**Methods:** 3215 adolescents of the HELENA study, 12.5-17.5 y, who completed >75% of the NKT and did not answer all the questions right or all the questions wrong were included in the analyses. The NKT consisted of twenty-three multiple-choice questions with four possible answers including the 'don't know' category. The dimensionality of the questionnaire was analyzed by the polychoric correlation matrix in factorial analysis with estimation by principal components analysis. The answers were analyzed by the three parameters logistic model. Discrimination, difficulty and guessing parameters and scores (measure of the construct) were estimated in scale (0,1). IRT parameters were estimated using Bilog-MG software. Other analyses were performed using Stata version 14.

**Results:** NKT was related to a single dimension scale. Twelve questions presented low discrimination of nutritional knowledge and were excluded from the scale. The discrimination, difficulty and guessing parameters varied from 0.88 to 1.65, from -2.13 to 1.50 and from 0.09 to 0.01, respectively. The scores estimates varied from -0.83 to 0.83. 11 questions showed a good empirical reliability (0.69) and were appropriate in classifying adolescents who present median nutrition knowledge scores.

Nutritional knowledge scale was classified in three different levels: 1) basic, including knowledge about energy expenditure and ingredients from recipes; 2) adequate, including knowledge about nutrients from foods and their role on health; and 3) advanced, including basic and advanced nutritional terms.

**Conclusions:** The IRT gives guidance in tailoring nutrition knowledge among adolescents. An 11 multiple-choice questions NKT is proposed as a new approach when aiming to classify adolescents according to their nutrition knowledge.

**Keywords:** Nutritional knowledge, IRT, Multiple choice-test.

**Background and objectives:** Polyunsaturated fatty acids (PUFA) may contribute beneficially to cardiovascular health, intellectual development and cognitive function. However, epidemiologic evidence is limited and inconsistent for PUFA intake and mortality, especially in a worldwide comparative study level. Our aim is to systematically evaluate associations between dietary intake of PUFA and mortality in a Sino-American national joint study.

**Methods:** We utilized data from the China Health and Nutrition Survey (CHNS, 1989-2011, n=14,323) and American

National Health and Nutrition Examination Survey [NHANES, 1988-1994 (III), continuous 1999-2010 (n=36,032)]. Participants with cardiovascular disease or cancer at baseline were excluded. A median follow-up duration of 14 and 9.8 years was conducted for CHNS and NHANES, respectively. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

**Results:** A total of 4826 and 1009 deaths accrued over 378,359 person-years of follow-up in NHANES and 199,091 person-years in CHNS, respectively. Intake of marine long-chain n-3 PUFA [eicosapentaenoic (EPA) + docosahexaenoic acids (DHA)] was significantly associated with a reduced risk of all-cause mortality in CHNS. In multivariable-adjusted model, the HRs across increasing intake levels were [0.63 (95% CI, 0.52-0.75), 0.72 (95% CI, 0.60-0.87), 0.74 (95% CI, 0.61-0.89); P<0.001 for trend] as compared with the lowest level. However, this inverse association was only observed in certain category of marine long-chain n-3 PUFA intake in NHANES. A weak inverse association was found between α-linolenic acid (ALA) intake and mortality in NHANES (P=0.04 for trend), whereas high intake level of ALA was related to an increased risk of mortality in the fourth quartile compared with first quartile [1.23 (95% CI, 1.01-1.51); P=0.05 for trend] in CHNS. Increment of arachidonic acid was associated with lower risk of mortality both in NHANES and CHNS, whereas linoleic acid intake was inversely linked with mortality only in NHANES. Importantly, a U-shape association of n-6/n-3 intake ratio with mortality was observed in CHNS.

**Conclusions:** Different types of dietary PUFA have divergent associations with mortality. The associations also vary between the two different ethnic populations. Our findings highlight preventive maintenance of n-6/n-3 balance diet and provide evidence-based insights into dietary PUFA recommendations for both Chinese and Americans.

**Keywords:** Polyunsaturated fatty acids; n-3 PUFA; n-6 PUFA; Mortality; Sino-American joint study

**Further collaborators:** Yu Zhang. PhD. Nutritionist. Department of Food Science and Nutrition. College of Biosystems Engineering and Food Science. Zhejiang University. China.
## INTAKE OF ULTRA-PROCESSED FOODS IN UK ACCORDING TO SOCIOECONOMIC AND DEMOGRAPHIC CHARACTERISTICS (2008–12)

(1)Rauber, Fernanda; (2)Louzada, Maria Laura da Costa; (2)Steele, Euridice Martínez; (3)Millett, Christopher; (2)Monteiro, Carlos; (4)Levy, Renata.

(1)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. FAPESP's Post-Doctoral fellowship nº 16/14302-7. Brasil.; (2)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. Brasil.; (3)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Universidade de São Paulo. Brasil. Public Health Policy Evaluation Unit. School of Public Health. Imperial College London. United Kingdom.; (4)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. Brasil.

**Background and objectives:** Ultra-processed food consumption has increased in the past decade and evidence has shown that higher intake is associated with obesity and poor diet quality. The aim of this study was to describe how ultra-processed food consumption, as defined by NOVA classification, varied according to sex, age, and household income in UK.

**Methods:** Analysis of data from the UK National Diet and Nutrition Survey (2008–12). Dietary information was collected using four-day, unweighted, food-diaries. Ultra-processed foods were defined as formulations mainly or solely of industrial ingredients. Percentage of energy intake provided by ultra-processed foods was compared by sex, age group and income quintiles.

**Results:** Ultra-processed food consumption did not significantly differ between men (57.1% of total energy) and women (56.4%). Adolescents (68.3%) and children (64.2%) consumed a higher percentage of energy from ultra-processed foods than adults (54.9%) and elderly (52.1%). Adolescents obtained significantly more energy than others age groups from French fries, soft and fruit drinks, packaged salty snack, and pizza; while children obtained significantly more energy from breakfast cereal, sausage, confectionary, biscuits, and milk-based drinks. The consumption of ultra-processed foods significantly decreased from the lowest (57.2%) to the highest quintile (53.5%) of household income. Among the subgroups, the energy contribution of French fries, soft and fruit drinks, margarine, and packaged salty snacks significantly decreased across quintiles of the household income.

**Conclusions:** Consumption of ultra-processed foods in UK was significantly higher among those with lower income levels. It was particularly higher in children and adolescents for whom they made up 2/3 of total energy intake.

**Keywords:** Food processing; ultra-processed food; NOVA; UK.

## CHANGES IN ANAEMIA PREVALENCE AND PROGRAMMATIC COVERAGE AMONG CHILDREN AGED 6 TO 59 MONTHS IN KARAMOJA BETWEEN 2006 AND 2016

(1)Mokori, Alex; (2)Mokori, Alex; (3)Kwagala, Rebecca; (4)Ahumuza, Gracious.

(1)MSc. Nutrition Specialist. UNICEF Uganda; (2)Kampala; (3)MSc. UNICEF. Uganda; (4)BSc. Nutritionist. Department of Human Nutrition and Technology. Makerere University. Uganda.

**Background and objectives:** Karamoja, an agro-pastoralist semi-arid region in Uganda has the highest prevalence of anaemia in the country. Although the region recorded a reduction in anaemia in 2016, there is no evidence of what could have contributed to this reduction. The study explored the plausible programmatic packages that reduced anaemia in Karamoja between 2006 and 2016.

**Methods:** Secondary analysis data from Uganda Demographic and Health Surveys 2006, 2011 and 2016. Children aged six to 59 months living with their mothers in Karamoja were studied.

**Results:** Anaemia decreased from 82.2 percent in 2006, 69.5 percent in 2011 to 67.7 percent in 2016. DPT3 and measles immunization increased by 12.2 percent in 2011. The proportion of children who had had diarrhea together with malaria and cough decreased by 1 percent from 10.2 percent in 2006 to 9.2 percent in 2011. Coverage with all three programs of bednets, deworming and vitamin A supplementation increased from 8.5 percent in 2006 to 23.0 percent in 2011. The proportion of children benefitting from one program decreased from 47.8 in 2006 to 30.5 percent in 2011, those from two programs increased from 21.7 to 25.9 percent. The percentage which never benefitted from any preventative program decreased from 21.7 in 2006 to 17.8 percent in 2011. Children who benefitted from more programs were less likely to have anaemia (p<0.005, OR=0.797). Although consumption of minimum acceptable diet improved, it was not significantly associated with anaemia between 2006 and 2011.

**Conclusions:** Although anaemia among children aged six to 23 months reduced in Karamoja in 2016, it remains of a high public health significance. The increased coverage with packages of programs has contributed to this reduction. Improved coverage with immunization, deworming, vitamin A supplementation, bed nets and adequate complementary feeding will likely reduce anaemia in Karamoja.

**Keywords:** Childhood anaemia, immunization, programs, vitamin A supplementation
# IMPACT OF COMMUNITY HEALTH CLUBS ON CHILD DIARRHOEA, NUTRITIONAL STATUS, AND WATER QUALITY IN WESTERN RWANDA: CLUSTER-RANDOMISED CONTROLLED TRIAL

(1)Sinaroy, Sheela; (2)Schmidt, Wolf-Peter; (3)Wendt, Ronald; (4)Mfura, Leodomir; (5)Crossett, Erin; (6)Grépin, Karen A.; (7)Jack, William; (8)Ngabo Rwabufigiri, Bernard; (9)Habyarimana, James; (10)Clasen, Thomas.

(1)PhD Candidate. Nutrition and Health Sciences Program. Emory University. USA.; (2)PhD. Assistant Professor. Faculty of Infectious and Tropical Diseases. London School of Hygiene and Tropical Medicine. UK.; (3)MIA. Research Manager. Innovations for Poverty Action. USA.; (4)BA. Senior Research Associate. Innovations for Poverty Action. USA.; (5)MIDP. Research Assistant. McCourt School of Public Policy. Georgetown University. USA.; (6)PhD. Associate Professor. Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada; (7)PhD. Assistant Professor. Department of Economics. Georgetown University. USA.; (8)MSPH. Research Assistant. School of Public Health. National University of Rwanda. Rwanda.; (9)PhD. Provost's Distinguished Associate Professor. McCourt School of Public Policy. Georgetown University. USA.; (10)PhD. Professor. Department of Environmental Health. Emory University. USA.

**Background and objectives:** Community health clubs (CHCs)—multi-session village-level gatherings led by trained facilitators, designed to promote healthful behaviors primarily related to water, sanitation, hygiene—have been implemented in several African and Asian countries but have never been rigorously evaluated.

**Methods:** We conducted a cluster-randomised trial to evaluate the health impact of two versions of the CHC model in Rusizi district, western Rwanda. We randomly selected 150 villages and enrolled 8734 households with children under five years of age in a baseline survey in 2013. We randomly allocated villages to three groups: no intervention (control, n=50), eight sessions (Lite, n=50), or 20 sessions (Classic, n=50). We re-enrolled 7934 (91%) of the households in an endline survey in 2015. The primary outcomes were caregiver-reported diarrhea within the previous seven days in children under five years of age and nutritional status of children under two years of age at baseline, measured through length-for-age (LAZ) and weight-for-length (WLZ) z-scores. We measured intermediate outcomes related to water, sanitation, and hygiene. Analysis was by intention to treat and per-protocol. The trial is registered with ClinicalTrials.gov (NCT01836731).

**Results:** We observed no impact on caregiver-reported diarrhea in the Lite (PR=0.97, 95% CI: 0.81-1.16) or the Classic group (PR=0.99, CI: 0.85-1.15). We observed no impact on LAZ in the Lite (β=-0.05, 95% CI: -0.07-0.17) or the Classic (β=-0.03, 95% CI: -0.08-0.14) group, nor on WLZ in the Lite (β=-0.002, 95% CI: -0.08-0.07) or the Classic (β=-0.02, 95% CI: -0.06-0.09) group. The Classic intervention had a positive impact on reported household water treatment (RD=0.086, 95% CI: 0.029-0.14), use of improved sanitation facilities (RD=0.085, 95% CI: 0.015-0.16), and presence of structurally complete sanitation facility (RD=0.065, 95% CI: 0.0013-0.13). There was no impact on the remaining intermediate

outcomes, including improved microbiological water quality, in the Lite or the Classic group.

**Conclusions:** CHCs, in this setting in western Rwanda, had no impact on caregiver-reported diarrhoea among children under five years of age, LAZ or WLZ among children under two years, or water quality. Our results call into question the value of implementing this intervention at scale for the purposes of achieving health gains in the short term.

**Keywords:** WASH, stunting, wasting, sanitation, dietary diversity

# DOES CONTEXT INFLUENCE BRAZILIAN WORKERS' BODY MASS INDEX? RESULTS FROM THE ELSA-BRASIL STUDY BASELINE

(1)Pereira de Castro Junior, Paulo Cesar; (2)Araújo Nobre, Aline;

(3)Rugani Ribeiro de Castro, Inês; (4)Chor, Dora; (5)Härter Griepp, Rosane; (6)de Oliveira Cardoso, Letícia.

(1)PhD student, Nutritionist, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil; (2)PhD, Researcher, Scientific Computing Programme, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil; (3)PhD, Nutritionist, university professor, Institute of Nutrition, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil; (4)PhD, Researcher, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil; (5)PhD, Researcher, Laboratory of Health and Environmental Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; (6)PhD, Nutritionist, Researcher, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.

**Background and objectives:** There is growing recognition of environmental effect on obesity by scientific community. In middle and low-income countries there are few studies evaluating the influence of contextual factors on obesity, especially regarding the perception about food and physical activity environments. This study investigates how food and physical activity environments associate, separately and jointly, with body mass index (BMI) in 10,445 adult Brazilians, from 35 to 74 years old, who participated in the longitudinal study of adult health (Estudo Longitudinal de Saúde de Adulto, ELSA-Brasil).

**Methods:** Food environment and physical activity environment were evaluated separately and jointly (combined environment) on a neighbourhood perception scale adapted to the Brazilian context. First, individual scores were calculated for perception of the environments, then an aggregate score was constructed for each of the three dimensions from the mean perceptions of ELSA participants residing in the same neighbourhood. BMI was analysed in continuous form, and gamma regression models with linked identify function were used.

**Results:** After adjustment for study centre, age, income, schooling, self-reported health, length of time physically active and consumption of vegetables, an inverse association between BMI and physical activity environment (β = -0.063 kg/m² CI: -0.106: -0.020)
and food environment (β = -0.175 kg/m² CI: -0.299: -0.051) was observed among the women, indicating that the better the environment, the smaller the BMI. Also, a stronger inverse association between BMI and favourable combined environment (β = -0.864 kg/m² CI: -1.343: -0.387) was identified, also among the women. Among the men, no association was found between exposures and outcome of interest.

**Conclusions:** The study findings indicate that contextual factors associate with obesity, demonstrating that choice of health-related habits is not solely a matter of individual responsibility, and that public policies should be implemented to favour healthier food and physical activity environments.

**Keywords:** Neighbourhood, Food environment, Physical activity environment, BMI.

144/1492

NORDIC DIET, MEDITERRANEAN DIET, AND THE
RISK OF CHRONIC DISEASES: THE EPIC-POTS-
DAM STUDY

(1)Galbete Ciaurriz, Cecilia; (1)Kröger, Janine; (2)Jannasch, Franziska;

(3)Schwingshackl, Lukas; (4)Schwedhelm, Carolina; (4)Iqbal, Khalid;

(5)Weikert, Cornelia; (6)Boeing, Heiner; (7)Schulze, Matthias.

(1)PhD. Department of Molecular Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany;

(2)Department of Molecular Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany;

(3)PhD. Department of Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany; (4)Department of Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany; (5)Department of Food Safety. Federal Institute for Risk Assessment. Berlin. Germany; (6)Prof.

Department of Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany; (7)Prof.

Department of Molecular Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany.

**Background and objectives:** The Mediterranean Diet (MedDiet) has been established as a healthy dietary pattern. However, its relation with risk of major chronic diseases in non-Mediterranean countries is still under debate. A healthy alternative proposed in Northern Europe is the Nordic Diet, although its beneficial effects on different chronic disease have been controversially demonstrated. We aimed at investigating the association between the Nordic Diet and the MedDiet and the risk of major chronic disease (type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer) in the EPIC-Potsdam cohort.

**Methods:** The EPIC-Potsdam prospective cohort recruited 27,548 participants between 1994 and 1998. After exclusion of participants with prevalent T2D, MI, stroke, or cancer, we evaluated the adherence at baseline to a score reflecting the Nordic diet and two different MedDiet scores; one based on the one created by Trichopoulou et al. (tMDS), and the other one based on the Mediterranean pyramid (MedPyr). Habitual diet intake was measured using food-frequency questionnaires. Multivariable-adjusted Cox regres-

sion models were applied to examine the association between the dif-
ferent diet scores and the incidence of T2D, MI, stroke, and cancer.

**Results:** During follow-up, 1,337 cases of T2D, 297 of MI, 331 of stroke, and 1,619 cases of cancer, were identified. Higher adherence to the Nordic diet showed an inverse association with the incidence of MI in the overall population and of stroke in men, although not statistically significant. Adherence to the MedDiet was associated with lower incidence of T2D for both scores (HR: 95%CI per 1 SD; 0.92: 0.87-0.98 for the tMDS, and HR: 0.91: 0.86-0.96 for the MedPyr score). The MedPyr score was also associated with lower incidence of MI in women, but not in men

**Conclusions:** In the EPIC-Potsdam cohort the Nordic diet showed a trend to decrease the risk for MI in the overall population and for stroke in men. Higher adherence to the MedDiet was associated with a decreased risk of T2D in the overall population and with a decreased risk of MI in women.

**Keywords:** Mediterranean diet, Nordic diet, chronic disease, EPIC-Potsdam Study

144/1554

THE CONTRIBUTION OF MICRONUTRIENT
DEFICIENCIES TO ANEMIA AND RED BLOOD
CELL (RBC) FOLATE INSUFFICIENCY AMONG
NON-PREGNANT WOMEN OF CHILDBEAR-
ING-AGE (WCBA) IN BELIZE

(1)Rosenthal, Jorge; (2)Alverson, CJ; (3)Cannon, Michael;

(4)Largaespada, Natalia.

(1)Ph.D., M.C. Epidemiologist. National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. United States; (2)M.Sc.,National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. Atlanta. United States.; (3)Ph.D.,National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. Atlanta. United States.; (4)MD, Chief, Maternal and Child Health Department. Ministry of Health. Belmopan. Belize.

**Background and objectives:** Although iron deficiency (ID) and other nutritional-related anemia is a significant public health concern among WCBA, relevant biomarkers are rarely concurrently measured. Iron and other nutritional deficiencies can have adverse effects on birth outcomes.

To estimate the population-attributable risk fractions (PARF) associated with risk factors for anemia and RBC folate insufficien-cy among non-pregnant WCBA in Belize.

**Methods:** In 2011, a national probability-based survey was completed among non-pregnant Belizean WCBA, 15-49 years. Blood samples to determine hemoglobin, ferritin, alpha-glycoprotein 1 (AGP), folate (RBC and serum) and vitamin B-12 and so-cio-demographic and health information were collected from 937 women. Adjusted prevalence risk ratios (PRRs) were estimated from logistic regression models to determine PARF contributing to anemia and RBC folate insufficiency.

**Results:** The overall prevalence of anemia (<12 g/dL) was 21.8% (95%CI 18.3, 25.8), ID (<15 µg/L) 12.0% (95%CI 9.0, 15.8);
AGP-adjusted ID (<15 µg/L) 15.0% (95%CI 11.60, 19.2); serum folate deficiency (<14 nmol/L) 11.0 (95%CI 8.3, 14.4); RBC folate deficiency (<624 nmol/L) 35.1% (95%CI 30.8, 39.8); RBC folate insufficiency (<748 nmol/L) 50.3% (95%CI 45.4, 55.1); and vitamin B-12 deficiency (<221 pmol/L) 49.8% (95%CI, 45.0, 54.6). We estimated that 30.2% (95%CI 20.4, 41.3); 8.0% (95%CI 1.9, 17.8) and 1.8% (95%CI 0, 11.4) of anemia cases were attributable to iron deficiency, serum folate and vitamin B-12 deficiency, respectively. We also estimated that 13.9% (95%CI 4.1, 24.0) and 6.2% (95% CI 2.8, 10.8) of RBC folate insufficiency cases were attributed to vitamin B-12 and serum folate deficiency, respectively.

**Conclusions:** To our knowledge, this is the first national study to present data on the substantial contribution of iron deficiency, folate deficiency and vitamin B-12 deficiency to the reduction of anemia and RBC folate insufficiency among women of childbearing-age in a low or medium income country.

**Keywords:** Population-attributable risk fractions, Micronutrient deficiencies, Anemia, Iron deficiency, Folate deficiency and insufficiency

IMPLEMENTING FOOD-BASED DIETARY GUIDELINES TO GUIDE POLICIES, PROGRAMMES AND NUTRITION EDUCATION

(¹)Wijesinha Bettoni, Ramani; (²)Khosravi, Ashraf; (³)Hernandez-Garbanzo, Yenory; (⁴)Sherman, Jane; (⁵)Vargas, Melissa; (³)Islas Ramos, Ana.

(¹)PhD; (²)BSc. Student (former volunteer at FAO), Metropolitan University College, Copenhagen, Denmark.; (³)PhD. Nutrition Officer. Food and Agriculture Organization of the United Nations. Italy.; (⁴)MSc. Independent Nutrition Education Consultant. Italy.; (⁵)MSc. International Nutrition Consultant. Food and Agriculture Organization of the United Nations. Italy.

**Background and objectives:** The need for food-based dietary guidelines (FBDGs) to guide national food-related policies and programmes including nutrition education programmes is increasingly recognized. Several sources such as the Framework for Action from the Second International Conference on Nutrition, the Global Nutrition Report 2015, and the Foresight Report, 2016, published by the Global Panel on Food Systems for Nutrition have highlighted the potential role for FBDGs in shaping healthy diets. However, there has been a lack of information on how FBDGs are actually implemented by national entities, and a lack of guidance on carrying out implementation. The aim of this study was to obtain a snapshot of country actions of FBDGs implementation.

**Methods:** To explore if current implementation covers the different levels of influence on people's food choices, namely personal/interpersonal factors, institutional/community, and the enabling environment, the "social-ecological" framework was used. A literature review covering key scientific databases and grey literature was carried out in 2016. The findings helped shape questions for a key informant survey. Responses were received from 47 key informants in 27 of the 34 countries contacted, mostly from developed countries.

Key informants included staff and researchers in government ministries, national nutrition organizations and academia. Responses therefore built a picture mainly of government-led activity rather than of informal actions and impacts.

