE QUOTIENT IN RURAL HIGHLANDS IN ECUADOR

**Background and objectives:** The nutrition during the early stages of life, is essential for an adequate neurological development. Beneficial effects of breast milk were reported even in pre-term infants. Thus, our objective was to analyse the relationship between breastfeeding and intelligence quotient in children from a rural school in Chimborazo.

**Methods:** The study included 37 children, belonging to EV-ANES project, aged 5 to 6 years, from San Juan primary school, in Chimborazo, Ecuador. They were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI™). A survey to parents was applied to identify the duration of exclusive breastfeeding and age of weaning. The breastfeeding parameters were divided into quartiles (Q1: ≤5, Q2: 6-6; Q3: 7-9 and Q4: >10 months, for exclusive breastfeeding, and Q1: ≤12, Q2: 13-18; Q3: 19-24 and Q4: >25, for weaning age). The verbal, manipulative and total intelligence quotient (IQ) was classified as extremely low (<70), borderline (70-79), low average (80-89), average (90-109), high average (>110) and superior (>120). Data analysis was performed by applying Chi-square test. Differences were considered significant at p<0.05. This study was conducted in accordance to the ethical rules of the Declaration of Helsinki and was approved by the Ethic Committee of the San Francisco de Quito University.

**Results:** The means of total, verbal and manipulative IQ scores were 89.25 ± 10.43, 86.46 ± 11.55 and 96.39 ± 9.96, respectively. Likewise, the value of duration of exclusive breastfeeding

<footnote>(1)Montenegro-Bethancourt, Gabriela; (2)Garcia-Meza, Rosario;</footnote>

<footnote>(3)Gonzalez, Wendy; (4)Vossenaar, Marieke; (5)Solomons, Noel W.</footnote>

<footnote>(1)PhD. Researcher. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala; (2)MA. Researcher. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (3)PhD. Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland.; (4)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.;</footnote>

<footnote>(5)MD. Director. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.</footnote>

<footnote>(1)Díaz Silva, Alicia Virginia; (2)Cando Pilatuña, Rosario Isabel;</footnote>

<footnote>(3)Guerendiain Margni, Marcela Esther.</footnote>

<footnote>(1)Psychologist. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (2)MSc. Psychologist. School of Clinical Psychology. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>
was 7.61 ± 4.34 months and the age of weaning was 17.89 ± 6.28 months. The manipulative IQ registered three levels, low average, average and high average, and there were no extremely low, borderline and superior scores. When we compared the quartiles of duration of exclusive breastfeeding according to the classification of intelligence quotient, it was observed that the average manipulative IQ was more frequent in the higher quartiles, and the low average level in Q1 (p=0.039). Although, no differences for weaning age were found.

**Conclusions:** The duration of exclusive breastfeeding may be a key factor in cognitive development of preschool children. However, further studies are required since other environmental factors could be influencing the results.

**Keywords:** Breastfeeding; cognitive development; intelligence quotient; preschool children; highlands.

practices were inappropriate; 41% of the children attained a minimum dietary diversity; only 27% attained minimum acceptable diet and 76% attained minimum meal frequency. With the exception of the minimum meal frequency, adjusted logistic regression findings showed that infants living in food secure households were significantly more likely to achieve appropriate infant feeding practices than those in food insecure households: minimum meal frequency (AOR 1.26, p= 0.530); minimum dietary diversity (AOR 1.84, p= 0.046) and minimum acceptable diet (AOR 2.35, p= 0.008).

**Conclusions:** The present study adds to the body of knowledge by showing how household food security relates to infant feeding practices in low-income settings. The findings imply that interventions aimed at improving infant feeding practices and ultimately nutritional status need to also focus on improving household food security.

**Keywords:** Infant feeding practices, household food security, urban informal settlements, complementary feeding

(¹)Njoki, Teresia; (²)Ochola, Sophie; (³)Mutua, Martin; (⁴)Kimani-Murage, Elizabeth.

(¹)BSc. Research Officer. Health Program. African Population and Health Research Center. Kenya.; (²)PhD. Senior Lecturer and Chairman. Foods Nutrition and Dietetics department. Kenyatta University. Kenya.; (³)MSc. Data Analyst. Health Program. African Population and Health Research Center. Kenya.; (⁴)PhD. Research Scientist. Health Program. African Population and Health Research Center. Kenya.

**Background and objectives:** Studies in the urban informal settlements show widespread inappropriate infant and young child feeding (IYCF) practices and high rates of food insecurity. These together with unique challenges with regards to child survival in these settings has led to widespread and persistent under-nutrition rates. Globally, few studies have explored the linkage between food security and infant feeding practices. This study assessed the association between household food security and IYCF practices in two urban informal settlements in Nairobi, Kenya.

**Methods:** The study adopted a longitudinal study design that involved a census sample of 1110 children less than 12 months of age and their mothers aged between 12-49 years. A researcher-administered questionnaire was used to collect information on infant and young child feeding practices (initiation of complementary foods, dietary diversity, frequency of feeding and minimum acceptable diet); household food security; maternal demographic and socio-economic characteristics. Logistic regression was used to determine the association between food insecurity and IYFC practices having controlled for maternal demographic and socio-economic characteristics as these may influence IYFC practices.

**Results:** The findings showed high household food insecurity as only 17.4% of the households were food secure. Infant feeding

(¹)Dibley, Michael; (²)Huda, Tanvir Mahmudul; (³)Rahman, Mohammad Masudur; (⁴)Raihana, Shahreen; (⁵)Tahsina, Tazeen;

(⁶)Rahman, Qazi Sadeq-ur; (⁷)Islam, Sajia; (⁸)Arifeen, Shams El;

(⁹)Agho, Kingsley; (¹⁰)Raynes-Greenow, Camille.

(¹)Professor in Global Public Health Nutrition. Sydney School of Public Health. Sydney Medical School. The University of Sydney. Australia.; (²)Research Associate and PhD Candidate. Sydney School of Public Health. Sydney Medical School. The University of Sydney. Australia.; (³)Senior Research Investigator. MBBS. MHE. MPS. Maternal and Child Health Division. icddr.b. Bangladesh.; (⁴)Research Investigator. MPHRM. MPH. Maternal and Child Health Division. icddr.b. Bangladesh.; (⁵)Senior Research Investigator. Maternal and Child Health Division. icddr.b. Bangladesh.; (⁶)Senior IT Specialist. Maternal and Child Health Division. icddr.b. Bangladesh.; (⁷)Research Investigator. BDS. MPH. Maternal and Child Health Division. icddr.b. Bangladesh.; (⁸)Senior Director and Senior Scientist. PhD. Maternal and Child Health Division. icddr.b. Bangladesh.; (⁹)Senior Lecturer. School of Health Sciences. Western Sydney university. Australia.; (¹⁰)Senior Research Fellow. Sydney School of Public Health. Australia

**Background and objectives:** Iron-deficiency is the most common nutritional deficiency globally. Due to the high iron requirements, it is highly prevalent and severe in pregnant women. Our objective was to evaluate if iron-folic acid supplementation starting in the first trimester of pregnancy and sustained throughout pregnancy reduces neonatal mortality.