**Results:** Implementation activities that had a direct link to the FBDGs were identified from various countries. These included some policy actions (such as school meal/institutional food standards and vending machine/cafeteria food standards in line with FBDGs), programmes (e.g. food assistance programmes, two examples of agriculture programmes, examples of food labelling/food advertising guided by the FBDGs, and reformulation of food to comply with the FBDGs), and many consumer education programmes. Information on evidence of effectiveness was collected, where available.

**Conclusions:** Some preliminary recommendations on how to maximize the impact of FBDGs are given, which include the need for a consumer-centred approach; an implementation plan with built in monitoring, evaluation, and funding; the need to target all policies/programmes that influence food, and the need to target policymakers as well as educators and the general public.

**Keywords:** Food-based dietary guidelines, implementation, food-systems.

**Further collaborators:**

We are very grateful to all those who participated in the key informant survey. We would also like to thank the working group made up of FAO staff and external experts (Jeanette Andrade, Minna Huttunen, Sarah Levesque, Ellen Meuhlhoff, Veronica Molina-Barrera, Celeste Naude, Sonia Olivares, Aileen Robertson and Fernanda Villamarin), who have been reviewing the resource documents FAO is preparing, on FBDGs implementation possibilities for various sectors and settings. We would also like to acknowledge useful review comments provided by others who were not part of the working group, in particular Karen Fukofuka, Ann Hayman and Sirpa Sarlio-Lähteenkorva, and other colleagues from FAO. Following review by a wider group of experts, these materials will be made available free to countries. For FAO work on FBDGs, see: http://www.fao.org/nutrition/education/food-dietary-guidelines/home/en/

THE EFFECTS OF THE DANISH TAX ON SATURATED FAT ON NUTRIENT INTAKE AND MODELLED HEALTH OUTCOMES FOR DIFFERENT SOCIO-DEMOGRAPHIC GROUPS: AN ECONOMETRIC AND COMPARATIVE RISK ASSESSMENT EVALUATION

(¹)Smed, Sinne; (²)Dejgård Jensen, Jørgen.

(¹)Department of food and research Economics, University of Copenhagen; (²)Professor. Economist. Department of Food and Resource Economics. University of Copenhagen.

**Background and objectives:** The WHO recommends the use of fiscal policies to promote healthy eating, but underline that the use of fiscal instruments might have potential regressive effects. However, there is very limited real-life evidence of the effect of food taxation, and even less on the potential regressive effects,
as most evidence is based on simulation studies. The objective of this study is to evaluate the effect of the Danish tax on saturated fat in terms of changes in nutritional quality of the diet i.e. changes in saturated fat consumption as well as other non-targeted dietary measures and to model the associated changes in NCD mortality for different socio-demographic groups.

**Methods:** Based on household scanner data we estimate the impact of the tax on consumption of saturated and unsaturated fat, salt, fruit, vegetables and fiber. The resultant changes in dietary quality are then used as inputs into a comparative risk assessment model (PRIME) to estimate the effect of these changes on Non-Communicable Disease mortality. We estimate the effects for four different educational groups; no education, vocationally trained, short tertiary education and long to medium tertiary education, using education as a proxy for socio-demographic status.

**Results:** The tax resulted in a 4.0% reduction in saturated fat intake on average with largest decrease among those with no education or medium to long tertiary education. Vegetable consumption increased especially for vocational trained and short educated. Salt consumption increased for most individuals, but mostly for short educated. We find a modelled reduction in annual NCD mortality per 100.000 persons of 3 lives saved for those with no education, 5.1 lives saved for the vocationally trained, 1.7 lives extra lost for the short educated and no change for the medium to long educated. All educational groups experience an increase in food-expenditure due to the tax. Largest increases are found for short and medium to long educated.

**Conclusions:** Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive contribution to public health in Denmark. The effects are regressive in terms of NCD mortality, but progressive economically

**Keywords:** Fat tax, progressivity, NCD mortality

**Conflict of Interest Disclosure:** None of the authors have financial relationships with any organization, that might have had an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work.

## SERUM PENTADECANOIC ACID, A BIOMARKER OF DAIRY FAT INTAKE, IS ASSOCIATED WITH LOWER RISK OF INCIDENT CARDIOVASCULAR DISEASE AND ALL-CAUSE MORTALITY IN SWEDISH MEN AND WOMEN

(1)Marklund, Matti; (2)Leander, Karin; (3)Vikström, Max; (4)Laguzzi, Federica; (5)Gigante, Bruna; (1)Sjögren, Per; (6)Cederholm, Tommy; (7)de Faire, Ulf; (8)Hellénius, Mai-Lis; (9)Risérus, Ulf.

(1)PhD. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University. Sweden.; (2)PhD. Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine. Karolinska Institutet. Sweden.; (3)MSc. Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine. Karolinska Institutet. Sweden.; (4)Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine. Karolinska Institutet. Sweden.; (5)PhD. Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine. Karolinska Institutet. Sweden. Division of Cardiovascular Medicine, Department of Clinical Sciences. Danderyds Hospital. Karolinska Institutet. Sweden.; (6)MD, PhD. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University. Sweden.; (7)MD, PhD. Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine. Karolinska Institutet. Sweden. Department of Medicine, Cardiology Unit. Karolinska Institutet, Karolinska University Hospital. Sweden.; (8)MD, PhD. Department of Medicine, Cardiology Unit. Karolinska Institutet, Karolinska University Hospital. Sweden.; (9)MMED, PhD. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University. Sweden.

**Background and objectives:** Dairy food is a major energy and nutrient source in many cultures. Studies assessing associations of milk and dairy intake with mortality and cardiovascular disease (CVD) have been inconsistent, in part possibly due to poor intake estimation. Circulating pentadecanoic acid (15:0) is commonly utilized as an objective biomarker of dairy fat intake. Here we evaluated associations of serum 15:0 with incident CVD and all-cause mortality in a Swedish population-based cohort study.

**Methods:** Serum cholesterol ester 15:0 was measured at baseline in 60-year-old men (n=2017) and women (n= 2133). With use of national registers, 578 incident CVD events and 568 deaths were identified during a median follow-up of 16.6 y in participants with no prevalent CVD at baseline (n=3785, 53% women). Associations of 15:0 with incident CVD and all-cause mortality were evaluated using Cox proportional hazard models. Serum 15:0 (expressed as proportion of total fatty acids) was assessed as a continuous variable and in quintiles. Nonlinear associations were evaluated by using restricted cubic splines.

**Results:** In multivariable-adjusted models (including sex, BMI, physical activity, smoking habits, alcohol intake, education, prevalent type-2 diabetes, and drug treated hypertension and hyperlipidemia), serum 15:0 was inversely associated with incident CVD in a linear dose-response manner: hazard ratio (95% CI) of the top vs bottom quintile, 0.75 (0.57-0.98). A nonlinear associa-
increased on average by 0.22 (p<0.05), 0.26 (p<0.05) and 0.32 (p<0.001) among women who cultivated vegetables in the home-stead, reared chickens and cultured fish respectively compared to women who did not follow these practices.

**Conclusions:** SPRING's FNS intervention enhanced food production practices, resulting in a diversification of women's diets among FNS participants.

**Keywords:** Diet community Bangladesh diversity SPRING

144/1695

MULTISECTORAL NUTRITION IN PRACTICE: ACCELERATING STUNTING REDUCTION THROUGH DECENTRALIZED MULTISECTORAL PLATFORMS IN YOROSSO DISTRICT, MALI

(1)Sanou, Dia; (2)Sodjinou, Roger; (3)Coulibaly, Bernard; (4)M'Mbakwa, Bienfait Eca; (5)Traore, Amadou; (6)Traore, Ousmane; (7)Diarra, Modibo; (8)Touré, Sidi El Moctar; (9)Zagre, Noel Marie; (10)Gervais, Suzanne; (11)Pelletier, David.

(1)Food and Agriculture Organization of the United Nations (FAO);

(2)UNICEF, New York City. USA; (3)Administrateur Civil Premier adjoint du Prefet, Yorosso, Sikaaso, Mali; (4)Nutrition Officer, UNICEF Mali, sous bureau de Sikasso, Mali; (5)PhD, Assistant Professor, University of Segou, Segou, Mali; (6)PhD, Executive Director, Association de Soutien au Développement des Activités de Population et Developpement (ASDAP), Bamako, Mali; (7)Point Focal SUN Mali, Bamaki, Mali; (8)Conseiller Technique, chargé des activités communautaires, ASDAP, Bamako, Mali; (9)PhD, Regional Advisor, UNICEF regional office for Western and Central Africa (WCARO), Dakar, Senegal; (10)PhD, Extension Associate, Cornell University, Ithaca, NY, USA; (11)PhD, Professor, Cornell University, Ithaca, New York, USA.

**Background and objectives:** Despite a decrease in the stunting rates in Mali, the estimated number of stunted children has increased from 0.90 to 0.94 million between 2012 and 2015. Sikasso, the Mali's most fertile region, was the most affected by stunting. Thus, the Government of Mali in collaboration with UNICEF and European Union has targeted Sikasso for the Africa Nutrition Security Partnership aimed at strengthening the enabling environment for multisectoral nutrition (MSN) focusing on stunting in Africa. This paper describes the project achievements with district MSN platform in Yorosso

**Methods:** A triangulation of methods were used including: a) documentation of workshop and meetings; b) key informant interviews; and c) SMART survey data to assess the impact of the intervention.

**Results:** Following a district multi-stakeholder workshop on nutrition, participants committed to implement key nutrition actions, which were compiled to form the district MSN road map. The road map was validated by the high level political authority at this level. An administrative decision was issued to officially establish the MSN platform with the mandate to coordinate, monitor and evaluate nutrition related plans of various actors;

facilitate joint planning and implementation of high impact interventions; and advocate for mainstreaming nutrition into development plans. Platform members were capacitated in multisectoral planning and implementation. The platform increased awareness and understanding of multidimensional nature of nutrition and stimulated coordinated implementation of nutrition sensitive interventions from health, agriculture, education and WASH. Overall nine sub-district platforms and 94 village MSN support groups were operationalized. There was a significant reduction in stunting rate in the district (30.2% in 2012 to 15.4% in 2016). Budgeting for nutrition in the local development plan was a major challenge. Additional challenges include staff turn-over requiring continuous renewal of advocacy/sensitization efforts and capacity building and capacity gaps within government and other stakeholders.

**Conclusions:** Involvement and leadership of the high level authority was crucial for the involvement of all stakeholders while commitment of the participating stakeholders to the platform principles and road map has accelerated improvement in nutrition indicators.

**Keywords:** Multisectoral nutrition; stunting; coordination, Sikasso, intervention

144/1703

ALIGNMENT OF WHEAT AND MAIZE FLOUR FORTIFICATION STANDARDS WITH WHO RECOMMENDATIONS IN COUNTRIES WITH MANDATORY FORTIFICATION

(1)Bobrek, Katya; (2)Broersen, Britt; (3)Aburto, Nancy; (4)Garg, Aashima;

(5)Serdula, Mary; (6)Beltran Velazquez, Filiberto; (7)Wong, Eugene C.;

(8)Pachón, Helena.

(1)BS Student. Emory College of Arts and Sciences. Emory University. USA.; (2)MSc. Nutritionist. Nutrition Division. World Food Programme. Italy.; (3)PhD, MSc. Chief. Nutrition Division. World Food Programme. Italy.; (4)PhD. Nutrition Specialist. Nutrition Section. UNICEF. USA.; (5)MD, MPH. Medical Epidemiologist. National Center for Chronic Disease Prevention and Promotion. Centers for Disease Control and Prevention. USA.; (6)MSc. Technical Officer, Regulatory Affairs. Evidence and Program Guidance, Department of Nutrition for Health and Development. World Health Organization. Switzerland.; (7)MPH. ORISE Fellow. National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. USA.; (8)PhD, MPH. Senior Nutrition Scientist & Research Associate Professor. Food Fortification Initiative & Emory University. USA.

**Background and objectives:** In 2009, the World Health Organization issued wheat and maize flour fortification recommendations for five micronutrients (iron, folate, vitamin B12, vitamin A, zinc). In 2016, WHO updated maize flour fortification recommendations for the same nutrients plus thiamine, riboflavin, niacin, pyridoxine, and pantothenic acid. WHO recommendations include fortification compounds and nutrient levels that, based on
per capita flour intake or availability, should be considered when only one food is fortified. This review evaluated alignment to WHO recommendations of flour fortification standards in countries with mandatory fortification.

**Methods:** Countries' grain availability and fortification standards were obtained from the Food and Agriculture Organization, the Food Fortification Initiative, and WHO. For each nutrient, countries' standards were assessed against WHO recommendations for compounds (e.g. recommended or not, not specified) and nutrient levels (e.g. less than, equal to, greater than).

**Results:** Official fortification standards were obtained for 61 of 85 countries with mandatory wheat flour fortification and for 15 of 16 countries with mandatory maize flour fortification. The number of standards with nutrients specified ranged from 60 for iron to 14 for vitamin B12 in wheat flour, and from 14 for iron to 0 for pantothenic acid for maize flour.

For wheat flour, among countries with standards, the number of standards with nutrient levels equal to or greater than WHO recommendations were 23 of 56 (folic acid), 3/21 (zinc), 2/14 (vitamin B12), and 2/14 (vitamin A). For maize flour, the corresponding numbers were 5/14 (folic acid), 0/13 (thiamine), 9/13 (riboflavin), 4/13 (niacin), 2/7 (vitamin B12), 2/10 (zinc), 3/9 (vitamin A), and 0/5 (pyridoxine).

For countries that included recommended iron compounds in their standards, 20/60 wheat flour and 3/14 maize flour standards had nutrient levels equal or greater than WHO recommendations for all iron compounds.

**Conclusions:** Preliminary results suggest that for most nutrients in countries' wheat and maize flour fortification standards using the suggested fortification compound, nutrient levels are lower than WHO recommendations. If these flours are the only fortified foods in countries, this may affect the public health impact of flour fortification in countries.

**Keywords:** Grains, enrichment, policies, micronutrients

IMPLEMENTATION OF A TOOL TO EVALUATE
POLICY ACTIONS AND COMMITMENTS OF
CHAIN RESTAURANTS IN CANADA

(1)Vanderlee, Lana; (2)Sacks, Gary; (3)Vergeer, Laura; (4)Robinson, Ella;

(5)Vandevijvere, Stefanie; (6)Swinburn, Boyd; (7)L'Abbé, Mary.

(1)PhD. Banting Postdoctoral Fellow. Department of Nutritional Sciences. University of Toronto. Canada.; (2)PhD. Senior Research Fellow. World Health Organization (WHO) Collaborating Centre for Obesity Prevention. Deakin University. Australia.; (3)BSc. Department of Nutritional Sciences. University of Toronto. Canada.; (4)BSc. Research Assistant. World Health Organization (WHO) Collaborating Centre for Obesity Prevention. Deakin University. Australia.; (5)PhD. Senior Research Fellow. Global Health, Food Policy, Obesity and NCD prevention. Department of Epidemiology and Biostatistics. University of Auckland. New Zealand.; (6)MD. MB ChB. FRACP. Department of Epidemiology and Biostatistics. University of Auckland. New Zealand.; (7)PhD. Earle W. McHenry Professor and Chair. Department of Nutritional Sciences. University of Toronto. Canada.

**Background and objectives:** Food company policies play an integral role in influencing the quality of the food environment and overall dietary habits. The objective of this study was to test methods to evaluate restaurant company commitments relating to the food environment, obesity and non-communicable diseases (NCDs).

**Methods:** This study builds on work of the International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) to monitor and benchmark food environment policies globally. The Business Impact Assessment – Obesity and related population-level nutrition (BIA-Obesity) tool adapts methods to evaluate nutrition-related commitments, performance and disclosure practices of the largest global food companies and distributors across four sectors (packaged food manufacturers, beverage manufacturers, restaurants and supermarkets). This preliminary study examined company commitments of the ten largest restaurant chains in Canada across eight domains (corporate nutrition strategy, relationships with external organizations, policy positions, product reformulation, product and menu labelling, promotion to children, product pricing and availability and selection) using company websites, social media accounts, annual reports, and media releases were scanned to identify policies.

**Results:** Ten top companies representing a total of 30% of the Canadian foodservice market share were included in this preliminary evaluation, including national and multinational companies. Of the ten companies, six mentioned 'nutrition' or 'health' in their mission statement or had a nutrition strategy; however, none mentioned obesity or NCDs. Eight companies reported having reformulated products for one or more nutrient, five reported ongoing reformulation, and two provided specific targets for future reformulation. Two chains published commitments to limit advertising to children, varying in strength. While all companies had nutrition information available on websites, only one company voluntarily listed calorie information on menu boards. No companies pub-
lished availability and selection policies, and few details on policies regarding funding relationships with external organizations or company policy positions were published on websites. Company scores according to the BIA-Obesity tool will be discussed.

**Conclusions:** Few major restaurant companies in Canada have published policy commitments to improve the food environment. Future work will include verifying policies with companies, testing these methods for scale up in other countries, and comparing company commitments to actions.

**Keywords:** Food industry, policy, food environment, food marketing

**Further collaborators:** For INFORMAS.

144/1758

THE DOUBLE BURDEN OF MALNUTRITION IN COLOMBIAN PREGNANT WOMEN

(1)Gaitan-Charry, Diego; (2)Vasquez, Efrain; (3)Gonzalez, Laura;

(4)Perez, Eliana; (5)Cediel, Gustavo.

(1)MD, PhD. Assistant Professor. Nutrition And Dietetics School. University Of Antioquia. Colombia; (2)BSc. National Faculty Of Public Health. University Of Antioquia. Medellin; (3)Phd. Professor. Nutrition And Dietetics School. University Of Antioquia; (4)Phd. Assitant Professor. Nutrition And Dietetics School. University Of Antioquia; (5)Phd. Postdoctoral Fellow. Faculty Of Public Health. University Of São Paulo.

**Background and objectives:** In Colombia, double burden of malnutrition (DB) has been evaluated by the coexistence of overweight and anemia at family level and at individual level in non-pregnant woman and children under 5 y old. However, DB has not been evaluated in pregnant population. Our goal was to estimate prevalence of DB in Colombian pregnant women.

**Methods:** We analyzed data from the Food and Nutrition National Survey 2010. Sample for this analysis comprised healthy pregnant women with available data of height, weight, hemoglobin, ferritin and C reactive protein. Nutritional status of participants was classified based on BMI for gestational age proposed by Atalah et al. Hemoglobin and ferritin were corrected based in WHO recommendation. The criteria for the evaluation of DB were coexistence of: 1) overweight and anemia, 2) overweight and iron deficiency anemia, or 3) overweight and iron deficiency (low ferritin).

**Results:** Data from 1761 pregnant woman were obtained; 15.9%, 52.3 %, and 31.8% in first, second and third trimester of gestation, respectively. Prevalence of DB according with criteria 1, 2, and 3 were, respectively: 6.1% (95%CI: 5.1-7.3), 4.4% (95%CI: 3.6-5.5), and 16.9% (95%CI: 15.2-18.7). By criteria 1, DB was 0.7% (95%CI: 0.2-2.9) first, 6.3% (95%CI: 4.9-8.0) second and 8.3% (95%CI: 6.3-10.9) third trimester of gestation. By criteria 2, DB was 0% first, 4.0% (95%CI: 2.9-5.4) second and 7.2% (95%CI: 5.3-9.7) third trimester of gestation. By criteria 3, DB was 4.3% (95%CI: 2.5-7.5) first, 16.4% (95%CI: 14.1-18.9) second and 23.1% (95%CI: 19.8-26.8) third trimester of gestation.

**Conclusions:** In Colombian DB in pregnant women increased during gestation course. Furthermore, DB evaluated by coexist of

overweight and iron deficiency affects at least one of four women during gestation. Because the potential health implications of DB on the life course, it is necessary that national surveys focus some analysis on this condition.

**Keywords:** Double burden malnutrition, pregnant women, iron deficiency, anemia, overweight

**Further collaborators:** Acknowledgments: Instituto Colombiano de Bienestar Familiar which provided date base.

144/1761

INITIAL SITUATION ASSESSMENT ON SCHOOL FOOD AND NUTRITION IN AFRICA

(1)Polo Galante, Andrea; (2)Kiamba, Josephine; (3)Mireles, Mauricio;

(4)Sablah, Mawuli; (5)AgBendech, Mohamed; (6)Sanou, Dia.

(1)Senior Nutrition Consultant FAO Nutrition and Food Systems Division. Rome. Italy; (2)Consultant FAO Regional Africa;

(3)Regional Project(s) Coordinator, FAO Regional Africa; (4)Director FAO Nutrition and Food Systems Division. Rome. Italy; (5)Former Senior Nutrition Officer FAO for Regional Africa; (6)Nutrition Officer, FAO Sub Regional for Africa.

**Background and objectives:** The United Nations Food and Agriculture Organization (FAO) is working to promote sustainable school food and nutrition in Africa. Recently FAO Africa undertook a regional situational analysis of school food and nutrition with the objectives to provide a regional perspectives of SFN programmes and policies in Africa and identify main gaps, challenges and opportunities in the delivery of SFN programmes in Africa, with particular reference to the nutrition and agriculture linkages.

**Methods:** A quantitative questionnaire was sent out to 46 African Union member states with FAO country offices where a team of stakeholders completed the survey. Forty one countries complete the questions.

**Results:** 90% of African countries are running at least one form of School feeding programme. However only four countries have universal programmes and most programmes are highly targeted. Four countries out of 41 have no school feeding programmes. Countries have prioritized school feeding objectives in in term of educational outcomes and hunger and secondly to deal with nutrition. Over-nutrition is not considered an important issue for consideration. About 54% of the Countries do not have dietary guidelines and 12% need to revise their guidelines. Ten specific challenges were highlighted by the survey: (1) Low coverage of schools; (2) Lack of policy or legal framework; (3) Weak political will and government ownership; (4) Lack of nutrition guidelines/standards for school meals; (5) Weak institutional arrangements and multi-sectoral coordination; (6) Insufficient financial, human, and technical capacities; (7) poor linkages with nutrition education; (8) Inadequate quantity and quality of school meals; (9) Poor infrastructure/facilities and (10) Lack of monitoring and evaluation mechanism.

**Conclusions:** Despite the fact that providing healthy, diversified, safe and nutritionally balanced meals in African schools is
recognized as a vital intervention to alleviating hunger & malnutrition and for children to grow well and learn well, current SFN have several weaknesses. Sustainable School Food and Nutrition should be re-designed to ensure sustainability, and improve nutrition knowledge.

**Keywords:** School feeding, dietary guidelines, assessment, nutrition education, policies

## MONITORING OF THE NATIONAL OIL AND WHEAT FLOUR FORTIFICATION PROGRAMME IN CAMEROON: APPLICATION OF A PROGRAMME IMPACT PATHWAY FRAMEWORK

(1)Mark, Henry; (2)Guintang Assiene, Jules; (3)Luo, Hanqi; (2)nankap, Martin; (4)Pattar, Amrita; (5)Killilea, David; (6)Engle-Stone, Reina.

(1)MSc. Nutrition Section. UNICEF. Nigeria.; (2)MSc. Nutrition. Helen Keller International. Cameroon.; (3)MSc. Graduate Group in Epidemiology. University of California, Davis. United States.; (4)BS. Department of Nutrition. University of California, Davis. United States.; (5)PhD. Nutrition & Metabolism Center. Children's Hospital Oakland Research Institute. United States.; (6)PhD. Department of Nutrition. University of California, Davis. United States.

**Background and objectives:** Since 2011 Cameroon has mandated the fortification of refined vegetable oil with vitamin A (target=40 IU/g, range=33-50 IU/g), and wheat flour with iron (60 mg/kg) and zinc (95 mg/kg). A 2012 interim impact assessment in Yaoundé and Douala indicated 76% of wheat flour samples were fortified and indicators of iron and zinc status in women and children were greater relative to prefortification values. However, only 44% of oil samples were fortified and indicators of vitamin A status were unchanged. We assessed Cameroon's food fortification programme using a programme impact pathway framework to identify barriers to optimal programme performance.

**Methods:** Using semi-structured interviews, data on inputs and processes were collected from factories of all active domestic producers of refined vegetable oil (n=9) or wheat flour (n=10). Twelve sentinel sites were selected for market and household surveys, including assessment of frequency of fortified food consumption by women and children (600 households total). Food samples were collected from factories, markets, and households for measurement of vitamin A (iCheck) and iron and zinc (ICP-OES) content.

**Results:** All factories had in-house methods (mostly qualitative) for testing the micronutrient content of fortified products, while 68% presented quality certificates for recent premix purchases. Industries cited premix import taxes and access to external laboratories as constraints. All but one factory oil sample had vitamin A content > 33 IU/g. Among the sentinel sites, 87% of n=393 market oil samples contained detectable vitamin A; 43% had levels > 33 IU/g. Among household oil samples, 86% contained detectable vitamin A; 46% contained > 33 IU/g. All factory flour samples appeared to be fortified, but only ~18% had mineral levels within 10% of the target. Among composite flour samples from markets

and households the mean iron and zinc content was 25 mg/kg and 43 mg/kg, respectively, ~45% of target levels.

**Conclusions:** The availability of fortified oil is encouraging and may partially reflect recent growth in the share of domestic oil production. The low levels of iron and zinc in wheat flour indicate the need for programme support, possibly through premix procurement and technical support for micronutrient analysis.

**Keywords:** Fortification, Micronutrient, Programme impact pathway, Implementation science, Vitamin A

**Conflict of Interest Disclosure:** This research was supported by a grant from Sight and Life to UC Davis (RES) and HKI (MN, JGA). The funding organization had no role in the study design, implementation, data interpretation, or dissemination. All other authors have no conflicts of interest to disclose.

## DUTCH FOOD-BASED DIETARY GUIDELINES: HEALTH AND SUSTAINABILITY COMBINED IN THE WHEEL OF FIVE

(1)Brink, Elisabeth; (2)Postma-Smeets, Astrid; (2)Stafleu, Annette;

(2)Wolvers, Danielle; (3)Van Dooren, Corné; (4)Van Rossum, Caroline;

(5)Geurts, Marjolein; (4)Toxopeus, Ido; (5)Van de Kamp, Mirjam; (4)Ocke, Marga.

(1)PhD. The Netherlands Nutrition Centre. The Hague, The Netherlands.; (2)PhD. The Netherlands Nutrition Centre (Voedingscentrum). The Hague. The Netherlands.; (3)MSc. The Netherlands Nutrition Centre (Voedingscentrum). The Hague. The Netherlands.; (4)PhD. National Institute for Public Health and the Environment (RIVM). Centre for Nutrition, Prevention and Health Services. Bilthoven. The Netherlands.; (5)MSc. National Institute for Public Health and the Environment (RIVM). Centre for Nutrition, Prevention and Health Services. Bilthoven. The Netherlands.

**Background and objectives:** End 2015 the Health Council of The Netherlands published the Dutch dietary guidelines 2015 which focus on dietary patterns and foods related to the prevention of chronic diseases, and take sustainability into account. The Netherlands Nutrition Centre (NNC) translated these guidelines to the general public, in order to offer practical tools that support behavioral change towards a healthier and more sustainable diet. The Wheel of Five (WoF) is the national counselling model.

**Methods:** With a mathematical approach (using Optimeal®) that takes multiple criteria into account the RIVM calculated optimal diets for different target groups (based on age, gender, activity level, preference and ethnicity). Criteria for this optimization were: complying with the Dutch dietary guidelines 2015, meeting the dietary reference values for energy and nutrients and fitting in with the different target groups' customary dietary patterns. Composition of foods consumed by each target group, and a ratio for foods inside and outside the WoF were considered. Maximum levels were set for the use of animal products. Based on the optimal diets the NNC established recommendations for daily amounts of
various food groups for the different target groups. RIVM calcu-
lated the nutrient content and greenhouse gas emissions (GHGE)
of the recommendations.

**Results:** The Wheel of Five shows recommended dietary pat-
terns that combine health benefits and nutrient provision, based on
foods that are customarily eaten in the Netherlands, taking sustaina-
bility into account. Foods high in saturated fatty acids, trans fatty ac-
ids, sodium, sugar or low in fiber are outside the WoF. The advice is
to eat mainly foods from the WoF. Foods outside the WoF should be
eaten neither too often nor in large quantities. GHGE was reduced
by around one third in diets omitting meat or by chosing diets that
contain more sustainable products within each food group.

**Conclusions:** The translation of the Health Councils' dietary guidelines resulted in a renewed Wheel of Five, the national counselling model. Using the Wheel of Five as a frame of reference, people can get an impression of their own dietary pattern, and an understanding of those areas in which they could make improvements.

**Keywords:** Food-based dietary guidelines, health, sustainability

**Further collaborators:**

Wieke van der Vossen
Valérie Klostermann
Elly Buurma-Rethans
Francy Venneman
Liesbeth Temme
Anne Hoillander

aged food products (n=5421 and n=5479) from 6 different super-
markets in Santiago, Chile. Foods were excluded if they required
reconstitution, had missing information or if total labelled energy
was estimated as incorrect (n=942). The initial (2016) and final
(2019) limits were used to evaluate if foods would receive a "High
in" Calories, Sodium, Sugars and/or Saturated Fats (initial/final,
solids: >350/275 kcal; >800/400 mg; >22.5/10 g; >6/4 g; liquids:
>100/70 kcal; >100/100 mg; >6/5 g; >3/3 g).

**Results:** Seven percent of foods had no added critical nutrients (n=720). In both 2015 and 2016, 63% of products had critical nutrients exceeding at least one initial limit indicative of a "high in" warning. Over 80% of snack foods, breakfast cereals/bars, sweet bakery goods and sweets would be classified as "high in calories", and over 80% of the latter two categories also as "high in sugars". Many (75%) savory sauces/spreads would be classified as "high in saturated fat". In 2015, only processed meats had >50% of products (54%) that surpassed the initial "high in sodium" limits that declined to 45% in 2016. Under the final phase limits, 17% of foods would have zero warning labels.

**Conclusions:** Between 2015 and 2016, only slight anticipatory
changes in the food supply were detected. Most products will have
to be reformulated or removed from the market if to avoid at least
one front-of-package warning label.

Funding: CONICYT-FONDECYT (R.K., Number: 3150183); and IDRC (C.C., M.R. Number: 107731-002).

**Keywords:** Law 20.606, INFORMAS, critical nutrients, food environment, Chile

144/1805

## CHANGES IN THE COMPOSITION OF THE FOOD SUPPLY IN ANTICIPATION OF THE IMPLEMENTATION OF THE CHILEAN LAW OF FOOD LABELING AND ADVERTISING: AN INFORMAS-BASED APPROACH

(1)Kanter, Rebecca; (2)Reyes, Marcela; (3)Swinburn, Boyd;

(4)Vandevijvere, Stefanie; (2)Corvalan, Camila.

(1)PhD. Unit of Public Health. Institute of Nutrition and Food Technology-University of Chile. Chile.; (2)MD, PhD. Unit of Public Health. Institute of Nutrition and Food Technology-University of Chile. Chile.; (3)MD. Department of Epidemiology and Biostatistics. University of Auckland School of Population Health. New Zealand.; (4)PhD. Department of Epidemiology and Biostatistics. University of Auckland School of Population Health. New Zealand.

**Background and objectives:** In 2012 Chile passed the Law of Food Labeling and Advertising (Law 20.606). The study objective was to evaluate potential anticipatory changes in the composition of the food supply ahead of the implementation of this law in June 2016. The law specifies limits for solids (per 100g) and liquids (per 100ml) in a 4-year increasingly stricter implementation, applying only to products with added sodium, sugars and/or saturated fat ("critical nutrients"). A product can have up to four "High in" front-of-pack warning labels, one for each critical nutrient and calories.

**Methods:** The INFORMAS framework for monitoring the composition of the food supply was used. In February 2015 and 2016, fieldworkers photographed a representative sample of pack-

144/1807

## PARENTS' COOKING SKILLS REDUCE CHILDREN'S CONSUMPTION OF ULTRA-PROCESSED FOODS

(1)Adriano Martins, Carla; (1)Machado, Priscila Pereira; (2)Louzada, Maria Laura da Costa; (3)Monteiro, Carlos.

(1)PhD candidate. Nutritionist. School of Public Health. Center for Epidemiological Studies in Health and Nutrition. University of Sao Paulo, Brazil.; (2)PhD. Nutritionist. Center for Epidemiological Studies in Health and Nutrition. University of Sao Paulo, Brazil.; (3)Professor. Departament of Nutrition. School of Public Health. Center for Epidemiological Studies in Health and Nutrition. University of Sao Paulo, Brazil.

**Background and objectives:** The consumption of ultra-processed foods is increasing in many countries and one of the possible determinants is the decrease of home cooking. Considering that parents are key people for children's health, this study analyzed the influence of parents' cooking skills on the children's consumption of ultra-processed foods.

**Methods:** Cross-sectional study with 657 child-parent pairs from nine private schools in São Paulo, Brazil. Food consumption data were collected through children's dinner dietary recall and food items were classified according to the 'NOVA Classification'. The parents' cooking skills were evaluated using the Cooking Skills Index – Brazil (CSI-Brazil), a 0-100 index specially designed
for this research and based on the Brazilian's Dietary Guidelines (2014). Linear regression analysis was used to test associations between the parents' cooking skills and the ultra-processed foods contribution on the total dinner energy intake, adjusting for socio-demographic variables: parent's age, gender, race, marital status, education, employment status; per capita family income and number of children in the house.

**Results:** The average age of the parents was 38.3 years old (SD 6.3) and the children's was 7.8 (SD 1.1). The parents were mostly women (93.2%), white (62.2%), married (88.3%), with incomplete higher education or more (51.4%), employed (71.4%), with per capita family income of up to ~USD 320.00/month (37.8%). These parents reached an average of 78.8 points (SD 14.8) according to the Cooking Skills Index - Brazil. Children's average dinner energy intake was 672.2 kcal, with 31.3% coming from ultra-processed foods. The average intake of ultra-processed foods ranged from 37.2% of total energy in the first quintile of the CSI-Brazil to 28.1% of total energy in the last quintile. The analysis showed that the increase of the parents' cooking skills was directly associated with the decrease of consumption of ultra-processed foods (β=-0.18 by quintile of the CSI-Brazil; p=0.008), remaining after adjustment (β=-0.16; p=0.020).

**Conclusions:** The findings of this study, the first that explores that relationship in Brazil, suggest that parents' cooking skills protect their children against the consumption of ultra-processed foods, indicating the need for a revaluation of cooking in order to promote adequate and healthy eating.

**Keywords:** Food. Culinary. Diet quality. Children. Parents.

**Further collaborators:** Source of funding: Sao Paulo Research Foundation/Processo FAPESP 2014/10155-4.

144/1808

EFFICACY OF A LOCALLY-PRODUCED MULTIPLE MICRONUTRIENT-FORTIFIED READY-TO-USE SUPPLEMENTARY FOOD (RUSF) FOR CHILDREN UNDER TWO YEARS IN CAMBODIA

(1)Borg, Bindi; (2)Sok, Daream; (3)Mihrshahi, Seema; (4)Griffin, Mark; (5)Chhoun, Chamnan; (6)Laillou, Arnaud; (7)Berger, Jacques; (8)Wieringa, Frank.

(1)PhD Candidate. School of Public Health. University of Sydney. Australia; (2)PhD Candidate. Department of Nutrition, Sport and Exercise. Copenhagen University, Denmark.; (3)PhD. Senior Research Fellow. School of Public Health. Sydney University. Australia.; (4)PhD. Adjunct Fellow. School of Public Health. University of Queensland. Australia.; (5)PhD. Director. Department of Post-Harvest Technologies and Quality Control. Ministry of Agriculture, Forestry and Fisheries. Cambodia.; (6)PhD. UNICEF. Cambodia.; (7)PhD. Director of Research. 5UMR-204 Nutripass. IRD. IRD/UM/SupAgro. Montpellier. France.; (8)PhD. Senior Researcher. 5UMR-204 Nutripass. IRD. IRD/UM/SupAgro. Montpellier. France.

**Background and objectives:** Cambodia's progress in combatting malnutrition has stalled. In 2014, 32% of all children under five years were stunted, 24% were underweight and 10% were wasted. This is due in part to poor quality complementary foods leading to

insufficient nutrient intakes. Therefore, UNICEF, the Cambodian Ministry of Agriculture, Forestry and Fisheries and IRD developed a locally-produced multiple micronutrient fortified lipid-based nutrient supplement (LNS) that can be used as a Ready-to-Use Supplementary Food (RUSF). The novel RUSF can be given to children to increase their intake of protein, energy and micronutrients.

This trial assessed the RUSF's efficacy in reducing growth faltering in comparison to CSB++, Sprinkles and a control group.

**Methods:** The trial was a nonblinded, cluster-randomised control trial. Healthy children aged 6-17 months (n=486) were allocated to one of three intervention groups or the control group for six months. The main outcome was anthropometric status (WHZ, HAZ, WAZ, MUAC).

**Results:** None of the interventions could completely prevent growth faltering, but children consuming the novel RUSF appeared to falter at a lower rate. The lowest decreases in base-endline z-scores were for the RUSF group, for WAZ [RUSF: -0.01 (-0.14, 0.11); control: -0.14 (-0.26, -0.01)]; HAZ [RUSF: -0.27 (-0.49, -0.05); control: -0.36 (-0.57, -0.15)]; and WHZ [RUSF: 0.00 (-0.17, 0.17); control: -0.10 (-0.28, 0.07)]. Increases in MUAC (cm) were greatest for CSB++ [CSB++: 0.27 (0.08, 0.47); RUSF: 0.22 (0.03, 0.42)].

Older children had slightly better outcomes, and children with lower anthropometric measures at baseline had larger increases over the intervention period, showing that the interventions were helpful for children with poorer nutritional status. Children who consumed more had better weight-related outcomes (WAZ and WHZ), but not HAZ, suggesting that weight is more amenable to intervention than height.

**Conclusions:** These results suggest that neither the commonly used supplements (Sprinkles and CSB++) nor the novel RUSF could prevent growth faltering. However, in comparison to the control group, all the supplements (particularly the novel RUSF, but also CSB++ and to a lesser extent, Sprinkles) contributed to improved nutritional status.

**Keywords:** Ready-to-use supplementary food (RUSF), lipid-based nutrient supplement (LNS), complementary feeding, CSB++, Sprinkles.

144/1816

COMPATIBILITY BETWEEN DIMENSIONS OF SUS TAINABLE DIETS (NUTRITIONAL ADEQUACY, EX POSURE TO FOOD CONTAMINANT AND 30% RE DUCTION OF GREENHOUSE GAS EMISSION): AN ANALYSIS BASED ON INDIVIDUAL DIET MODELING

(1)Maillot, Matthieu; (1)Vieux, Florent; (2)Gazan, Rozenn; (3)Darmon, Nicole.

(1)PhD. MS-Nutrition. France; (2)MSc. MS-Nutrition. France;

(3)PhD. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.

**Background and objectives:** To test the compatibility between nutritional adequacy, acceptable exposure to food contaminant and 30% reduction of greenhouse gas emissions at individual level.
**Methods:** Dietary data from the French national survey (2006) were crossed with the "SUStable" database (Gazan et al., 2016) which summarizes, for 204 representative food items, nutritional composition, 27 contaminants (including pesticides, heavy metals, mycotoxins, non dioxin-like polychlorinated biphenyls (NDL-PCBs) and dioxin-like compounds) and GreenHouse Gas Emissions (GHGE). Intakes of nutrients and contaminants, and GHGE were estimated for each adult (n=1808). For each individual, 4 iso-caloric modeled diets departing the least from his/her observed diet were designed to fulfill i) French nutrient recommendations (NUT model), ii) French recommendations and a 30% reduction of GHGE from observed (NUT_30%GHGE model), iii) French recommendations without exceeding observed contaminant exposures (NUTOX model) and iv) all together (NUTOX_30%GHGE). In each scenario, the percentage of individuals for whom it was not possible to model a diet was estimated. In case of infeasibility, the incompatible constraints (i.e. the constraints that made the model infeasible) were identified.

**Results:** The percentage of infeasible modeled diets was 1.4%, 25.3%, 2.7% and 27.5% in the NUT, NUTOX, NUT_30%GHGE and NUTOX_30%GHGE models respectively.

In infeasible NUT models, the constraint on energy (i.e. isocalory) was always incompatible with constraints on fiber, vit E and vit B1. In the NUT_30%GHGE models, constraints on energy and GHGE (i.e. 30% reduction) were always incompatible with each other.

Among infeasible NUTOX_30%GHGE models, the most frequent infeasible constraints were water (99.6%), GHGE (99.6%), fibre (96.4%), energy (95.9%), inorganic mercury (95.8%), calcium (93.4%), Methylmercury (89.6%), Non dioxin-like PCBs (89.4%), hexachlorobenzene (75.7%), PB (73.5%), potassium (65.7%) and CD (62%), DHA+EPA (60.2%).

**Conclusions:** For the first time, nutritional, toxicological and environmental dimensions were combined to design sustainable diets with individual diet modeling. The results showed that all dimensions are compatible for a majority of French adults. Compatibility between nutritional and environmental goals would be feasible for the majority of French adults. However, reaching those goals without exceeding observed contaminant exposures would be difficult or even infeasible, underlining the need to decrease the contamination of food to promote diet sustainability.

**Keywords:** Individual diet modeling, contaminant exposure, sustainable diet, nutritional adequacy, greenhouse gas emissions

**Background and objectives:** To identify individual dietary changes that simultaneously combine nutritional adequacy, acceptable exposure to food contaminant and 30% reduction of greenhouse gas emissions.

**Methods:** Dietary data from the French national survey were crossed with the "SUStable" database (Gazan et al., 2016) which summarizes, for 204 representative food items, nutritional composition, 27 contaminants (including pesticides, heavy metals, mycotoxins, non dioxin-like polychlorinated biphenyls (NDL-PCBs) and dioxin-like compounds) and GreenHouse Gas Emissions (GHGE). Intakes of nutrients and contaminants, and GHGE were estimated for each adult (n=1808). For each individual, 4 iso-caloric modeled diets (using linear programming) departing the least from the observed diet were designed to fulfill i) French nutrient recommendations (NUT model), ii) French nutrient recommendations and a 30% reduction of GHGE from observed (NUT_30%GHGE model), iii) French nutrient recommendations without exceeding observed contaminant exposures (NUTOX model) and iv) all together (NUTOX_30%GHGE). The sub-sample of adults having a feasible diet for each model was kept for analyses. Solid energy density (SED), diet cost and food content were compared in observed and modeled diets.

**Results:** Seventy-two percent of adults had a feasible solution for each model. In nutritionally adequate diets (NUT model) SED decreased compared to observed diets (144 vs 179kcal/100g) and diet cost and GHGE increased (8.3 vs 7.2 euros/d; 4574 vs 4325 g CO2eq/d, in NUT and observed diets, respectively). In the NUTOX_30%GHGE diets, SED (178kcal/100g) did not differ from the observed and diet cost (6.7 euros/d) decreased. Compared to observed diets, vegetables, refined starches, meats and tea-coffee increased or remained stable in the NUT diets (+55g/d, +3g/d, +3g/d, +73g/d respectively) but decreased in NUTOX_30%GHGE diets (-22g/d, -18g/d, -49g/d, -306g/d respectively) due to contaminant constraints for refined starches and tea-coffee, GHGE reduction constraint for meats and both constraints for vegetables. Fresh fruits, fish and water increased in NUT diets (+148g/d, +21g/d, +561 g/d, respectively) but that increase was attenuated in the NUTOX_30%GHGE diets (+104g/d, +1.5g/d and 450g/d, respectively), mainly due to contaminant constraints.

**Conclusions:** Nutritional, environmental, toxicological, cultural and economic goals should be considered simultaneously when designing sustainable diets, as the food choices needed to achieve them separately aren't necessarily the same.

<footnote>(1)Maillot, Matthieu; (2)Vieux, Florent; (3)Darmon, Nicole.</footnote>

<footnote>(1)MS-Nutrition; (2)PhD. MS-Nutrition. France; (3)PhD. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.</footnote>
NUTRITIONAL STATE, NUTRIENT INTAKE AND PHYSICAL ACTIVITY IN PRIMARY SCHOOL CHILDREN: A REPRESENTATIVE SAMPLE FROM SAO PAULO, BRAZIL

(1)Dan, Milana; (2)Eldridge, Alison.

(1)PhD. Nutritionist. Nestle Brazil. Sao Paulo. Brazil; (2)PhD. Nutritionist. Institute of Nutritional Science. Nestle Research Center. Lausanne. Switzerland.

**Background and objectives:** There is growing interest in investigating the prevalence and factors associated with obesity in children. Brazil is experiencing a nutritional transition characterized by a reduction in the prevalence of nutritional deficits and an increase in overweight and obesity. However, there are only limited data on dietary habits and behaviors of Brazilian children. Our objective was to evaluate nutrient intakes, eating patterns, weight status, level of physical activity and associated demographic characteristics of primary school children in the metropolitan region of Sao Paulo, Brazil.

**Methods:** A cross-sectional study in 1000 children aged birth-12y was conducted in the metropolitan region of Sao Paulo, including 439 7-9y olds. Participants were randomly selected and stratified by sex, age and social class. Weight status (underweight, normal, overweight or obese) was calculated based on measured height and weight and evaluated using the Body Mass Index, according to World Health Organization criteria (WHO, 2007). Physical activity and screen time were measured using the Children Physical Activity Questionnaire adapted to the recommendations of the Brazilian Society of Pediatrics (SBP, 2008). Two non-consecutive 24-hour recalls were conducted to estimate food and nutrient intakes. Energy, macronutrient and micronutrient intakes were calculated using Brazilian and American food composition tables. Statistical analysis were performed using SPSS version 18.0.

**Results:** Almost 50% of the primary school children aged 7-9y in the metropolitan region of Sao Paulo were found to be overweight (25.6%) or obese (23.6%) and also to have unhealthy life-styles. We observed high levels of sedentary behavior (prevalence of low physical activity was 49% and 75.3% of school children reported screen-time of more than four hours daily). Caloric intakes were high (1728 ± 680 kcal / day) and were above recommendation for children at this age-range with a low physical activity level. In general, the children had inadequate daily intakes of calcium (62%) and vitamin D (90%).

**Conclusions:** The prevalence of overweight and obesity among primary school-aged children in Sao Paulo is already high, with low levels of physical activity, high screen-time, and an energy rich diet. Prevention strategies are needed to reverse this trend, with opportunities for school-based interventions and improved parental education.

IMPACT OF A DIGITAL FACEBOOK CAMPAIGN ON THE PURCHASE AND CONSUMPTION OF FOOD IN MEXICAN FAMILIES WITH CHILDREN UNDER 12 YEARS: A SOCIAL MARKETING STRATEGY

(1)Anzo, Anahi; (2)Klassen-Wigger, Petra; (3)Luna-Carrasco, Javier;

(4)Monroy-Gómez, Jimena.

(1)Msc. Nutritionist. Methodology Department. National Institute of Pediatrics. Mexico; (2)PhD. Scientific Advisor. Corporate Nutrition Health and Wellness Unit. Nestlé. Switzerlad; (3)MSc. Nutritionist. Nutrition Health and Wellness. Nestlé. México;

(4)BsC. Nutritionist. Nutrition Health and Wellness. Nestlé. México.

**Background and objectives:** Social networking sites have been widely used in public health and prevention interventions to change behavior and improve healthy habits. The nutrition transition in Mexico has been associated with a sharp rise in obesity rates. Whereas traditional foods continue to be consumed, urban dwellers have adopted diets with more animal products, vegetables, fruits, fast foods and soft drinks. Among the drivers of food choice are availability, cost, cultural norms, personal beliefs and the proximal food environment. Higher obesity rates are being observed in urban areas.

The emergence of social media has transformed health-related communication and changed the way people consume health information. This intervention study aimed to evaluate the impact of a digital campaign on changes in the habits of purchase and food consumption of Mexican families in urban areas.

**Methods:** A quasi-experimental study was implemented around a locally-designed digital campaign. It lasted five months with pre and post campaign evaluations. The intervention consisted of a United for Healthier Kids online campaign to promote healthy eating habits. Selection criteria: A subset of households with children under 12 years of age, desktops or laptops with access to the Internet, socioeconomic level a/c and c +, belonging to nationally representative consumer panel of Kantar in Mexico. They are chosen to represent and reflect consumer behavior.

**Results:** Pre-intervention households with higher socioeconomic levels spent more on low nutritious food so far which calorific beverages were consumed most. After three months of intervention, consumption of fruits and vegetables was increased, especially in households with children under 4 years old (p <.001) where 1 in2 consumed these foods 3 or more times per week and 9 of every 10 households consumed them during lunch.

**Conclusions:** A locally designed digital campaign to encourage the purchase and consumption of healthy foods resulted in increased consumption of vegetables and fruits and decreased consumption of pastry and fast food among the target group. This digital campaign with appropriate customization offers the possibility of being a useful addition to existing efforts that could be implemented in other communities to promote healthy eating habits.
**Keywords:** Social marketing intervention, healthy habits, food consumption.

CAN CONDITIONAL CASH TRANSFER COMBINED WITH NUTRITIONAL SUPPLEMENTATION PLAY A ROLE IN REDUCING CHILD STUNTING IN RURAL MALI?

**Background and objectives:** The World Food Program implemented a conditional cash transfer intervention (~€2.30 per month) coupled with a nutritional supplementation (Plumpy'doz*), targeting pregnant women and children under two during the 1,000-day window of opportunity, to prevent stunting in Kayes region, Mali. The objective of this study was to assess the impact of the intervention on child stunting.

**Methods:** We conducted a cluster randomized trial, with health community centers (CHCs) randomized in 4 intervention arms: Arm 1, control; Arm 2, cash to women attending prenatal follow up and postnatal visits (childhood immunization and growth monitoring); Arm 3, distributions of Plumpy'doz* (PPDoz) to children attending growth monitoring sessions and Arm 4, cash and PPPDoz. In all 4 arms, the program provided health and nutrition education activities as a basis. We compared repeated cross-sectional samples of 12-42 months old children surveyed before the intervention (2013, n=5046) and at the end of the intervention (2016, n=5098), through a difference-in-differences approach using logistic or linear regression. A qualitative process evaluation (PE) study conducted one year before the end of the program provided insights on program implementation.

**Results:** In arms 2 and 3, the prevalence of stunting decreased from 36% to 32% and 34% to 29%, respectively, while it remained stable in the control arm as in arm 4. The interaction was not statistically significant (p-value=0.10). Significant impact of the program was measured on secondary outcomes: mothers' knowledge (p-value<0.001), growth monitoring: number of weighing (p-value <0.01), percentage of women having slept under insecticide-treated mosquito net during pregnancy (p-value=0.01) and proportion of women having experienced fever during pregnancy (p-value<0.001). The PE identified program complexity, implementation

delays at the start of the program, irregular distributions and a low amount of the cash as the main barriers for achieving impact.

**Conclusions:** Positive trends have been observed and some indicators have improved significantly through the program. However, a complex intervention, as well as a difficult implementation context may explain the modest impact on children's anthropometrics.

**Keywords:** Conditional cash transfers, nutritional supplementation, stunting, rural Mali

MTHFR GENOTYPE AND ITS INTERACTION WITH RIBOFLAVIN AS DETERMINANTS OF BLOOD PRESSURE IN PREGNANT AND NON-PREGNANT WOMEN

**Background and objectives:** Several meta-analyses have reported that the common 677C→T polymorphism in the MTHFR gene is associated with an increased risk of hypertension in pregnancy. Previous trials from this center in non-pregnant hypertensive adults have shown that riboflavin can lower blood pressure specifically in those with the MTHFR 677TT genotype. However, this relationship has not been examined in relation to pregnancy. The study aimed to investigate the MTHFR 677C→T polymorphism and its interaction with riboflavin in pregnant and non-pregnant women.

**Methods:** Data for this study were generated from two existing cohorts, namely the Irish National Adult Nutrition Survey (NANS) and participants from a trial of Folic Acid Supplementation in the Second and Third Trimester (FASSTT) in pregnancy.

**Results:** In non-pregnant women from NANS (n=347), those with the MTHFR 677TT genotype compared to the CC genotype had significantly higher mean±SD systolic (117.2±13.5 vs 110.5±11.6 mmHg; P=0.002) and diastolic (78.3±11.4 vs 73.3±9.6 mmHg; P=0.003) blood pressure; CT genotype had intermediate blood pressure values. This genotype effect was influenced by prevailing riboflavin status, such that blood pressure differences among the three genotypes were greatest in those with lower riboflavin status, and not significant among participants with higher riboflavin status. When pregnant women from the FASSTT trial (n=226) were examined at the 14th gestational week (GW), those with the TT genotype compared those with CC/CT genotypes were found to have significantly higher blood pressure. In addition, the TT genotype group showed a greater increase in mean ±SD blood pressure from the 14th to the 36th GW (increase in diastolic blood pressure of 11.0±7.9 vs 4.2±11.1mmHg; P=0.013).

**Conclusions:** These results suggest that the MTHFR 677TT genotype adversely influences blood pressure in women of repro-

<footnote>(1)Adubra, Laura; (2)Fortin, Sonia; (2)Kameli, Yves; (3)Le Port, Agnes;</footnote>

<footnote>(4)Kodjo, Niamke Ezoua; (5)Savy, Mathilde; (6)Martin-Prével, Yves.</footnote>

<footnote>(1)MSc. UMR 204 Nutripass IRD UM Supagro. Institut de Recherche pour le Développement (IRD). France.; (2)MSc. UMR 204 Nutripass -IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Montpellier. France.; (3)MSc, PharmD, PhD. Poverty, Health and Nutrition Division (PHND), International Food Policy Research Institute (IFPRI). Dakar. Senegal.; (4)MSc. World Food Program. Bamako. Mali.; (5)MSc, PhD. UMR 204 Nutripass -IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Montpellier. France.; (6)MSc, MD, PhD. UMR 204 Nutripass -IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Montpellier. France.</footnote>

<footnote>(1)O'Sullivan, Emma; (2)Pentieva, Kristina; (3)Ward, Mary; (4)McAuley, Amy; (3)Strain, Sean JJ; (3)McNulty, Breige A.; (3)Walton, Janette;</footnote>

<footnote>(3)Flynn, Albert; (3)McNulty, Helene.</footnote>

<footnote>(1)PhD Student. Nutritionist. United Kingdom; (2)PhD. MD;</footnote>

<footnote>(3)Professor of Human Nutrition. School of Biomedical Sciences. Ulster University. Northern Ireland; (4)MSc.</footnote>
further decrease in growth retardation prevalence between the two rounds among beneficiaries (30.3% to 24.2%) and a statistical difference between the intervention and control groups (p-value=0.03). The CT program also had a positive impact on the proportion of children with LBW which dropped from 13.5% to 7.2% between baseline and endline among beneficiaries, and remained stable among non-beneficiaries (9.5% versus 11.6%) (p-value=0.02). Similar results were observed in PP analysis.

**Conclusions:** Despite implementation issues the CT program contributed to reduce low birth weight and growth retardation.

**Keywords:** Cash transfer program, growth retardation, low birth weight, Togo

**Background and objectives:** In 2010 UNICEF developed the Community Infant and Young Child Feeding (C-IYCF) Counselling Package of generic materials to promote specific practices known to have an impact on nutritional status, morbidity, and mortality. Despite widespread uptake of the package by over 60 countries, very little research has been done to examine the impact of the package. To help fill this evidence gap, the USAID-funded Strengthening Partnerships, Results, Innovations in Nutrition Globally (SPRING) project, the Nigerian Federal Ministry of Health, and UNICEF have just completed an evaluation of the effectiveness of this package, implemented at scale in one local government area (LGA) where approximately 140,000 people live in Kaduna State, Nigeria.

**Methods:** The intervention included a series of sensitization meetings, training of health workers and community volunteers, support group meetings, review meetings, and community mobilization events. Implementation processes and costs were closely tracked. To evaluate the effectiveness of the C-IYCF package in changing IYCF knowledge, attitudes, and practices as well as nu-

trition outcomes we used a mixed methods approach. We conducted baseline (Dec 2014 – March 2015) and post-intervention (Jan – March 2017) household surveys in the intervention LGA and in one comparison LGA. We also conducted semi-structured interviews to collect information on IYCF knowledge and attitudes among local government, health workers, and community leaders.

**Results:** We observed significant improvements in knowledge and attitudes among pregnant women, mothers, and community leaders. As a result, practices changed. At baseline, 30.9% of children under 6 months old in the intervention site (N=366) were exclusively breastfed. After the intervention, 49.9% of children under 6 months old (N=709) were exclusively breastfed. The percentage of infants 6-8 months old who had received solid foods during the previous day increased from 56.0% (N=250) to 64.1% (N=287). Maternal nutrition practices also improved – the percent of women reporting that they ate more during her last pregnancy increased from 35.6% (N=1,752) to 50.0% (N=761).

**Conclusions:** After implementing the C-IYCF Counselling Package at scale in one LGA, knowledge, attitudes, and IYCF practices had improved. This study demonstrates that the C-IYCF package is an effective and feasible approach for implementation at scale.

**Keywords:** Nutrition, scale, community-based, infant and young child feeding (IYCF)

**Background and objectives:** Unhealthy food environments are a major driver of obesity and non-communicable diseases (NCDs). Government actions are essential to prevent these conditions. The international network INFORMAS developed protocols to evaluate and benchmark these actions. The Food Environment Policy Index (Food-EPI) was created to assess them. The objective of the study is to determine the level of implementation of policies for healthy food environments in Mexico with reference to international best practice.

**Methods:** The Food-EPI tool and process were adapted to the Mexican context. 72 indicators were assessed. Evidence for imple-

<footnote>(1)Lamstein, Sascha; (2)Adeyemi, Susan; (3)Stammer, Emily; (4)Koniz-Booher, Peggy; (5)Kaligirwa, Christine; (6)Osa Isokpunwu, Chris; (7)Begin, France; (8)Adebisi, Babajide; (9)Perez-Escamilla, Rafael.</footnote>

<footnote>(1)SPRING Project, JSI Research & Training Institute, Inc. USA; (2)MPH. Study Coordinator. SPRING Project. Helen Keller International. Kaduna State, Nigeria; (3)MPH. Monitoring & Evaluation Advisor. John Snow, Inc. USA; (4)MPS. SPRING Project. JSI Research & Training Institute, Inc. USA; (5)MPH Human Nutrition and Public Health. Nutrition Specialist/IYCF Manager. UNICEF. Abuja, Nigeria; (6)MPH. Head of Nutrition / SUN Focal Point. Department of Family Health, Federal Ministry of Health. Abuja, Nigeria; (7)PhD. Senior Advisor, Infant & Young Child Nutrition. UNICEF. USA; (8)M.Sc Human Nutrition. Deputy Chief of Party. JSI Research & Training Institute, Inc. Ghana; (9)PhD. Professor & Director. SPRING and Yale School of Public Health. USA.</footnote>

<footnote>(1)Sánchez-Bazán, Karina; (2)Nieto, Claudia; (3)Rodríguez-Martínez, Estefanía; (2)Tolentino Mayo, María Lizbeth; (4)Vandevijvere, Stefanie; (5)Barquera, Simon.</footnote>

<footnote>(1)MPA. Researcher. Health and Nutrition Research Center. National Institute of Public Health. Mexico; (2)MSc. Health and Nutrition Research Center. National Institute of Public Health. Mexico; (3)BA. Health and Nutrition Research Center. National Institute of Public Health. Mexico; (4)PhD. Department of Epidemiology and Biostatistics. School of Population Health. University of Auckland. New Zealand; (5)PhD. Health and Nutrition Research Center. National Institute of Public Health. Mexico.</footnote>
mentation was gathered for all. An online questionnaire was an-
swered by 70 actors. These actors were categorized into three groups:
1) independent(n=36 academia, civil society, and legislators), 2)
government(n=28), and 3) private sector(n=6). After the online
assessment, prioritization workshops were held for each group sep-
arately. A consensus workshop with independent and government
actors was held to propose concrete actions to be implemented.

**Results:** 5 indicators were identified as priority: 1) labeling easy to interpret, 2) incentives to increase the supply of healthy foods, 3) guidelines to prevent conflict of interest, 4) budget to tackle obesity and NCDs, and 5) promotion of healthy foods in schools.

Four types of cases were identified: 1)The groups coincide: in the indicator on labeling in fast food restaurants, the groups rated with very little level of implementation. 2)Independent and government coincide: In the indicator on monitoring of overweight and obesity in children and adults, both rated with high level of implementation. 3)Independent and industry coincide: In the indicator on monitoring of food promotion, both rated with very little level of implementation. 4)Independent and government differ: In the indicator on presidential support to nutrition independent rated with very little level of implementation, and government rated with high level of implementation.

**Conclusions:** The food environment is a complex and multidimensional system. Therefore, when analyzing it, all actors that have influence should be considered. This assessment is useful to identify policy agreements and oppositions. The consensus is a platform for continued policy dialogue towards cross-sectoral coherence and effective actions to address the burden of NCDs and obesity in Mexico.

**Keywords:** Healthy food environments, INFORMAS, obesity prevention, government policies, Non-communicable diseases

**Conflict of Interest Disclosure:** The authors declare that this study was funded by the Canadian International Development Research Centre (IDRC). No conflicts of interest were identified.

144/2310

MAPPING THE AVAILABILITY OF HEALTHY
FOOD IN BUENOS AIRES

(1)Garipe, Leila Yasmin; (2)Santoruffo, Ornella; (2)Papurello, María Guadalupe; (2)Chiavassa, Sofía Belén; (2)Goldsztejn, Gabriela; (3)Pace, Natalia; (4)Giunta, Diego Hernán.

(1)Nutritionist. Hospital Italiano de Buenos Aires. Universidad Isalud. Argentina.; (2)Nutricionist. Universidad Isalud. Argentina.; (3)Doctor. Hospital Italiano de Buenos Aires. Argentina.; (4)PhD. Doctor. Hospital Italiano de Buenos Aires. Universidad Isalud. Argentina.

**Background and objectives:** Dietary behaviors are a result of a complex relation between multiple factors: individual, mental, social and environmental. In recent years there has been a surge in interest in understanding how the environment influences the health of a population, both directly and also in forming the context in which decisions for it are made. It has been widely studied that availability and accessibility are key factors for the adoption of healthy lifestyles. The presence of food shops and the availability of healthy products at them are important contributors to the dietary

patterns of a population. Therefore, we proposed constructing a
georeferenced map of healthy food in the city of Buenos Aires to
facilitate its consumption.

**Methods:** This study is part of the #MeHaceBien project of the Hospital Italiano de Buenos Aires and was carried out together with Nutrition students at the Universidad Isalud. Taking into account the limitations on human resources initial we decided to include healthy food stores with low visibility, stores that would be accessible to vulnerable groups and/or shops promoting a non-industrialized and non-agrotoxic diet. The methods of the search used were virtual (websites), fieldwork and interviews with people knowledgeable in the area. Data collection was carried out between April and June 2016. All resources were validated. A georeferenced map was created on Google Maps indicating location, telephone number, website address, food offered with days and times.

**Results:** a total of 401 health food store were mapped, such as supply fairs neighborhood (110), fish markets (53), health food stores (100), organic food retailers (42), and restaurants that focused on healthy, gluten-free, vegan or organic foods (95). In addition vegetable garden and healthy cooking classes were identified.

**Conclusions:** We believe that healthy food mapping could be an innovative tool to facilitate accessibility and adherence to healthy eating, as well as a future opportunity for collaborative work with the community to map healthy foods in their neighborhoods.

**Keywords:** Health food, Food availability, Mapping food.

144/2311

RELIABILITY OF HEMOCUE ON THE ANEMIA DIAGNOSTIC IN UNDER FIVE YEARS OLD CHILDREN

(1)Rugani Ribeiro de Castro, Inês; (2)Pereira, Alessandra Pereira;

(3)Feldenheimer, Ana Carolina; (4)Moraes, Milena.

(1)PhD. Associate professor. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.; (2)Professor. UNIRIO. Rio de Janeiro. Brazil.; (3)Rio de Janeiro. Brazil.; (4)PhD. Nutricionist. Posdoctoral fellow. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.

**Background and objectives:** Controlling iron deficiency anemia is a priority in the public health agenda. There are many methods for diagnosing anemia. However, some of them did not have their performances evaluated among children below five years of age. This study evaluated the reliability of portable hemoglobinometer HemocueÔ in the diagnosis of anemia in children.

**Methods:** This was carried out with children aged 6-59 months assisted at the Unified Health System in the city of Rio de Janeiro (n=357). Blood samples was collected by capillary puncture and placed in microcuvets for immediate hemoglobin (Hb) concentration assessment. From the first finger puncture two drops were taken (D1 and D2) for assessing instrument reliability and from the second finger punccutre, a third drop (D3) was taken to deter-
mine the reliability of the method. Values obtained with D1 were considered the reference and Hb=11g/dl was adopted as the cutoff point for anemia diagnosis. Mean and standard deviation of Hb values were calculated and the agreement analyses of the anemia diagnosis were made using Cohen's Kappa (k) and prevalence- and interviewer bias-adjusted kappa (ka). The values of k and ka were classified according to Byrt (1996).

**Results:** Mean and SD of Hb values of D1, D2 e D3 were 12,03±1,12, 11,90±1,15 e 12,00±1,10, respectively. By Cohen's Kappa the agreement of the diagnostics was fair comparing D1 with D2 (k=0.42) and D1 with D3 (k=0.36). Considering the ka, the agreement was good when comparing D1 with D2 (ka=0.62) and D1 with D3 (ka=0.60).

**Conclusions:** The reliability of both the instrument and the method was good, suggesting stability of the instrument in the diagnosis of anemia in children.

**Keywords:** Reliability; anemia; children; Hemocue.

144/2321

## FRUIT AND VEGETABLE CONSUMPTION IN EIGHT LATIN-AMERICAN COUNTRIES: RESULTS FROM ELANS STUDY

(¹)Cortes, Lilia Yadira; (²)Nogueira Previdelli, Agatha; (³)Fisberg, Mauro; (⁴)Kovalskys, Irina; (⁵)Guajardo, Viviana Beatriz; (⁶)Gómez Salas, Georgina.

(¹)PhD. Nutritionist. Departamento de Nutrición y Bioquímica. Pontificia Universidad Javeriana. Bogota. Colombia; (²)PhD. Nutritionist. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil; (³)MD. Instituto Pensi, Hospital Infantil Sabara, São Paulo 01239-040, Brazil; (⁴)MD. Commitee of Nutrition and Wellbeing. International Life Science Institute (ILSI-Argentina). Buenos Aires. Argentina; (⁵)BSc.Nutrition and health area. International Life Science Institute (ILSI-Argentina). Buenos Aires. Argentina; (⁶)MSc. Departamento de Bioquímica. Escuela de Medicina. Universidad de Costa Rica. San José. Costa Rica.

**Background and objectives:** It has been recognized that fruit and vegetable intake (FVI) are important to prevent chronic diseases such as cancer, coronary heart disease and diabetes. World Health Organization (WHO) recommended a minimum of five servings of fruit and vegetables or 440 g per day. The aim of this study is to determine the intake of fruits and vegetable by sex, age and SES in eight Latin-American countries.

**Methods:** Data from the ELANS study, conducted in eight Latin-American countries (Argentina, Brazil, Colombia, Costa Rica, Chile, Ecuador, Peru and Venezuela) was analyzed using descriptive statistics. The ELANS study interviewed 9218 subjects (4409 males and 4809 females) of the main cities in each country. The FVI was collected using two 24 hours' dietary recall, following the multiple pass methodology. The analysis was performed by age group, gender and socioeconomic level (SES).

**Results:** The mean FVI in the eight countries was 200 g/day (males 202 g/day, females 198 g/d), being the highest in Ecuador

(282 g/day) and lowest in Colombia (161 g/day). It is important to highlight that the FVI is highest in males than females in all countries except Brazil, Peru and Argentina. The FVI increases with age, ranging from 176 g/day (CI 90.4-261.6) at 15-19 years of age to 226 g/day (133-319) at 50-65 years of age. Despite this increase with age, 70.99% of the 50-65y interviewed did not reached recommendations in any of the two days compared to 80.95% of the 15-19y group (p<0.001). As expected, the intake was lower in the low SES 180 g/day (CI 98.8 - 261.2) and higher in the high SEL 224 g/day (CI 128 - 320). Only 4.2% of overall population met the recommendation in both days of interview, and 19.13% did it in at least one day.

**Conclusions:** The findings reinforce the low intake of FIV by the Latin-American population, since 95.8% did not reach the recommendation in both days. In addition, this low intake was independent of sex, age or SES. Programs and policies to encourage FVI are required to help mitigate future health issues associated with inadequate FVI.

**Keywords:** Fruit and vegetable intake, Latin-America, Multiple pass method, ELANS,

**Conflict of Interest Disclosure:** The ELANS is supported by a scientific grant from the Coca Cola Company and support from the Instituto Pensi / Hospital Infantil Sabara, International Life Science Institute of Argentina, Universidad de Costa Rica, Pontificia Universidad Católica de Chile, Pontificia Universidad Javeriana de Colombia, Universidad Central de Venezuela (CENDESUCV)/Fundación Bengoa, Universidad San Francisco de Quito, and Instituto de Investigación Nutricional de Peru. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of this manuscript.

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

144/2339

## ADDRESSING DIETARY DIVERSITY BY SCALING UP MULTI-SECTORAL INTEGRATED NUTRITION INTERVENTIONS IN AFRICA

(¹)Mukuria, Altrena; (²)Williams, Tim; (³)Du, Lidan; (⁴)Hogan, Sara; (⁵)Bonku, Edward; (⁶)de Wolf, Bob; (⁷)Adebisi, Babajide; (⁸)Mwadime, Robert.

(¹)DrPH. Director of Country Initiatives. SPRING Project. Save the Children. Arlington. Va. USA; (²)MA MES. Sr. Evaluation Advisor. SPRING Project. JSI. Arlington. Va. USA; (³)PhD. Research Advisor. SPRING Project. JSI.Arlington. Va. USA; (⁴)BA. Project Officer. SPRING Project. JSI. Arlington.Va. USA; (⁵)MD MSc. Chief of Party. SPRING/GHANA. JSI. Tamale. Ghana; (⁶)MPH. Chief of Party. SPRING/Senegal.JSI. Dakar. Senegal; (⁷)MSc. Deputy Chief of Party. SPRING/GHANA. Tamale. Ghana; (⁸)PhD. Chief of Party. SPRING/Uganda. Kampala. Uganda.

**Background and objectives:** Malnutrition is a contributing factor in 45% of deaths of children under 5 years, and in developing countries, more than 3.5 million children under 5 die each year with undernutrition as an underlying cause. In Africa, stunting rates average about 30% or higher. Complementary feeding can prevent 6% of all deaths in children 6-23 months. Improved
dietary diversity (DD) is one of the 10 proven nutrition-specific interventions as well as a measure of food security and agriculture practices to address stunting. The objective of this paper is to describe how the USAID-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project addressed DD through scale up of integrated multi-sectoral nutrition interventions in four African countries.

**Methods:** Targeting the first 1000 days, Ghana, Nigeria, Senegal and Uganda used slightly different approaches to scale up evidenced-based interventions. Using these examples, the paper describes experiences, successes, and challenges of SPRING programs in addressing dietary diversity. Where available, baseline and endline survey data and/or DHS data will be presented to complement programmatic experiences and routine data.

**Results:** In Nigeria where children's DD is 19.3%, IYCF training of facility and community-based health workers improves their counselling of mothers and family members. In Ghana (DD =28.1%), SPRING partners with the government to improve IYCF through WASH, mother support groups and nutrition-sensitive agriculture. In Senegal (DD = 27.4%), SPRING works through partnerships with government and NGOs to improve knowledge and practices in nutrition-sensitive agriculture. In Uganda (DD = 12.8%), to improve the provision and consumption of nutrient-rich fortified foods, SPRING works with government to strengthen national policies and practices. Previously in Uganda, SPRING supported IYCF at facility and community levels in three districts.

**Conclusions:** A transformation in nutrition programming is needed if malnutrition is to be addressed successfully. In order to sustain food and nutrition security, health, agriculture, and water and sanitation along with many other sectors must be mobilized in an integrated multi-sectoral way. Using evidenced-based approaches as well as building the evidence, we have begun to demonstrate how to promote dietary diversity to address chronic undernutrition within the African context.

**Keywords:** Multi-sectoral nutrition, Africa, diet diversity

against a variety of acute and chronic disorders. We here, share some of our observations reported in Lactation Management Center (LMC) established by Bangladesh Breastfeeding Foundation (BBF) to deliver different services on lactation management.

**Methods:** The BBF-LMC in a central area of Dhaka city included the services to the pregnant and lactating mothers are: mothers/family counseling on BF and on various aspects of maternal nutrition & demonstration on appropriate positioning & attachment during breastfeeding, solving difficulties, relactation, breast-milk expression & scientific method of breast massage 'OKETANI'.

**Results:** In BBF-LMC, 232 mothers aged (mean±SD) 29.0(±4.3) years with a child from 1 day to 2.5 years were served over the last 2 years from March, 2015 to March, 2017. Average birth weight of the children was 2.8(±0.4) kg and measured body weight of the children 4.8(±1.8) kg. About 78.4% (183) came in 1st visit, 15.5% (36) for 2nd, 4.3% (10) for 3rd and 1.2% (3) came for 4th visit. Most (32%) of the mothers were not confident to feed their baby while 21% didn't know appropriate positioning and attachment during breastfeeding. About 24% mothers had poor knowledge on BF and appropriate complementary feeding (CF) whereas 21% complained about low milk flow. Breast engorgement, flat/ inverted/cracked nipples were observed among 14% of the mother. Besides, 12% of mother came for relactation. In BBF-LMC, 72% received counseling on BF and CF while correct positioning & attachment demonstrated for 21% mothers. Oketani massage was given to 28% mother and 4% were taught milk expression. Seventeen who came with poor confidence & milk flow came in 2nd visit for demonstration and needed Oketani, 14 came for only follow-up while 5 came for recipe book for CF. In 3rd visit, 4 came for follow-up their inverted/cracked/engorged breast and 5 came for Oketani while in 4th visit all came for only follow-up who were doing successful BF.

**Conclusions:** Most of the mothers who have received the services at the BBF-LMC were satisfied both physically and mentally.

**Keywords:** Lactation Management Center. Breastfeeding.

<footnote>(1)Roy, Swapan Kumar; (2)Jahan, Khurshid; (3)Ara, Ferdous; (4)Halder, Shampa.</footnote>

<footnote>(1)MBBS, MSc, Dip in Biotech, PhD, FRCP. Senior Scientist. Chairperson. Board of Trustees. Bangladesh Breastfeeding Foundation. Chairperson. Nutrition Foundation Bangladesh.;
(2)MSc. Director. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (3)MSc, MPhil. Senior Program Officer. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (4)MSS.Lactation Management Officer. Bangladesh Breastfeeding Foundation (BBF).</footnote>
**Background and objectives:** Anemia affects more than half of Indian women and children but the contribution of its causes is unknown. We examined the contribution of nutritional, environmental, infectious, genetic, and social determinants of anemia in rural and urban women and children living in Uttar Pradesh (UP).

**Methods:** We conducted a state-representative, cross-sectional survey of rural and urban households in 25 districts of UP between October and December 2016. We collected information on socio-economic factors, diet, water and sanitation (WASH), household hunger, anthropometry, stool, and venous blood in 1238 non-pregnant women 18-49 years and children 6-59 months of age. We are analyzing venous samples for malaria, hemoglobin, ferritin, transferrin receptor, hepcidin, retinol, folate, zinc, vitamins B12 and D, C-reactive protein, α1-acid glycoprotein, and β-thalassemia. Blood laboratory analyses are ongoing and will be completed by May 2017. Preliminary statistical analyses use inflammation-adjusted iron biomarkers only from 10 of the 25 districts. We are using structural equation modeling to examine the pathways through which diet, household hunger, iron, WASH, and anthropometry are associated with hemoglobin concentrations. Preliminary models indicate appropriate fit and we report standardized coefficients.

**Results:** 36% of women and 54% of children were anemic; 42-50% of these women and children also had iron deficiency. In women, ferritin concentrations were more strongly and significantly (p<0.05) associated with hemoglobin in rural than in urban areas (standardized β=0.33 vs 0.28, respectively). In rural areas, dietary diversity and WASH were significantly directly associated with women's hemoglobin. In children, ferritin was more strongly associated with hemoglobin concentrations in urban than in rural areas (β=0.38 vs 0.17). WASH was significantly indirectly associated with hemoglobin through height-for-age z-scores.

**Conclusions:** Preliminary findings suggest a multi-causal etiology of anemia in women and children in UP. We will present an

updated comprehensive analysis of blood indicators, stool parasites, dietary intake, and genetic factors that will clarify the contribution of the major causes of anemia in this population that can be used to guide preventive measures.

**Keywords:** Anemia, causes of anemia, iron, infection, diet, water and sanitation

**Background and objectives:** Childhood obesity, accompanied by an increased waist circumference (WC), which is linked to an increased risk of adult chronic diseases, is rapidly increasing in urban India. The pathogenesis of childhood obesity is multi-factorial, combining genetic predisposition and environmental factors. Home and school are major contributors to the environmental factors. The objective of this study was to use a sibling-pair model to quantify the contribution of home environment to an increased waist circumference (WC) in children.

**Methods:** Children aged 3-16 years from middle income urban schools in Bangalore, India were measured between 2008 and 2011 and data on 2896 siblings were obtained. Anthropometric measurements of weight, height and waist circumference were performed according to standard protocols. Additional details on demographics, diet, lifestyle, behavior and reported parental anthropometrics were also collected. The intraclass correlation at the home level represented as sibling pairs (level 2) and school level (level 3) were obtained using multilevel modelling. Factors at individual (level 1) and home were also considered in the model. Parental weight and height were used to partly explain the genetic factors.

**Results:** The prevalence of abdominal obesity (waist circumference percentile>75) was higher at 20% than overweight/obesity prevalence which was only 12%. A multi-level linear regression model for WC percentile with no covariates (simple variance component model) gave an intraclass correlation of 0.36 such that 36% of the variability in WC of siblings could be attributed to the siblings living in the same house. The fractional variability attributed to the school was 16%. Maternal and paternal overweight status were positively associated with the waist circumference of the children. The percentage variability of BMI attributable to sibling pair was comparable to that of WC.

**Conclusions:** The maximum variability of waist circumference in children was attributed to them being siblings, thus ascer-

<footnote>(1)Larson, Leila; (2)Thomas, Tinku; (3)Kurpad, Anura; (4)Martorell, Reynaldo;</footnote>

<footnote>(5)John, Hoddinott; (6)Swaminathan, Sumathi; (7)Neufeld, Lynnette M.</footnote>

<footnote>(1)MPH. PhD Candidate. Nutrition and Health Sciences Doctoral Program. Emory University. USA.; (2)PhD. Associate Professor. Department of Epidemiology. St John's Research Institute. India;</footnote>

<footnote>(3)MD, PhD. Professor and Head of the Division of Nutrition and Physiology. Department of Physiology. St John's Medical College. India.; (4)PhD. Robert W. Woodruff Professor of International Nutrition. The Hubert Department of Global Health and the Nutrition and Health Sciences Program. Emory University.; (5)Phd.</footnote>

<footnote>H.E. Babcock Professor of Food & Nutrition Economics and Policy. Divison of Nutritional Sciences. Cornell University. USA.; (6)PhD. Associate Professor. Department of Nutrition. St John's Research Institute. India.; (7)PhD. Director Monitoring, Learning and Research. Global Alliance for Improved Nutrition. Switzerland.</footnote>

<footnote>(1)Thomas, Tinku; (2)Kuriyan Raj, Rebecca; (3)Kurpad, Anura;</footnote>

<footnote>(4)Subramanian, S.V.</footnote>

<footnote>(1)PhD. Department of Biostatistics. St John's Medical College. India; (2)Associate Professor. India.; (3)MD, PhD. Department of Physiology. St John's Research Medical College. India; (4)PhD.</footnote>

<footnote>Department of Social and Behavioural Sciences. Harvard TH Chan School of Public Health, USA.</footnote>
taining the importance of home based interventions. Schools also
have a substantial role to play in bringing about positive changes
and can be considered as another action point for intervention.

**Keywords:** Waist circumference, school age, siblings, multi-level model

144/2371

ROLE OF FOLATE AND THE METABOLICALLY RE-
LATED B-VITAMINS IN BRAIN HEALTH IN OLDER
ADULTS: THE TUDA STUDY

(1)Moore, Katie; (2)Hughes, Catherine; (2)Hoey, Leane; (2)Ward, Mary;

(2)Porter, Kirsty; (2)Strain, Sean JJ; (3)Molloy, Anne; (4)Cunningham,

Conal; (5)Pentieva, Kristina; (2)McNulty, Helene.

(1)BSc. Registered Dietitian. Northern Ireland Centre for Food and Health. Ulster Univeristy Coleraine. Northern Ireland; (2)PhD. Northern Ireland Centre for Food and Health. Ulster University Coleraine. Northern Ireland; (3)PhD. Institute of Molecular Medicine. Trinity College Dublin. Ireland; (4)MD. Mercers Institute for Research on Ageing. St James's Hospital Dublin. Ireland;

(5)MD. Northern Ireland Centre for Food and Health. Ulster University Coleraine. Northern Ireland.

**Background and objectives:** Folate and the metabolically related B-vitamins involved in one-carbon metabolism may be important for maintaining brain health in aging but few studies have investigated the biomarker status of all relevant B-vitamins. The aim of this study was to examine the role of folate, vitamin B12, vitamin B6 and riboflavin in mental and cognitive health in older adults.

**Methods:** Participants were recruited (n 5186) to the Trini-
ty, Ulster, Department of Agriculture (TUDA) Ageing Cohort
study in 2008-2012, from across the Island of Ireland; of these, a
sub-sample (n 587) of participants were reinvestigated 5 years af-
ter the initial TUDA study. Cognition was assessed using the Mi-
ni-Mental State Examination (MMSE), the Repeatable Battery for
the Assessment of Neuropsychological Status (RBANS) and the
Frontal Assessment Battery (FAB). Depression and anxiety were
assessed using the Centre for Epidemiologic Studies Depression
(CES-D) and the Hospital Anxiety and Depression (HADS) scales.
Biomarkers of all the relevant B-vitamins were determined.

**Results:** At baseline, poor B-vitamin status (i.e. lowest 20%) was associated with an increased risk of depression (by 47-78%) for folate (p 0.003), vitamin B6 (p 0.034) and riboflavin (p 0.011), whereas only vitamin B6 deficiency was associated with anxiety (p 0.010) and cognitive dysfunction (p ≤0.001). Furthermore, at the 5 year follow up assessment, lower biomarker status at baseline (i.e. below median value) of vitamin B6 and riboflavin, but not folate or vitamin B12, were significant predictors of the rate of cognitive decline, as measured by change in MMSE (vitamin B6 p 0.020) and RBANS (vitamin B6 p 0.008; riboflavin p 0.018). Concentrations of all B-vitamin biomarkers increased significantly with increasing intake of fortified foods and with supplement use, while non-consumers of fortified foods or supplements had the lowest status of all B-vitamin biomarkers.

**Conclusions:** These results suggest that better B-vitamin status can have a positive impact on mental and cognitive health older adults. Optimization of B-vitamin status, via fortified foods or supplements, may offer a means of protecting brain health in aging.

**Keywords:** B-vitamins. One-carbon metabolism. Cognition.
Depression. Aging.

**Further collaborators:**

Miriam Casey. MD. Mercers Institute for Research on Ageing.
St James's Hospital Dublin. Ireland

Eamon Laird. PhD. Institute of Molecular Medicine. Trinity
College Dublin. Ireland

Kevin McCarroll. MD. Mercers Institute for Research on Age-
ing. St James's Hospital Dublin. Ireland

144/2372

PROTEIN INTAKE AND THE DEVELOPMENT OF
TYPE 2 DIABETES

(1)Voortman, Trudy; (2)Chen, Zhangling; (2)Franco, Oscar; (2)Voortman, Trudy.

(1)Postdoctoral scientist. Department of Epidemiology. Erasmus
University Medical Center Rotterdam. The Netherlands;

(2)Department of Epidemiology. Erasmus University Medical
Center. Rotterdam. The Netherlands.

**Background and objectives:** Short-term trials suggest a beneficial effect of high protein intake on obesity and other diabetes risk factors, however, epidemiological studies observed positive associations of dietary protein with type 2 diabetes (T2D) risk. We aimed to examine, in a large prospective cohort, associations of intake of different sources of protein with insulin resistance, prediabetes, and T2D; and the role of obesity in these associations.

**Methods:** This study has been performed in the Rotterdam Study, a prospective cohort of subjects ≥45 years in the Netherlands. Prediabetes and T2D were diagnosed on the basis of medical records and fasting glucose and insulin concentrations, which were measured every few years in our research. We included 6814 subjects who were free of T2D at baseline, of whom 5795 were without prediabetes. Protein intake was assessed with the use of validated food-frequency questionnaires and expressed in energy percentages (E%). We used multivariable cox proportional hazard regression to analyze the associations between protein intake and risk of prediabetes and T2D; multivariable linear mixed models to analyze the associations with insulin resistance; and joint models to examine the role of repeatedly measured obesity data in this association. For all models, we used nutrient density substitution models to examine macronutrient substitution effects.

**Results:** We documented 643 cases of T2D during a median 7.2 years of follow up; and 931 cases of prediabetes during 5.7 years. In multivariable models, higher intakes of total protein were positively associated with insulin resistance, risk of prediabetes (hazard ratio (HR)=1.35 (95%CI 1.20-1.51) per 5 energy-percent), and risk of T2D (HR=1.38 (95%CI 1.20-1.60)). Additional adjustment for repeatedly measured BMI or waist circumference atten-
uated these associations, but associations remained significant. Results: **Conclusions:** Our results suggest that a higher intake of protein, mainly from animal sources, is associated with insulin resistance, and a higher risk of developing prediabetes and T2D. Our findings also suggest that obesity partly but not fully mediates this association.

**Keywords:** Macronutrients, protein, diabetes, epidemiology, cohort

144/2377

MULTISECTORAL ANEMIA PLATFORM
STRENGTHENING: LESSONS LEARNED IN SIERRA LEONE AND UGANDA

(1) Sarkar, Danya Sarkar; (2) Fisseha, Teemar; (3) Murphy, Hillary;

(4) Hodges, Mary; (5) Adero, Nancy; (6) Namaste, Sorrel.

(1) MHS. Nutrition Specialist. SPRING Project. JSI Research & Training Institute, Inc.; (2) MPH. M&E Officer. SPRING Project. JSI Research & Training Institute, Inc. Arlington. United States.;

(3) MPH. Project Officer. SPRING Project. JSI Research & Training Institute, Inc. Arlington. United States.; (4) MBBS, MRCP. Hon DSC. Country Director. Helen Keller International. Freetown. Sierra Leone.; (5) MPH. Technical Advisor Anemia & Micronutrients.

SPRING Project. John Snow, Inc. Kampala. Uganda.; (6) MHS. DrPH. Technical Advisor/Team Lead Anemia. SPRING Project. Helen Keller International. Arlington. United States.

**Background and objectives:** Reduction of anemia requires a multisectoral and country-driven approach. In order to understand how countries coordinate efforts across sectors to set agendas and develop anemia strategies, the USAID-funded Sustaining Partnerships, Results, and Innovations for Nutrition Globally (SPRING) Project documented the approach undertaken in Sierra Leone and Uganda.

**Methods:** We used an instrumental case study approach to document the country experiences in anemia coordination in Sierra Leone and Uganda. Data were collected between 2015 and 2017 via two rounds of semi-structured interviews with key stakeholders in each country, and participant observations from National Anemia Working Groups and National Anemia Stakeholder meetings. A total of 43 key informant interviews were conducted. Data were thematically coded to identify recurrent factors that facilitated or inhibited anemia coordination efforts. Codes were used to develop key findings, which were supported by illustrative quotes.

**Results:** Experiences in Sierra Leone and Uganda were unique to their context, but three overarching issues emerged with respect to creating an enabling environment. Use of data helped facilitate the creation of such an environment by serving as an advocacy tool, generating awareness, and helping to align sectoral and donor priorities. Second, collaboration through the establishment of a multisector National Anemia Working Group resulted in enhanced networking opportunities, stronger working relationships, and in some instances decreased duplication of efforts. Third, dis-

trict representation as part of national level collaboration efforts was often lacking; there was a need for improved feedback loops between national and district efforts.

**Conclusions:** Commitment and active participation from all relevant sectors is critical to move efforts forward and strategically address anemia in Sierra Leone and Uganda. Fostering multisectoral collaboration and providing a structure for national strategy development was important to set the agenda at the national level, and results from these efforts will be translated to sub-national levels, where multisectoral planning and implementation can strengthen the delivery of anemia programs. The experiences in these two countries can help global and country stakeholders learn from and adapt their efforts to address anemia in their context.

**Keywords:** Anemia multisectoral planning coordination enabling environment

144/2393

INCORPORATING FRESH FOODS IN DAILY MEAL IN NAIROBI URBAN SLUM SCHOOLS EFFORTS TO INCREASE DIETARY DIVERSITY

(1) Aburmishan, Dina; (2) Fossi, Lara; (3) Ndungu, Judy; (2) Hughes, Shaun;

(4) Akunaye, Christine.

(1) United Nations World Food Programme; (2) MS. Humanitarian.

World Food Programme. Nairobi. Kenya.; (3) BS. Humanitarian.

World Food Programme. Nairobi. Kenya.; (4) BS. Nutritionist. World

Food Programme. Nairobi. Kenya.

**Background and objectives:** School Meal Programmes in Kenya have aided in improving students nutrition status as an essential element to improve their health and well-being since inception in 1980. KDHS 2014 reported that only 21% of children in the lowest wealth quintile consumed 4 or more food groups. Traditionally the national school meal contributed to the reduced dietary diversity by providing the caloric requirement with only three food groups, grains, pulses and oil. Beginning May 2016, WFP began incorporating fresh fruits and vegetables as a fourth food group into the diets of over 7,000 students. Transition into Fresh Foods for School Meals Programme (FF4SMP) provides a diversified basket offering the required level of energy and meeting the dietary diversity of at least four food groups. We are going to highlight the operational aspect of the Fresh Foods for School Meal Programme for students in the urban slums of Nairobi.

**Methods:** WFP supports School Meals in seven of the poorest and most vulnerable unplanned urban settlements in Nairobi, Kenya; Kangemi, Kawangware, Mathare, Kibera, Kariobangi, Mukuru and Makandara. Piloting of the project by adding ksh 2 (0.02 USD) in 88 schools in a phased approached over a year. Two modalities were tested to obtain the fresh food ration, 1) through cash transfers and school self procurement and 2) fresh food through outside catering that uses repurposing cosmetically unacceptable fresh foods (CUFFs).

**Results:** The food basket piloted includes maize, beans, oil and salt complemented by a serving of fresh vegetables or fruit. The
diversified food basket is possible for under 11 ksh/meal/day. The food basket with avocado met 35% of daily kcal requirement while the vegetable option met 31%. The difference in cost for the two was 0.39 cents. The budget for this pilot reaching 77,000 students for term 3, 2016 and term 1, 2017 is $489,322 with expected challenges of control over food quality and safety and uncertainty in accessing resources.

**Conclusions:** Fresh Foods pilot baskets have high nutrition value than traditional basket benefiting kids highlighting the need for its roll out countrywide and contributed to a higher dietary diversity.

**Keywords:** Schools, children, dietary diversity, Kenya

144/2394

REPURPOSING COMMERCially UNACCEPTABLE FRESH FOODS IN SCHOOL MEALS IN NAIROBI URBAN SLUM PRIMARY SCHOOLS

**Background and objectives:** Kenya's second largest horticultural export is fruits and vegetable, mainly to the UK and Europe. However, over 115,000 MT of cosmetically unacceptable fresh food (CUFFs) are discarded yearly due to strict standards set for export. Although the food is perfectly fit for human consumption, it doesn't meat the certain shape or color standards set for resale in the international markets and is then discarded in a variety of ways. WFP is aiming to develop an alternative market for these CUFFs by redistributing them into the school meals programme as an effort for students to receive a high quality low-cost fresh food ration.

School meals are a cost-effective safety net: they attract and retain learners in school, they contribute to alleviating short term hunger and for many children they constitute a significant portion of their daily energy and nutrient intake. Incorporating a fourth food group, consisting of fresh vegetables and fruits, contributes to improved dietary diversity and increased nutritional value.

**Methods:** Participants include 3 schools in the urban slums of Nairobi, Kenya, reaching almost 2,000 students daily. Schools receive a daily prepared hot meal that includes maize, beans, oil, salt and a fresh fruit or vegetable. The source of the fresh food ration comes from previously rejected fresh produce based on cosmetic standards only and is fit for human consumption. The cosmetically unacceptable fresh food (CUFF) would have been traditionally discarded by the packhouse.

**Results:** Contribute to the reduction of 115,000 MT of food annual food waste and increase the nutrition density of the school meals by diversifying the food basket. Increase access to low cost fresh nutritious foods. Contribute to the local economy by creating number of micro-entrepreneurial opportunities along the val-

ue chain. It will create a reproducible scalable model with global impact, particularly in countries with high horticulture exports and WFP supported school meals.

**Conclusions:** Developing a sustainable way to incorporate previously rejected food into Kenyan food systems, has the potential to create a reproducible scalable model with global impact, particularly in countries with high horticulture exports and WFP supported school meals.

**Keywords:** Food waste, schools, Kenya, dietary diversity.

144/2408

EGG VS ORGANIC EGG PREFERENCES OF TURKISH CONSUMERS ACCORDING TO FOOD VALUE SCALE

**Background and objectives:** People choice of healthier food have positive effects on healthy life. Therefore, the priorities of consumers varies and attitudinal, motivational, demographic and behavioural factors has impact on food choices. This study was designed to determine the food values when purchasing organic and non-organic eggs among Turkish consumers by food value scale.

**Methods:** In order to determine the values that consumers give importance in organic and non-organic egg, the food value scale was administered. The questions on socio-demographic characteristics and organic food preferences were also included in the questionnaire. The sample comprised healthy adults, 385 women and 123 men, ranged from 19 to 64 years. The questionnaires were analysed with the statistical programme SPSS

**Results:** The vast majority of participants were normal weight (11% underweight, 60% normal weight, 22% overweight and 7% obese). More than half of the consumers were young adult individuals aged 19-24 years (56.9%). 17.1% of the population is between 25-34 years, 10.4% is between 35-44 years, 11.6% is between 45-54 years of age and 3.9% is between 55-64 years of age. Compare to unhealthy eaters, It has been shown that healthy eaters pay more attention to naturalness for eggs and organic eggs when compared with taste (p<0.05). Healthy eaters also pay more attention to naturalness for eggs and organic eggs when compared with price (p<0.05). Although there was no statistical difference in the price and nutritional value of egg and organic egg preferences in healthy eaters (p>0.05), but in organic egg consumers thought nutritional value was more important than the price when compared to egg (p<0.05). In addition there was a significant difference in the values of environmental impact when compared with price in egg preference but not in organic egg (p>0.05)

**Conclusions:** This study showed naturalness, nutritional value and environmental impact were the most important values for

<footnote>(1)Aburmishan, Dina; (2)Jones, CJ; (2)Castelijns, Marjon; (3)Fossi, Lara;</footnote>

<footnote>(3)Hughes, Shaun.</footnote>

<footnote>(1)MPH. Nutritionist. World Food Programme. Nairobi. Kenya;</footnote>

<footnote>(2)MS. ENVIU. Nairobi. Kenya.; (3)MS. Humanitarian. World Food Programme. Nairobi. Kenya.</footnote>

<footnote>(1)Ozturk-Duran, Elif Esra; (1)Erdinc, Ayse Seyma; (2)Dikmen, Derya;</footnote>

<footnote>(3)Ellahi, Basma.</footnote>

<footnote>(1)BSc, Nutrition and Dietetics Department, Hacettepe University, Turkey.; (2)PhD, Nutrition and Dietetics Department, Hacettepe University, Turkey.; (3)Prof, PhD, Faculty of Health and Social Care, University of Chester, United Kingdom.</footnote>
consumers in egg preferences. Food values were related with the food preferences of consumers. Since food values have an influence on food choices, it can be use to identify effective strategy to promote healthy eating habits.

**Keywords:** Organic foods, Food value scale, food choice.

144/2565

IMPACT OF METHODOLOGICAL CHOICES WHEN
DEVELOPING A FOOD BASED DIETARY GUIDE-
LINES WITH DIET OPTIMIZATION TECHNIQUES

(1)Van Rossum, Caroline; (2)Geurts, Marjolein; (2)Toxopeus, Ido;

(2)Vennemann, Francy; (2)Buurma-Rethans, Elly; (3)Brink, Elisabeth;

(2)Ocke, Marga.

(1)PhD, Nutritionist, Centre for Nutrition, Prevention and Health Services, RIVM, The Netherlands; (2)Centre for Nutrition Prevention and Health Services. RIVM. Bilthoven. The Netherlands.; (3)The Netherlands Nutrition Centre (Voedingscentrum). The Hague. The Netherlands.

**Background and objectives:** Diet optimization is a mathematical approach that simultaneously takes multiple factors into account (such as limits between which intake of foods and nutrients should satisfy, and an optimization function) and facilitates the development of food based dietary guidelines (FBDG). This approach can be used to reduce subjective decision-making in guideline development. However, also when using diet optimization, subjective choice options cannot be avoided.

**Objective:** To provide insight into the effects of methodological choice options when developing FBDG with diet optimization techniques.

**Methods:** With data from young men aged 19 to 30 years from the Dutch food consumption survey the impact of different choice options were illustrated, by calculating the optimal diet for nine scenarios compared to a reference scenario. The choice options were related to the selection of food groups, the determination of food composition per food group, the current consumption per food group, the criteria and the optimization function.

**Results:** The present study demonstrates that, even though diet optimization techniques are less prone to subjective decision-making, choice options encountered in the development process remain to affect the final FBDG. The impact of the different choices options varied. A substantial effect occurred when increasing the number of food groups and/or the nutrient density of food groups (by including only healthier foods). Whereas a minimal effect was observed for different weighing factor for the food composition and introducing additional constraints. In- or excluding fortified foods in the nutrient composition calculation had an unclear effect.

**Conclusions:** Various methodological choices impact the resulting optimized diet for FBDG when using optimization techniques. Considering the various choices and recording of the decisions made is therefore essential.

**Keywords:** Food-based dietary guidelines, health, food composition, food consumption, optimization.

144/2636

FOOD AND BEVERAGE REFORMULATION
WOULD MAKE IT EASIER TO REACH SIMULTAN-
OUSLY ALL NUTRITIONAL RECOMMENDATIONS
IN THE FRENCH ADULT POPULATION

(1)Maillot, Matthieu; (2)Privet, Lisa; (3)Masset, Gabriel.

(1)PhD. MS-Nutrition. Marseille, France; (2)MD. MS-Nutrition. Marseille, France; (3)PhD. Nestlé Research Center. Lausanne, Switzerland.

**Background and objectives:** Reaching nutritionally adequate diet is possible but may require significant deviation from observed consumptions. The objective was to evaluate whether food and beverage reformulations following the Nestlé Nutritional Profiling System (NNPS) could reduce this necessary deviation in the French population.

**Methods:** Dietary data from the French national survey was crossed with the French food composition database (CIQUAL-2013). The category-specific NNPS classified all in-scope foods (70% of consumed foods) into "PASS" or "FAIL". Nutritional intakes were estimated for each adult (n=1808) according to 3 scenarios based on: i) the original food composition database (BASELINE), ii) a "reformulated" database in which the nutrient composition of FAIL products was adjusted to the NNPS standards (REFORMULATION) and iii) a replacement of FAIL products by the most nutritionally similar PASS products from the same category (SUBSTITUTION).

Mean Excess Ratio (MER,%/d) and Solid Energy Density (SED,kcal/100g) were calculated on observed diets. For each scenario, starting from each observed diet, a new iso-caloric modeled diet was designed (Maillot,PLoSOne,2017), to fulfill French nutrient recommendations and stay as close as possible to the observed one. The optimization process prioritized the modification of the amount of foods already consumed (repertoire foods), and foods which were not consumed could be added if necessary (non-repertoire foods). The total dietary deviation (TDD) was calculated as the sum of the absolute difference between observed and optimized amount of repertoire foods plus the amount of non-repertoire foods added.

**Results:** The MER and SED were improved in REFORMULATION (100%/d and 154kcal/100g) and SUBSTITUTION (103%/d and 146kcal/100g) scenarios compared to BASELINE (130%/d and 165kcal/100g). The TDD was significantly reduced in the REFORMATION and the SUBSTITUTION scenarios compared to BASELINE (1253g/d, 1226g/d and 1412g/d respectively). This was explained by a smaller increase of repertoire foods (661g, 609g vs 742g respectively), a smaller decrease of repertoire foods (-474g, -503g vs -520g respectively) and less additions of non-repertoire foods (118g, 113g vs 152g respectively).

**Conclusions:** Nutritional reformulation of the food supply according to the NNPS profile reduces the dietary effort required to achieve nutritionally adequate diets.

**Keywords:** Individual diet modeling, Nestlé Nutritional Profiling System, substitution, reformulation, diet quality

**Conflict of Interest Disclosure:** GM is employed by Nestec SA. MM and LP are employed by MS-Nutrition. Nestec SA funded this study.
## GENDER SPECIFIC DETERMINANTS OF STUNTING AMONG RWANDAN CHILDREN 6-23 MONTHS OLD

(1)Matsiko, Eric; (2)Melse-Boonstra, Alida; (3)Ahishakiye, Jeanine;

(4)Dandanell Garn, Kristine; (3)Iyakaremye, Damien; (5)Tuyisenge, Lisine; (2)Feskens, Edith.

(1)Msc. Division of Human Nutrition and Health. Wageningen University & Research. The Netherlands.; (2)PhD. Division of Human Nutrition and Health. Wageningen University & Research. The Netherlands.; (3)MSc. Department of Human Nutrition and Dietetics. University of Rwanda. Rwanda.; (4)MSc. Nutritionist. Unicef. Rwanda.; (5)MD. Department of Paediatrics. Kigali University Teaching Hospital. Rwanda.

**Background and objectives:** Stunting is a major public health concern in developing countries, with a disproportionate global burden affecting South-East Asia and Sub-Saharan Africa. Although a disparity in childhood stunting to the disadvantage of boys has been reported, it is not universal across countries. Moreover, the difference between the sexes seems rather extreme in Rwanda where boys have been affected more than girls for over a decade. We aimed to identify factors that explain the difference in stunting between boys and girls aged 6-23 months in Rwanda.

**Methods:** Cross-sectional data of 1533 children aged 6-23 months were collected from ten districts with a high burden of malnutrition in Rwanda. Predictors of stunting prevalence were modelled by Cox proportional hazard regression with robust variance, stratified for sex.

**Results:** Stunting significantly affected boys more than girls with a weighted prevalence of 43.3% vs. 28.0%, respectively. The multivariate analysis showed that living in a female-headed household (PR=1.20, 95% CI=1.09-1.31), off-farm occupation of the mother (PR=1.12, 95% CI=1.104-1.21), diarrhea (PR=1.07, 95% CI=1.01-1.13) and malaria (PR=1.27, 95% CI=1.16-1.39) were significant risk factors for stunting in boys solely. For both sexes, consistent significant risk factors were large household size (PR=1.20, 95% CI=1.11-1.30 in boys and PR=1.18, 95% CI=1.06-1.31 in girls), low wealth category (PR=1.17, 95% CI=1.10-1.1.24 in boys and PR=1.27, 95% CI=1.16-1.28 in girls), use of untreated drinking water (PR=1.15, 95% CI=1.09-1.22 in boys and PR=1.18, 95% CI=1.09-1.28 for girls) and dietary diversity below the minimum (PR:1.11, 95% CI= 1.03-1.21 in boys and PR=1.39, 95% CI=1.24-1.55 in girls).

**Conclusions:** The risk for stunting among boys remains substantially higher than among girls in Rwanda. This is most prominently related to morbidity, female headship of the household and off-farm occupation of the mother.

**Keywords:** Rwanda, Stunting, children of 6-23 month old, gender specific determinants.

## UNDERSTANDING BARRIERS AND FACILITATORS FOR BREASTFEEDING, DONOR HUMAN MILK, AND KANGAROO MOTHER CARE AMONG MOTHERS AND INFLUENCERS OF PRETERM AND SICK NEONATES IN INDIA

(1)Chugh Sachdeva, Ruchika; (2)Mondkar, Jayashree; (3)Shanbhag, Sunita; (4)Sinha, Minu; (5)Khan, Aisha; (6)Wankhede, Maya;

(7)Mahapatra, Sudip; (8)Dasgupta, Rajib.

(1)Team Leader- Nutrition. PATH.India; (2)MD. Neonatologist. Lokmanya Tilak Municipal Medical College and General Hospital. Mumbai. India.; (3)MD. Project Manager- MBFI+. Lokmanya Tilak Municipal Medical College and General Hospital. India.; (4)BSc. MBA. Research Officer-MBFI+. Lokmanya Tilak Municipal Medical College and General Hospital. India.; (5)BPT. MBA. Research Officer-MBFI+. Lokmanya Tilak Municipal Medical College and General Hospital. India.; (6)MD. Neonatologist. Rajawadi Hospital. Mumbai. India.; (7)M.Sc. Regional Monitoring and Evaluation Specialist. PATH. India; (8)PhD. Professor. Center of Social Sciences and Community Health. Jawaharlal Lal Nehru University. India.

**Background and objectives:** With the highest number of preterm, low birth weight, sick babies in the world, an integrated approach to newborn care is essential in India. Increasing access to human milk through human milk banks (HMB) has the potential to reach 5 million babies in India annually. Thus, assessment on knowledge of breastfeeding practices, kangaroo mother care (KMC) and perception of donor human milk among mothers and influencers of preterm and sick neonates was undertaken as a baseline prior to strengthening Mother Baby Friendly Initiative Plus (MBFI+) model that integrates breastfeeding promotion, KMC, and providing safe donor human milk to vulnerable babies.

**Methods:** Focus group discussions with mothers, influencers of preterm and sick neonates who have received donor milk, mothers who have donated milk and are potential donor and recipient at two facilities in Mumbai, India.

**Results:** More than half of the mothers were aware of the benefits of breastfeeding and nearly half were aware about the duration of exclusive breastfeeding. Most mothers and fathers were aware that colostrum should be fed to babies while few mothers stated that it is harmful. Most mothers mentioned that doctors during antenatal care told them about their diet, but no information was given on breastfeeding. Some mother shared challenges faced with feeding preterm, LBW babies. Only mothers who practiced KMC were aware of the practice and benefits. Overall, low awareness about human milk banking among mothers and influencers was found. Donor mothers and fathers were comfortable with donating milk once they knew it is life-saving and did not compromise supply for their own baby. All mothers accepted use of donor milk as per the unit norms, however, some parents had concerns about quality and safety as they were not aware of the process followed in a HMB. Most grandmothers were not comfortable with either donating or receiving donor human milk.

**Conclusions:** There is a need for capacity building and behavioral change communication strategies targeted at mothers and influ-
encers about MBFI+ interventions right from the antenatal period
so that mothers receive adequate support and information to help
increase access and uptake of human milk for vulnerable babies.

**Keywords:** Breastfeeding, human milk bank, preterm, kangaroo mother care, donor human milk.

(1)Williams, Timothy; (2)Pomeroy-Stevens, Amanda; (3)Mukuria, Altrena.

(1)MA. MEM. Senior Strategic Information Advisor. SPRING Project. John Snow Inc.; (2)MSc. Research and Evaluation Advisor. SPRING Project. John Snow, Inc. USA.; (3)DrPH. MPH. Director of Country Initiatives. SPRING Project. Save the Children. USA.

**Background and objectives:** Nutrition projects face chal-
lenges when measuring behavior change in low-resource settings.
Projects often lack resources to carry out population-based sur-
veys with comparison groups, and time lags between surveys can
limit usefulness for program management. Further, projects may
not reach enough people to enable dose-response surveys to de-
tect significant behavior change at population level during project
timeframes. Some of these issues can be addressed using "bene-
ficiary surveys" among people reached by project interventions.

**Methods:** In Bangladesh, Ghana, and Nigeria, the SPRING Project used beneficiary surveys to measure select nutrition outcomes. In all cases, SPRING also used secondary analysis from existing large-scale surveys among similar populations and regions, before interventions began. Beneficiary survey results were compared against those population-based surveys, providing a rough indication of project effect on outcomes. In Bangladesh, SPRING surveyed a cohort of 386 women before and after nine-month "farmer nutrition schools" (FNS), and again one year later. In Ghana (N=420) and Nigeria (N=371), beneficiary surveys (endline only) were carried out after one+ years of exposure to SPRING activities.

**Results:** In Bangladesh, diet diversity and other indicators increased significantly among participants following the nine-month FNS program. Women consuming 5+ out of nine food groups increased from 29% to 83% immediately following FNS, remaining high (76%) one year later. Secondary analysis of existing survey data among similar populations and similar timeframe showed negligible change (20% to 21%). In Nigeria, exclusive breastfeeding among support group beneficiaries was 61%, compared to 29% in a comparable population-based survey in the same area before SPRING activities began. In Ghana, the percentage of households with handwashing stations near latrines was 62% in a survey of SPRING beneficiaries, compared with 2.5% in a population-based baseline.

**Conclusions:** Beneficiary-only surveys can be an economical way for projects to learn about behavior change in target populations, especially if results can be analyzed against population-based surveys with comparable indicators and sampling. SPRING's experience suggests that behavior change can occur rapidly in small populations reached with intensive, multifaceted interventions. Achieving population level change takes longer due largely to issues of scale.

**Keywords:** Nutrition, surveys, behavior change, diet diversity, breastfeeding.
# Track 4: Nutrition and Management of Diseases

144/219

## THE CHALLENGES AND SUCCESSES OF SALT, SUGAR AND FAT REDUCTION PROGRAM TO PREVENT NCDS (IRAN EXPERIENCES)

(1)Hajifaraji, Majid; (2)Abdollahi, Zahra.

(1)National Nutrition & Food Technology Research Institute, Shahid Beheshti Univ. of Medical Sciences. Iran.; (2)PhD. in Nutrition, Dept. of Community Nutrition Development, Ministry of Health.

**Background and objectives:** In January 2015, WHO released a global estimate report which showed more than 1.9 billion overweight adults including 600 million obese people. Unbalanced diets and low physical activity can contribute to chronic diseases. % 65 of Iranian adults 40-64Y are overweight and obese, %45 with hypercholesterolemia and %47 are hypertensive, 16% identified and non-identified diabetes.

The studies show that %80 of CVD and Diabetes and %40 of cancers are preventable by controlling the above risk factors and dietary patterns have a pivotal role in the control of NCDs.

**Methods:** Two main restrictive policies which performed by Iranian authority to minimize the consumption of fat, salt and sugar: The first one is putting the tax for unhealthy food products and the updated list of unhealthy food products are published every year by Ministry of Health. In this program, tax of unhealthy foods spends on healthcare system. The second strategy is designing of a food traffic light labeling system which easily helps to estimate amounts of fat, salt, sugar and trans-fatty acids in one serving of food products.

**Results:** This system of labeling is mandatory for all of the industrial food products. We succeeded to reduce %1- 2.5 salt in bread, snacks, cheeses and sauces. The standard of salt in bread decreased from %2.3 to %1.8 and then %1 in 2016.

According to the legislation and operational plans SFA in oil products was reduced to <%25 and in food products such as snacks, biscuits and confections <%30. TFA was reduced from >%20 to <8% in food products and <%2 in edible oils in 2016.

**Conclusions:** As a Future plan, the road map in the national nutrition policy and food security in Iran by 2025 is mainly emphasizing on NCDs.

**Keywords:** Challenges, Successes, Salt, Sugar, Fat, Reduction, Program, Prevention, Non-Communicable Diseases.

144/297

## DIETARY INTAKE OF FIBRE AND GUT MICROBIO-TA IS RELATED TO LOWER LEVEL OF GLYCOPRO-TEIN ACETYLATION, A MARKER OF LOW-GRADE INFLAMMATION, IN OVERWEIGHT PREGNANT WOMEN

(1)Mokkala, Kati; (2)Houttu, Noora; (2)Koivuniemi, Ella; (3)Laitinen, Kirsi.

(1)M.Sc, Institute of Biomedicine, Univeristy of Turku, Finland;

(2)MSc, Institute of Biomedicine, Univeristy of Turku, Finland;

(3)PhD, Institute of Biomedicine, Univeristy of Turku, Finland.

**Background and objectives:** Overweight may induce health complications during pregnancy. One suggested mechanism arises from low-grade inflammation that has been linked with aberrant metabolic responses such as deranged glucose metabolism. Diet and gut microbiota may regulate low grade inflammation. Therefore the objective was to explore the relation of dietary fibre intake and gut microbiota richness with serum markers of low-grade inflammation in pregnancy.

**Methods:** Overweight and obese women (BMI 30.7±4.4 kg/m2, n=100) were studied in early pregnancy (≤17 weeks). Intake of fibre was calculated from 3-day food diaries. Faecal microbiota composition was analysed using 16S rRNA gene sequencing. Glycoprotein acetylation (GlycA, determined by NMR) and high-sensitive C-reactive protein (hs-CRP) were used as markers for low-grade inflammation. The alpha diversity, measured as Chao1, observed OTUs, phylogenetic diversity and the Shannon index were calculated using alpha rarefaction values at sequence 36382. Spearman's correlation was used to evaluate the associations between the variables.

**Results:** Dietary fibre intake correlated inversely with GlycA ($\rho$=-0.316, p=0.002, n=95). Also, the gut microbiota richness indexes correlated inversely with GlycA; Chao ($\rho$=-0.281, P=0.007), phylogenetic diversity ($\rho$=-0.238, P=0.022) and observed number of OTUS ($\rho$=-0.271, P=0.009). No association were detected between fibre or gut microbiota with hs-CRP.

**Conclusions:** Higher dietary intake of fibre and gut microbiota richness were related to lower maternal inflammatory status, measured as glycoprotein acetylation. The suggested mechanism how fibre may induce beneficial effects on maternal metabolism may take place through fibre induced alterations in gut microbiota richness. This finding opens novel opportunities in designing approaches for modification of diet and microbiota to induce beneficial alterations in maternal inflammatory status with potential to improve the health of both the mother and child.

**Keywords:** Fibre, inflammation, GlycA, gut microbiota richness, pregnancy.
POSTPRANDIAL LIPID RESPONSES AFTER
LONG-TERM INTAKE OF DAIRY PRODUCTS
VARYING IN FATTY ACID COMPOSITION

(1)Markey, Oonagh; (2)Markey, Oonagh; (3)Vasilopoulou, Dafni;

(4) Jackson, Kim G.; (5) Todd, Susan; (6) Givens, David I.; (7) Lovegrove,
Julie A.

(1)Loughborough University; (2)BSc (Hons). PhD. RNutr. Hugh Sinclair Unit of Human Nutrition. University of Reading. UK. School of Sport, Exercise and Health Sciences. Loughborough University. UK.; (3)BSc (Hons). MSc. Hugh Sinclair Unit of Human Nutrition. University of Reading. UK.; (4)BSc (Hons). PhD. Hugh Sinclair Unit of Human Nutrition. University of Reading. UK.; (5)BSc (Hons). MSc. PhD. Department of Mathematics and Statistics. University of Reading. UK; (6)BSc (Hons). PhD. CBIol. MSB. Institute for Food, Nutrition and Health. University of Reading. UK; (7)BSc (Hons). Diet (Dip). PhD. RNutr. Hugh Sinclair Unit of Human Nutrition. University of Reading. UK. Institute for Food, Nutrition and Health. University of Reading. UK.

**Background and objectives:** Consumption of modified
dairy products with a saturated fatty acid (SFA)-reduced, mono-
unsaturated fatty acid (MUFA)-enriched content may have ben-
eficial effects on the fasting cholesterol profile but their effects on
metabolic perturbations during the postprandial state, a signifi-
cant contributor to the pathogenesis of atherosclerosis, remain
unknown. Specifically, it is important to consider the effects of
sequential meals on postprandial metabolism, as this more accu-
rately reflects Western dietary patterns. We investigated whether
consumption of fatty acid (FA)-modified dairy products altered
postprandial metabolic responses, when compared to dairy foods
with a FA composition typical of retail products (control).

**Methods:** A 12-week, randomised, crossover, double-blinded controlled dietary intervention was conducted in fifty-one adults at moderate CVD risk (RESET study; NCT02089035). Using a food-exchange model, two iso-energetic high-fat (38% total energy (TE)), high-dairy diets that contained milk, cheese and butter: control (dietary target: 19%TE SFA; 11%TE MUFA) and modified (16%TE SFA; 14%TE MUFA) were implemented. Before and after each intervention period, a sequential two-meal, high-fat postprandial investigation was performed. Using mixed models, changes from the baseline study visit in postprandial serum triacylglycerol, glucose, apolipoprotein B (apoB) and insulin responses were reported as incremental area under the curve (iAUC) for 0-480min postprandially and following breakfast (0-330min) and lunch meals (330-480min), that were rich in control or modified dairy products.

**Results:** A differential effect was observed for the apoB re-
sponses from 0-480min and 0-330min, with attenuations ob-
served in iAUC following the modified diet (P<0.01 and P<0.0001,
respectively). No differences were evident between diets for other
outcome measures.

**Conclusions:** Chronic consumption of FA-modified dairy products decreased postprandial apoB responses, suggesting a potentially beneficial acute effect of these foods on TAG-rich lipo-

proteins metabolism. Supported by the Medical Research Council
(Ref: MR/K020218/1), with food in-kind from Arla Foods UK and
AAK (UK) Ltd.

**Keywords:** Dairy products, postprandial metabolism, saturat-
ed fatty acids, monounsaturated fatty acids, cardiovascular disease.

**Conflict of Interest Disclosure:** J A. Lovegrove is an expert on the UK Scientific Advisory Committee for Nutrition (SACN) Saturated Fats Working Group.

**Further collaborators:** Colette C. Fagan. BSc (Hons). MSc (Agr). PhD. Department of Food and Nutritional Sciences. University of Reading. UK.

Kirsty E. Kliem, BSc (Hons). PhD. Institute for Food, Nutrition and Health. University of Reading. UK.

METABOLICALLY UNHEALTHY OBESITY IN
SPANISH PREPUBERTAL CHILDREN AND ITS AS-
SOCIATION WITH CARDIOVASCULAR RISK BIO-
MARKERS

(1)Rupérez, Azahara Iris; (2)Olza, Josune; (3)Gil-Campos, Mercedes;

(4) Leis Trabazo, Maria Rosaura; (5) Bueno-Lozano, Gloria; (2) Aguilera, Concepción María; (2) Gil, Ángel; (6) Moreno, Luis A.

(1)PhD. Biochemist. Growth, Exercise, Nutrition and Development, School of Health Sciences, CIBEROBN. University of Zaragoza. Spain.; (2)PhD. Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix", CIBEROBN. University of Granada. Spain.; (3)MD. Paediatric Research and Metabolism Unit, CIBEROBN. Reina Sofía University Hospital, Maimonides Institute for Biomedical Research. Spain.; (4)MD. Unit of Investigation in Nutrition, Growth and Human Development of Galicia, Paediatric Department, CIBEROBN. University of Santiago de Compostela. Spain.; (5)MD. Paediatric Department of Lozano Blesa University Hospital, CIBEROBN. University of Zaragoza. Spain.; (6)MD. Growth, Exercise, Nutrition and Development, School of Health Sciences, CIBEROBN. University of Zaragoza. Spain.

**Background and objectives:** Childhood obesity is associated with metabolic complications that can derive into a higher risk of cardiovascular diseases (CVD). Some individuals with obesity do not display metabolic abnormalities, called metabolically healthy (MH), as opposed to those exhibiting metabolic alterations, called metabolically unhealthy (MU). The objective was to evaluate the association between CVD biomarkers and MU status in prepubertal children.

**Methods:** 930 Spanish prepubertal children (622 overweight/ obese, 462 males) aged 5 to 10.9 years were recruited. Anthropometric measurements were taken and adiponectin, leptin, resistin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were analyzed. Children were classified as having normal-weight or overweight/obesity using age- and sex-specific BMI cut-off points. MU status was based upon fulfillment of one or more of the following criteria: ≥90th percentile of SBP and/or
DBP for age, sex, and height; >90th percentile of TG for age, sex, and race; <10th percentile HDL-C for age, sex and race; ≥100 mg/dL glucose; >2.5 HOMA. A general linear model adjusted for age and BMI was used to assess differences between groups and a linear regression analysis was performed to evaluate the association between biomarkers and MU obesity using the software SPSS.

**Results:** In children with overweight/obesity, MU prevalence was 62.5% and in normal-weight children, 23.9%. In children with overweight/obesity, plasma concentrations of resistin (P=0.010), leptin (P=0.022), tPAI-1 (P=0.011) and MPO (P=0.001) were higher and adiponectin (P=0.008) was lower in MU than in MH children, while adjusting for age and BMI. Linear regression analysis indicated an independent association between tPAI-1 (β=0.215, 95% CI: 0.085-0.167, P<0.001) and MPO (β=0.167, 95% CI: 7.607-18.742, P<0.001) and MU status.

**Conclusions:** MU obesity is associated with a high fibrinolytic and vascular stress in prepubertal children. The measurement of biomarkers such as tPAI-1 and MPO could aid in the detection of children at high CVD risk, for their inclusion in adequate prevention programs.

**Keywords:** Metabolically unhealthy obesity, children, prepubertal, cardiovascular diseases.

**Methods:** Randomized, simple-blind, placebo-controlled clinical trial, 54 patients with T2DM received 520mg DHA+EPA-enriched fish oil (FOG) or placebo (PG) daily for 24 weeks. Baseline and final anthropometric and biochemical measurements included leptin and adipokine concentrations. We obtained dietary intake by multiple 24-hour recalls.

**Results:** Waist circumference and glucose showed significant reductions in FOG (p=0.001 and p=0.011 respectively). Glycosylated hemoglobin (p=0.009 and p=0.004), leptin (p=0.000 and p=0.000) and leptin to adiponectin ratio (p=0.000 and p=0.000) decreased significantly in both groups after supplementation (FOG and PG respectively); while serum resistin levels (FOG p=0.000 and PG p=0.001), insulin (FOG p=0.000 and PG p=0.000), and HOMA-IR (FOG p=0.000 and PG p=0.000) increased significantly in both groups. EPA (p<0.000) and DHA (p=.001) intake was higher in FOG.

**Conclusions:** We found a significant beneficial effect of six-month n-3 PUFA supplementation only on waist circumference and glucose. Acknowledgments: This project was financed by CONACYT, and is part of JCMG's thesis to obtain the degree of Master in Health Science. Key words: type 2 diabetes mellitus, adipokines, n-3 PUFA.

**Keywords:** Type 2 diabetes mellitus, adipokines, n-3 PUFA

## EFFECT OF SUPPLEMENTATION WITH FISH-OIL OMEGA-3 POLYUNSATURATED FATTY ACIDS ON ADIPOKINES IN SUBJECTS WITH TYPE 2 DIABETES MELLITUS IN MEXICO

**Background and objectives:** Background: Type 2 diabetes mellitus (T2DM) is associated with chronic low-grade inflammation, characterized by an increase in secretion of pro-inflammatory adipokines and a decrease of anti-inflammatory adipokines, worsening insulin resistance (IR). Omega-3 polyunsaturated fatty acids (PUFA), through their potent anti-inflammatory effects could help improve insulin sensitivity and the inflammatory profile, supplementation with PUFA in subjects with diabetes decreases inflammatory markers such as C-reactive protein and interleukin-2, little is known about their effects on adiponectin, resistin and leptin. Objective: Investigate the effect of n-3 PUFA on metabolic indicators of T2DM Mexican adults.

## MUCOSAL LEVELS OF IGE+ AND IGA+ CELLS AND ANTIBODIES IN PROTEIN DEFICIENT RATS DURING TRICHINELLA SPIRALIS INFECTION

**Background and objectives:** This study was aimed to analyze, in Trichinella spiralis-infected rats, the effect of protein deficiency on antibody (Ab) levels and IgE+ and IgA+ cells counts in lung and intestine (relevant organs in protection against this pathogen).

**Methods:** Weaning Wistar rats received a protein-deficient diet (PD, 6.5% casein) or a control diet (C, 20% casein). After ten days, both groups were orally infected with *T. spiralis* muscle larvae (ML); non-infected rats served as controls.

The organs were obtained at different days post-infection (p.i.). The numbers of IgA+ and IgE+ cells were determined by immunofluorescence. Total and specific Ab (against ML) were determined by ELISA in tissue extracts. Data were analyzed using the two-way ANOVA.

<footnote>(1)Valdes-Ramos, Roxana; (2)Jacobo-Cejudo, María Gorety;</footnote>

<footnote>(3)Guadarrama-López, Ana Laura; (4)Pardo Morales, Rosa Virgen;</footnote>

<footnote>(5)Martinez-Carrillo, Beatriz Elina; (6)Harbige, Laurence S.</footnote>

<footnote>(1)Faculty of Medicine, Universidad Autónoma del Estado de México; (2)MSc, Nutritionist. Faculty of Medicine. Universidad Autónoma del Estado de México. Mexico; (3)DSc, Medical Doctor. Faculty of Medicine, Universidad Autónoma del Estado de México. Mexico; (4)DSc. Medical Doctor. Instituto Materno-Infantil del Estado de México. Mexico; (5)PhD. Medical Doctor. Faculty of Medicine. Universidad Autónoma del Estado de México; (6)PhD. Biochemist. Faculty of Life Sciences and Computing. London Metropolitan University. UK.</footnote>

<footnote>(1)Vila, Cecilia Celeste; (1)Saracino, María Priscila; (1)Falduto, Guido Hernán; (2)Calcagno, Marcela Adriana; (3)Pallaro, Anabel N; (4)Baldi, Pablo César.</footnote>

<footnote>(1)PhD Student. Biologist. Cátedra de Inmunología-IDEHU (UBA-CONICET). Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Argentina.; (2)Biochemist. Cátedra de Inmunología-IDEHU (UBA-CONICET). Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Argentina.; (3)PhD. Biochemist. Departamento de Nutrición. Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Argentina.; (4)PhD. Biochemist. Cátedra de Inmunología-IDEHU (UBA-CONICET). Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Argentina.</footnote>
**Results:** Total IgE and IgG1 increased in C group from day 9 p.i. in both organs. In lung also IgG2a increased from day 9 p.i. In intestine IgA decreased from day 3 p.i. Although the same kinetics were observed in PD group for all isotypes, Ab levels were lower than in C group and did not increase significantly compared to non-infected animals. Specific IgG1 was significantly lower in PD group in both organs.

In lung IgE+ cells increased, compared to non-infected con-
trols, in C group from day 3 p.i. (p<0.05) and in PD group from
day 33 p.i. (p<0.01). In intestine IgE+ cells increased in C group
from day 3 p.i. (p<0.001) and in PD group from day 6 p.i. (p<0.01).
C group presented more IgE+ cells in both organs. No significant
changes were observed for IgA+ cells in any group.

**Conclusions:** Protein deficiency seems to affect the mucosal levels of Ab and IgE+ cells during Trichinella spiralis infection. Given the important role of IgE in helminthiases, this may explain the severe infection previously found in PD rats.

**Keywords:** Trichinella spiralis. Protein deficiency. IgE and IgA. Antibodies. Mucosal immunity.

144/740

NMR METABOLOMIC SIGNATURES REVEAL
PREDICTIVE PLASMA METABOLITES ASSOCI-
ATED WITH LONG-TERM RISK OF DEVELOPING
BREAST CANCER

(1)Lécuyer, Lucie; (2)Victor Bala, Agnès; (3)Vasson, Marie-Paule;

(4)Galan, Pilar; (5)Hercberg, Serge; (6)Srour, Bernard; (1)Fassier, Philippine; (7)Savarin, Philippe; (8)Touvier, Mathilde.

(1)MSc. PhD student. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (2)MSc. Chemistry Structures Properties of Biomaterials and Therapeutic Agents (CSPBAT). CNRS 7244 Paris 13 University SBMB. France.; (3)PharmD PhD. University Professor and Hospital Practitioner. Human Nutrition Unit (UNH). Clermont Auvergne University INRA CRNH Auvergne. France.; (4)MD PhD. Research Director. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (5)MD PhD. University Professor and Hospital Practitioner. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (6)PharmD MPH. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (7)PhD. Professor. Chemistry Structures Properties of Biomaterials and Therapeutic Agents (CSPBAT). CNRS 7244 Paris 13 University SBMB. France.; (8)PhD. Researcher. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.

**Background and objectives:** Combination of metabolom-
ics and epidemiological approaches opens new perspectives for

ground-breaking discoveries. The aim of the present study was to
investigate for the first time whether plasma non-targeted metabo-
lomic profiles, established from a simple blood draw from healthy
women, could contribute both to predict the risk of developing
breast cancer within the following decade and to better under-
stand the etiology of this complex disease.

**Methods:** A prospective nested case-control study was set up in the SU.VI.MAX cohort, involving 206 breast cancer cases diagnosed during a 13y follow-up, and 396 matched controls. Non-targeted NMR metabolomic profiles were established from baseline plasma samples. Multivariable conditional logistic regression models were computed for each individual NMR variable and for combinations of variables derived by principal component analysis.

**Results:** Several metabolomic variables from 1D NMR spectroscopy were associated with breast cancer risk. Women characterized by higher fasting plasma levels of valine, lysine, arginine, glutamine, creatine, creatinine, and glucose and lower plasma levels of lipoproteins, lipids, glycoproteins, acetone, glycerol-derived compounds and unsaturated lipids had a higher risk of developing breast cancer. P-values ranged from 0.00007 (ORT-3vsT1=0.37[0.23-0.61] for glycerol-derived compounds) to 0.04 (ORT3vsT1=1.61[1.02-2.55] for glutamine).

**Conclusions:** This prospective study showed that baseline NMR plasma metabolomic signatures reveal predictive metabolites associated with long-term breast cancer risk. These results provide interesting insights to better understand complex mechanisms involved in breast carcinogenesis and evoke plasma metabolic disorders favorable for carcinogenesis initiation. This study may contribute to develop screening strategies for the identification of at-risk women for breast cancer well before symptoms appear.

**Keywords:** Metabolomics, breast cancer, NMR, plasma, prospective study.

**Further collaborators:** Nadia Bouchemal, Mohamed Nawfal Triba, Adrien Rossary, Aicha Demidem, Mélanie Deschasaux, Thibault Fiolet, Valentin Partula, Laurence Le Moyec, Emmanuelle Kesse-Guyot, Paule Latino-Martel.

144/768

EFFECT OF STIGMASTEROL ISOLATED FROM
THE CALYXES OF BOMBAX COSTATUM ON HY-
PERLIPIDEMIC ALBINO RATS

(1)Nnam, Ngozi; (2)IOMBOR, TERHEMBA.

(1)PhD. Lecturer. Department of Home Science Nutrition and Dietetics. University of Nigeria Nsukka. Nsukka. Nigeria.; (2)M.Sc. Lecturer. Department of Home Science and Management. University of Agriculture. Makurdi. Benue State. Nigeria.

**Background and objectives:** Hyperlipidemia or hypercholesterolemia often occurs in conjunction with glucose intolerance, obesity, diabetes and metabolic syndromes. The study evaluated the effect of stigmasterol administration on total cholesterol, low density lipoprotein cholesterol, triglycerides and high density lipoprotein cholesterol contents of poloxamer-407 induced hyperlipidemic albino rats.
**Methods:** Thirty albino rats were divided into 6 groups of 5 rats each. Poloxamer-407 was dissolved in saline (1g/ml, 4 degree centigrade) and administered to the rats in group 2-6 by intraperitoneal injection at a dose of 1g/kg body weight to induce hyperlipidemia. The injections were given at days 1 and 3. Rats in group 1 were not induced and were fed rat chow and water only (control). On induction of hyperlipidemia, rats in group 2 were fed rat chow and water alone (2nd control). Rats in group 3 were fed rat chow, water and atorvastatin a standard drug (positive control) while rats in group 4-6 were fed rat chow, water and different doses (50, 100 and 200mg) of stigmasterol isolated from the calyxes of Bombax costatum, respectively. Blood samples were obtained from all the rats by cardiac puncture at baseline and endline. Total cholesterol (TC), triglyceride (TG) low density lipoprotein cholesterol (LDLC) and high density lipoprotein cholesterol (HDLC) were determined on the blood samples.

**Results:** The different doses of stigmasterol (50, 100, 200 mg) decreased TC, TG, LDLC and increased HDLC in the rats. The group given 50mg stigmasterol had the highest decrease in TC (12.99%) and TG (21.13%) relative to the group given standard drug atorvastatin, which had 7.2% decrease in TC and 6.31% decrease in TG. The group of rats given 200mg stigmasterol had the highest decrease in LDLC (13.55%) relative to the group given the standard drug atorvastatin (10.41%) while the group given 100mg stigmasterol had the highest increase in HDLC (11.86%) relative to the group given the standard drug atorvastatin (5.21%).

**Conclusions:** The different doses of stigmasterol were more effective in improving hyperlipidemia in albino rats relative to the standard drug atorvastatin.

**Keywords:** Hyperlipidemia, atorvastatin, stigmasterol, albino rats.

**Further collaborators:** University of Nigeria Teaching Hospital Ituku Ozalla. Enugu state. Nigeria.

144/868

BLUE MUSSEL (MYTILUS EDULIS) INTAKE DECREASES DISEASE ACTIVITY (DAS-28 CRP) IN FEMALE PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS FROM A RANDOMIZED CROSSOVER DIETARY INTERVENTION

(1)Lindqvist, Helen; (2)Gjertsson, Inger; (2)Eneljung, Tove; (3)Winkvist, Anna.

(1)PhD. Assistant Professor in Food Science and Biochemistry. Department of Internal Medicine and Clinical Nutrition. Institute of Medicine. Sahlgrenska Academy. University of Gothenburg. Sweden; (2)MD. Department of Rheumatology and Inflammation Research. Institute of Medicine. Sahlgrenska Academy. University of Gothenburg. Sweden; (3)PhD. Professor in nutrition. Department of Internal Medicine and Clinical Nutrition. Institute of Medicine. Sahlgrenska Academy. University of Gothenburg. Sweden.

**Background and objectives:** There is unfortunately an ambiguous evidence base for the relation between diet and Rheumatoid Arthritis (RA) and not possible to optimize treatment com-

bining both pharmacological treatment and lifestyle factors. The aim of this study was to test whether a diet rich in blue mussels, an environment sustainable seafood option, in addition to conventional medical treatment could reduce disease activity and improve quality of life in patients with established RA.

**Methods:** Women with established RA and DAS28>3.0 were recruited to a randomized 2x11-week cross-over dietary intervention. The participants continued with their medication and habitual diet but exchanged one cooked meal a day, five days a week with a meal including 75 g blue mussels or 75 g meat. Diets were switched after an eight week washout period. Blood samples were collected and analysed for blood lipids, erythrocyte sediment rate (ESR) and C-reactive protein (CRP). Tender and swollen joints were also examined at start and end of each dietary period. Data regarding patient global health, pain and fatigue (Visual Analog Scales, VAS), disability (Health Assessment Questionnaire) and quality of life (SF36) were recorded. As primary outcome variable, the composite measure DAS28 including the number of swollen and tender joints out of 28, patients' estimation of global health on a visual analog scale (VAS) and ESR was chosen.

**Results:** Twenty-three women (n=14 seropositive, n=9 seronegative) completed the intervention. Intake of the blue mussel diet reduced DAS28 CRP significantly (p=0.048) compared to control diet. The positive effect was due to a combination of a decreased CRP, fewer tender joints and a significantly lower rating in VAS global health (p=0.041). The numbers of EULAR criteria responders, that is based on DAS28, were significant higher when consuming blue mussel diet compared to control diet (p=0.036). Further, several aspects of quality of life such as fatigue (p=0.021) and mental health (p=0.008) was significantly improved by the blue mussel diet.

**Conclusions:** A substitution of meat with blue mussels reduced disease activity and improved quality of life in women with RA. Further analysis on biomarkers explaining the results and larger trials including blue mussels is necessary to confirm the results.

**Keywords:** Rheumatoid arthritis, diet, shellfish, Mytilus Edu- lis, DAS 28.

144/1034

VITAMIN D SUPPLEMENTATION ASSOCIATED WITH LIFESTYLE INTERVENTION ENHANCED THE LOSS OF ABDOMINAL FAT MASS IN OBESE ADOLESCENTS: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL (NCT02400151)

(1)Amiot-Carlin, Marie Josephpe; (2)Morrissey, Christopher; (3)Vinet, Agnes.

(1)PhD, Nutritionist, Institut National de la Recherche Agronomique, MOISA, Montpellier, France; (2)UAPV; (3)PhD, Cardiology Physiologist, Université d'Avignon, Avignon, France.

**Background and objectives:** Obesity in children was associated with lower concentration of vitamin D and higher metabolic risk factors. In adults, adiposity loss was correlated with increase
of 25(OH)D level (Pannu et al, 2016, Nutr Res). We hypothesized that combining vitamin D intake with a weight loss program may have a stronger effect on adiposity. We aimed to examine the effect of cholecalciferol (VD) supplementation with a lifestyle intervention on body fat and inflammatory status in obese adolescents.

**Methods:** Twenty-six 12-17 yr-old obese adolescents (OA) (BMI-Z score=4.0±0.6) were randomized into two arms: OS (n=13) were supplemented during 3 months with 4000 IU/d of VD given in a fruit juice and, ONS (n=13) received a fruit juice without VD. All OA followed a weight-loss program consisting of a reduction of 500 kcal per day combined with 180 min/week of supervised moderate-to-vigorous intensity exercise. Serum 25(OH)D, body fat (DEXA), inflammation (IL-6 and hs-CRP) were measured at inclusion and after 3-months. Changes of the parameters (in %) were compared between the both arms.

**Results:** At inclusion, 70% OA were deficient in 25(OH)D (< 50 nmol L-1). The deficiency was similar between OS and ONS groups. After 3 months, 25(OH)D significantly increased without any difference between OS and ONS (59% vs 36%, p=0.08). 25(OH)D also increased in ONS group probably due to both sun exposure and outdoor physical activities during the intervention study. Abdominal fat mass decreased by 14% for the both groups. Interestingly, the change of 25(OH)D was strongly correlated with the change of abdominal fat mass in OS (r=-0.76, p<0.01), but not in ONS (r=-0.41, p=0.19). Note that inflammatory markers decreased in both groups without any significant difference between OS and ONS (-42% vs -33% for IL-6, -37% vs -61% for hs-CRP).

**Conclusions:** We showed that i) the loss of abdominal adiposity mediated by a lifestyle program (diet and exercise) was correlated to the increase of plasma 25(OH)D level in obese adolescents; ii) vitamin D supplementation enhanced the effect of a lifestyle program on abdominal fat mass loss. We concluded that vitamin D supplementation should be recommended with a weight loss program in obese adolescents.

**Keywords:** Cholecalciferol, obesity, adolescent, adiposity, inflammation.

**Further collaborators:** VIDADO-Study Group: Agnès Vinet. PhD (UAPV), Christopher Morrissey. MSc (UAPV), Marie Josèphe Amiot. PhD (INRA), Antonia Perez-Martin. PhD, MD (CHU Nimes, France). Catherine Defoort (PhD AMU) Catherine Tardivel. MSc (INRA) Cécile Raverdy. MD. Delphine Masson. MD (SSR, ISP, France). Aurélie Goncalvez. PhD (UAPV). Sandrine Gayrard. BSc (UAPV).

## TENOMODULIN GENETIC VARIANTS ON THE X CHROMOSOME ARE ASSOCIATED WITH CHILDHOOD OBESITY

(1)Anguita-Ruiz, Augusto; (1)Ruiz-Ojeda, Francisco J.; (2)Olza, Josune;

(3)Rupérez, Azahara Iris; (4)Vázquez-Cobela, Rocio; (5)Gil-Campos, Mercedes; (6)Moreno, Luis A.; (2)Gil, Ángel; (7)Bueno-Lozano, Gloria;

(8)Leis Trabazo, Maria Rosaura; (2)Aguilera, Concepción María.

(1)MSc. Biochemist. Department of Biochemistry and Molecular Biology II. Institute of Nutrition and Food Technology "Jose Mataix". Centre of Biomedical Research. University of Granada. Granada. Spain.; (2)PhD. Department of Biochemistry and Molecular Biology II. Institute of Nutrition and Food Technology "Jose Mataix". Centre of Biomedical Research. University of Granada. Granada. CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Spain; (3)PhD. Health Sciences Institute in Aragon. Zaragoza. Pediatric Department. Lozano Blesa University Clinical Hospital. University of Zaragoza. Spain.; (4)PhD. Unit of Investigation in Nutrition. Growth and Human Development of Galicia. Paediatric Department. Clinic University Hospital of Santiago. University of Santiago de Compostela. Santiago de Compostela. Spain.; (5)MD. Unit of Pediatric Endocrinology. Reina Sofía University Hospital. Córdoba. CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Madrid. Spain.; (6)PhD. Health Sciences Institute in Aragon. Zaragoza. Pediatric Department. Lozano Blesa University Clinical Hospital. University of Zaragoza. CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Madrid. Spain.; (7)MD. Health Sciences Institute in Aragon. Zaragoza. Pediatric Department. Lozano Blesa University Clinical Hospital. University of Zaragoza. CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Madrid. Spain.; (8)MD. Unit of Investigation in Nutrition. Growth and Human Development of Galicia. Paediatric Department. Clinic University Hospital of Santiago. University of Santiago de Compostela. CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Spain.

**Background and objectives:** Current genetic association studies are usually focused on autosomal variants only, and the sex chromosomes are often neglected. In recent years, a number of statistical techniques and strategies have been widely described making much easier overcoming X-chromosome technical hurdles and including this region within genetic studies. Tenomodulin (TNMD) is a Xq22 chromosome anti-angiogenic locus which has been recently linked to different obesity-related phenotypes. These results have not been replicated to date. Given these facts, we have conducted a genetic association analysis in Spanish children population including several TNMD SNPs as potential candidate markers for obesity and metabolic dysfunctions.

**Methods:** A total of 915 DNA samples from 258 normal weight, 177 overweight and 480 obese Spanish children (438 males, 477 females) were genotyped for seven TNMD SNPs and associations with anthropometric measurements and glucose metabolism were investigated. To handle with the X-chromosomal location of TNMD, specific association analysis design (Clayton's statistics and sex stratified regression analysis) as well as specific quality control
criteria were implemented in R code and PLINK software. Adjust-
ments for BMI, age and sex were done when necessary.

**Results:** In our population, two previously reported link-
age disequilibrium (LD) blocks were observed: haploblock-1
(rs2073162, rs2073163, rs4828038, and rs1155974) and hap-
loblock-2 (rs11798018, rs5966709 and rs4828037). All mark-
ers are located through all of TNMD sequence domains and are
representative for the region. Several obesity-related phenotypes
were gender-specific and separately associated. We identified
rs4828038_T as one of the tag SNPs within the haploblock-1
and the one with the strongest association signals. Particularly,
this variant showed association with anthropometric measure-
ments such as BMI (P=0.0099, BETA=1.466) and BMI z-score
(P=0.0035, BETA=0.636) in males. Regarding to glucose metabo-
lism phenotypes, genetic associations with insulin resistance were
observed; HOMA index (P=0.0105, BETA=0.226) and insulin lev-
els (P=0.0184, BETA=0.919) in the female-male mixed group; and
glucose levels (P=0.0130, BETA=2.137) in males.

**Conclusions:** These data show that TNMD variants are asso-
ciated with obesity and alterations in glucose metabolism in chil-
dren population and, therefore, replicate some previous findings
from adult human population.

**Keywords:** Childhood obesity, glucose metabolism, genetics, tenomodulin, X chromosome.

**Methods:** In a longitudinal cohort of 687 stable RTR with a median [interquartile range (IQR)] follow-up of 5.4 [4.8-6.1] years, and 297 healthy controls, plasma PLP was measured by a validated high performance liquid chromatography assay. Vitamin B6 deficiency and sufficiency were defined as plasma PLP <20 and ≥20 nmol/L, respectively. In addition, 3-hydroxykynurenine (3-HK) and xanthurenic acid (XA) were analyzed by a validated liquid chromatography tandem mass spectrometry assay. As functional biomarker of vitamin B6, 3-HK/XA-ratio was assessed, with higher ratio reflecting worse functional vitamin B6 status. Cross-sectional and prospective associations were assessed by linear and Cox regression analyses, respectively, in which adjustments were made for potential confounders.

**Results:** Median plasma PLP was 29 [17-50] nmol/L in RTR (31% deficient) and 41 [29-60] nmol/L in healthy controls (11% deficient) (P<0.001). 3-HK/XA-ratio in RTR was 2.38 [1.68-3.49], compared to 2.13 [1.63-2.71] in healthy controls (P<0.001). The differences in plasma PLP and 3-HK/XA between controls and RTR were independent of age, sex, and kidney function. In RTR, 3-HK/XA-ratio was inversely associated with plasma PLP (β=-0.20, P<0.001). During follow-up, 147 (21%) RTR died. 3-HK/XA-ratio was associated with all-cause mortality (hazard ratios (HR) [95% confidence intervals] 1.31 [1.15-1.45], P<0.001). This prospective association was independent of age, gender, smoking, BMI, kidney function, alkaline phosphatase, high-sensitivity C-reactive protein, alcohol intake, energy intake, and plasma PLP (HR 1.26 [1.08-1.48], P=0.003)].

**Conclusions:** Vitamin B6 deficient RTR have worse functional vitamin B6 status than healthy controls and vitamin B6 sufficient RTR. Importantly, worse functional vitamin B6 status in RTR is independently associated with increased risk of mortality.

**Keywords:** Vitamin B6, Functional Biomarkers, Kynurenines, Renal Transplantation, Long-Term Mortality.

144/1044

FUNCTIONAL BIOMARKERS OF VITAMIN B6 DEFICIENCY AND MORTALITY IN RENAL TRANSPLANT RECIPIENTS

**Background and objectives:** Low plasma concentrations of the direct vitamin B6 status marker pyridoxal-5'-phosphate (PLP) are common in renal transplant recipients (RTR). It is not known whether a low direct vitamin B6 status has functional, i.e. intracellular, consequences and, if so, whether such consequences are associated with increased risk of mortality. Hence, we aimed to assess the association of plasma PLP with functional vitamin B6 status and to explore the potential association of functional vita-min B6 status with mortality in RTR.

<footnote>(1)Minovic, Isidor; (2)van der Veen, Anna; (3)van Faassen, Martijn;</footnote>

<footnote>(4)van den Berg, Else; (5)Kootstra-Ros, Jenny; (6)Geleijnse, Johanna;</footnote>

<footnote>(7)Eggersdorfer, Manfred; (4)Navis, Gerjan; (5)Kema, Ido; (4)Bakker, Stephan J.L.</footnote>

<footnote>(1)PharmD. Isidor Minovic. Department of Nephrology. University Medical Center Groningen. The Netherlands.; (2)MSc. Department of Laboratory Medicine. University Medical Center Groningen. The Netherlands.; (3)BSc. Department of Laboratory Medicine. University Medical Center Groningen. The Netherlands.; (4)MD PhD. Department of Nephrology. University Medical Center Groningen. The Netherlands.; (5)PhD. Department of Laboratory Medicine. University Medical Center Groningen. The Netherlands.; (6)PhD. Division of Human Nutrition. Wageningen University. The Netherlands.; (7)PhD. Nutritional Products. DSM. Switzerland.</footnote>
EFFECTS ON DIET INTAKE FROM THE HEALTHY
START PRIMARY INTERVENTION

(1)Rohde, Jeanett Friis; (2)Larsen, Sofus Christian; (3)Ångquist, Lars;

(2) Olsen, Nanna Julie; (4) Stougaard, Maria; (5) Mortensen, Erik Lykke;

(6)Heitmann, Berit Lilienthal.

(1)PhD. cand scient sant publ. Research Unit for Dietary Studies at the Parker Institute. Bispebjerg and Frederiksberg Hospital, the Capital Region. Denmark; (2)PhD. Research Unit for Dietary Studies at the Parker Institute. Bispebjerg and Frederiksberg Hospital, the Capital Region. Denmark.; (3)PhD. senior statistician. Department of Clinical Epidemiology (Formerly 'Institute of Preventive Medicine'). Bispebjerg and Frederiksberg Hospital. Denmark.; (4)PhD student. Research Unit for Dietary Studies at the Parker Institute. Bispebjerg and Frederiksberg Hospital, the Capital Region. Denmark.; (5)Professor MSO. Department of Public Health and Center for Healthy Aging. University of Copenhagen. Denmark.; (6)Professor.PhD. Research Unit for Dietary Studies at the Parker Institute. Bispebjerg and Frederiksberg Hospital, the Capital Region. Denmark. The Boden Institute of Obesity. Nutrition, Exercise & Eating Disorders. The University of Sydney. Australia.

**Background and objectives:** Evidence of effective obesity prevention interventions is limited, and hence new strategies are needed. This study reports the dietary intervention effects from the 15 month primary obesity prevention intervention (Healthy Start).

**Methods:** The “Healthy Start primary intervention study” aimed to prevent excessive weight gain among Danish obesity-prone normal weight preschool children. The intervention was conducted during 2009-2011, and focused on improving the child’s diet, physical activity and sleep as well as managing stress in the families of the young children. Children were considered obesity prone if they had either a high birth weight (≥ 4,000 g), a mother with a pre-pregnancy BMI≥ 28 kg/m2), or low maternal education (<10 years of schooling). From a baseline population of 543 Danish normal weight preschool children, 285 completed the intervention with complete information on dietary intake at the baseline- and follow-up examination. Information on diet intake was obtained using a 4-day dietary record, from which a diet quality index assessing compliance with the Danish national dietary guidelines was constructed. Linear regression per protocol and intention-to-treat analyses of differences in total energy-, macronutrients-, fruit-, vegetables-, fish- and sugar sweetened beverages intakes and diet quality index between the two groups were conducted.

**Results:** Children in the intervention group had a lower total energy intake after the 15-month intervention compared to the control group (Group mean: 5.3 vs. 5.6 MJ; p=0.02). We found no effect of the intervention on the individual macronutrients-, fruit-, vegetables-, fish- and sugar sweetened beverages intakes or the diet quality.

**Conclusions:** Our results suggest an overall effect of the Healthy Start primary intervention on total energy intake. However, no effects were seen for the individual components of children's dietary intake.

**Keywords:** Obesity, prevention, diet, children, intervention.

FASTING AND RESTRICTIVE DIET TO LOSE WEIGHT AMONG CANCER SURVIVORS: PROFILES, SOURCES OF NUTRITIONAL INFORMATION, KNOWLEDGES AND OPINIONS: RESULTS FROM THE NUTRINET-SANTÉ COHORT

(1)Fassier, Philippine; (2)Srour, Bernard; (3)Zelek, Laurent; (4)Touillaud, Marina; (5)Bachman, Patrice; (6)Cohen, Patrice; (7)Raynard, Bruno;

(2)Lécuyer, Lucie; (8)Latino-Martel, Paule; (9)Touvier, Mathilde.

(1)PhD student. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (2)Ms. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (3)Md. PhD. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (4)PhD. Cancer. environment and nutrition Unit. Léon Bérard Center. F-69000. Lyon. France; (5)PhD. PU-PH. Cancer. environment and nutrition Unit. Léon Bérard Center. F-69000. Lyon. France; (6)PhD. PU-PH. Sociology department. University of Rouen. DySola. EA 4701; (7)Md. PhD. Nutrition Department. Gustave Roussy European Cancer Center.; (8)PhD. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (9)PhD. HDR. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.

**Background and objectives:** Cancer survivors need to get more actively involved in their disease, notably through their nutritional behavior. For instance restrictive diets may be considered, including fasting practice or restrictive diets to lose weight. For the moment, no previous study has investigated these both types of restrictive diets among cancer survivors.

Aims of this study were to describe profiles of patients having practiced fasting or restrictive diet to lose weight after cancer diagnosis and to investigate knowledges/opinions of these patients and their sources of nutritional information, among cancer survivors in a large web based cohort.

**Methods:** In the NutriNet-Santé cohort, 10,309 cancer survivors received the “Sources of information and knowledges/opinions about nutrition” questionnaire in June 2016. Among them 2,942 completed it in October 2016. Associations were explored by multivariate logistic regression adjusted for socio-professional and lifestyle factors.

**Results:** 4.5% of participants had already practiced fasting practices since their diagnosis. They were more likely to be women (p=0.01), youngsters (p=0.03), with higher educational level (p=0.003), lower incomes (p=0.004), to use dietary supplements (p=0.03) and practice higher physical activity (p=0.01). 32.2% of patients had practiced restrictive diet to lose weight since diagnosis with higher proportion of women (p<0.0001), professionally
active (p<0.05), breast cancer (p=0.0008), overweight (p<0.0001), and of patients using dietary supplements (p=0.0002). Logically, patients reporting believe to the effect of fasting on improved cancer prognosis were more likely to practice fasting (p<0.0001). Contrary, there was no relation between patient's knowledges of the links between overweight and cancer prognosis and tendency to practice restrictive diet (p=0.4). Patients who practiced fasting after cancer diagnosis were less likely to have receive nutritional information by a healthcare professional (p=0.001) and less likely to be proposed nutritional monitoring (p=0.002). Patients who practiced diet after cancer diagnosis were less likely to have received nutritional information by a healthcare professional (p<0.0001) and less likely to be proposed nutritional monitoring (p=0.0002).

**Conclusions:** These results show that fasting was practiced for its impact on their disease, while diet was not practiced to their cancer. Discussing this matter with a healthcare professional or following a nutritional program would have an impact on practicing a restrictive diet.

**Keywords:** Fasting, Diet, cancer survivors, nutritional knowledges, nutritional opinions.

**Further collaborators.**

Nathalie Druesne-Pecollo, Hélène Hoarau, Vanessa Cottet, Florence Couson-Gelie, Veronique Dhondt, Stephane Servais, Marie-Paule Vasson, Pilar Galan, Serge Hercberg

weight gain, energy intake, and potential renal solute load of infants u6m old with SAM when fed F-100, diluted F-100 or infant formula during the rehabilitation phase.

**Methods:** Double blind randomized clinical trial comparing infant formula, F-100 diluted and F-100 was conducted at the Nutrition Rehabilitation Unit (NRU) of Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. One hundred and fifty-three u6m old infants with SAM were enrolled who were admitted for diarrhea and other illnesses. After recovering from illnesses, infants were randomly assigned to any of the three diets. During first 2 d, diets were fed at 130ml/kg/d in 12 feeds and then 10 ml more at each feed until some is left. Diets were offered in 8 feeds thereafter. Two ml blood was collected on study d 1, 3, and 7 for measuring serum electrolytes, creatinine and osmolality. Spot urine samples were also tested for specific gravity and osmolality:creatinine. Renal solute load and potential renal solute was calculated. Infants were discharged from NRU when gained 15% of the admission bodyweight or as soon as they became oedema free or had oedema free weight-for-length Z-score ≥ -2.

**Results:** There was no difference in dietary intake (g/d) across the study groups (p=0.18), but infants consumed more energy (kcal/d) who received F-100 (p<0.001). Infants gained significantly more weight when fed F-100 and F-100 diluted than those who received infant formula (p=0.023). Potential renal solute load was significantly more in those fed with F-100 (<0.0001), but was within normal limit.

**Conclusions:** Both F-100 diluted and F-100 can be used as an effective rehabilitation diet in u6m old infants suffering from SAM.

**Keywords:** Infants under-6 months, severe acute malnutrition, F-100 diluted, F-100.

144/1088

REHABILITATION OF INFANTS UNDER-6
MONTHS OLD WITH SEVERE ACUTE MALNU-
TRITION: A RANDOMIZED, CLINICAL TRIAL OF
THREE RECOVERY DIETS: INFANT FORMULA,
F-100 DILUTED AND F-100

(1)Islam, M Munirul; (2)Huq, Sayeeda; (3)Hossain, Md Iqbal; (4)Ahmed, Tahmeed.

(1)MBBS. PhD. Scientist. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Dhaka. Bangladesh; (2)MBBS. MPH. Associate Scientist. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Dhaka. Bangladesh.; (3)MBBS. PhD. Senior Scientist. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Dhaka. Bangladesh.; (4)MBBS. PhD. Senior Director. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Dhaka. Bangladesh.

**Background and objectives:** Challenges in managing severe acute malnutrition (SAM) in infants under-6 mo (u6m) old have been widely reported over the past decade. Current guidelines do not explicitly mention about any specific dietary management of infants u6m olds. Both facility-based and community-based programs face difficulties in their management. Thus, information is required on effects of rehabilitation diets in u6m old infants suffering from SAM. The study was intended to compare the body