**Methods:** The program is aimed at people over 60 with physiological aging or initial to moderate stage of cognitive impairment; additionally we provide support groups for care givers.

Activities carried out in the Nutrition area:

* Cooking workshops with creative recipes of pureed foods, finger food.

* Healthy modifications of Argentine recipes

* Practice with adapted kitchen utensils.

* Specialist talks.

* Evoking an emotional value of food

* Identifying correct meals to eat at certain times in the day

* A memory recollection game with matched cards

**Results:** Using qualitative evaluation we observed:

* A decrease in caregiver's workloads.

* Feedback from family members of an increase in pleasure derived when eating.

* A need to quantify results, which will be used with the Mini Nutritional Assessment

* Attendance at the workshops has been maintained while the number of new attendees has increased.

**Conclusions:** Nutrition is not only the mechanical activity of incorporating substances into the body, but also involves emotions, evokes memories, and generates pleasure. Food is a useful vehicle when working with cognition and emotions, maintaining or improving people's independence.

**Keywords:** Elderly, Nutrition, Cognitive

**Results:** The average age was 22.61±5.04 years, 4.90% were underweight, 66.67% eutrophic, 18.63% were overweight and 9.80% were obese. The WCS showed adequate factorial adjustment in the total sample (l=0.49-0.84; c²/gl=1.832; CFI=0.969; NFI=0.936; RMSEA=0.091). The convergent validity (AVE=0.43; CR=0.78) was bellow recommendations and the internal consistency was adequate (α=0.77). The prevalence of eating disorder risk was 33.33%.

**Conclusions:** The online version of WCS showed satisfactory validity and adequate reliability. When it comes to the developing of eating disorders, the sample has presented a high prevalence of risk.

**Keywords:** Body image. College students. Validation.

144/1599

PLASMA VITAMIN C AND THE RISK OF GASTRIC CANCER RISK IN THE EURGAST STUDY

(1)Jakszyn, Paula; (2)Lujan, Leila; (3)Aranda, Nuria; (4)Sarrats, Ariadna;

(5)Agudo, Antonio.

(1)Unit of Nutrition and Cancer. Catalan Institute of Oncology. Spain; (2)Biostatistitian. Unit of Nutrition and Cancer. Catalan Institute of Oncology. Spain; (3)Reseacrher. Unitat de Nutrició i Salut Pública. Facultat de Medicina i Ciències de la Salut. Universitat Rovira i Virgili. Spain; (4)Researcher. Spain;

(5)Epidemiologist. Unit of Nutrition and Cancer. Catalan Institute of Oncology. Spain.

144/1583

WEIGHT CONCERNS SCALE (WCS): VALIDATION OF THE ONLINE VERSION APPLIED TO NUTRITION STUDENTS

(1)Chioda Ribeiro Dias, Juliana; (2)Olivati de Sarro, Isabela.

(1)PhD. Nutricionist. Centro Univiversitário Unifafibe. Bebedouro. Brasil; (2)Graduation student. Centro Universitário Unifafibe. Bebedouro. Brasil.

**Background and objectives:** The body image is a multidimensional construct. One aspect of this construct is weight concerns. The Weight Concerns Scale (WCS) aims to evaluate the degree of concern with body weight. The aim of this study was to estimate the reliability and validity of WCS's online version in female Nutrition students.

**Methods:** 102 students from a Brazilian private university completed the WCS in the online format. Information about the age, economic level, weight and height were also collected. The validity of the scale was measured by means of factorial and convergent validity. Confirmatory factor analysis of scale was carried by using goodness-of-fit indices: the chi-square by degrees of freedom ratio (c2/df), Comparative Fit Index (CFI), Normed Fit Index (NFI) and Root Mean Square Error of Approximation (RMSEA). Convergent validity was estimated by Average Variance Extracted (AVE) and Composite Reliability (CR) and the internal consistency by standardized Cronbach's alpha coefficient (α).

**Background and objectives:** Vitamin C is an antioxidant and inhibitor of carcinogenic N-nitroso compound production in the stomach. Higher dietary vitamin C consumption is associated with decreased risk of gastric cancer (GC) in numerous case-control studies, but data from prospective studies are limited. Recently the WCRF have included citrus fruit as a protective factor with limited-suggestive evidence specifically for gastric cardia cancers. Our previous analysis based on 256 cases and using a fluorometric method has an inverse association between GC and serum vitamin C. The objective of this study was to re-assess the association of plasma vitamin C levels with the risk of GC in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) including a larger sample size and a more accurate methodology.

**Methods:** Serum vitamin C was measured using liquid chromatography coupled to mass spectrometry in 456 GC cases and 456 matched controls (sex, age and blood collection) form teh nested case control study EURGAST. Conditional logistic regression models adjusted smoke, education, BMI, helicobacter pylori infection, red meat, processed meat, alcohol, and energys were used to estimate relative cancer risks.

**Results:** After adjusting by potential confounders, No association with plasma vitamin C and gastric cancer risk was found (HR 20 microg/l: 0.947, 95 CI: 0.82-1.08). When results were analyzed by tumor localization, comparing highest vs. lowest tertiles of serum vitamin C results have shown a negative association for cardia cancer site (HR 0.482, 95% CI: 0.235-0.99). No association was found for non cardia site.
**Conclusions:** Plasma vitamin C levels may play a role decreasing the risk of cardiac gastric cancer. More prospective studies, including a larger number of cardiac cancers are needed to confirm these findings.

**Keywords:** Gastric cancer, biomarkers, vitamin C, risk, cohort study

(1)Inan-Eroglu, Elif; (2)Ozdemir, Aslihan; (2)Madali, Berna; (1)Dikmen, Derya.

(1)PhD. Nutrition and Dietetics Department. Hacettepe University.
Turkey.; (2)MSc. Nutrition and Dietetics Department. Hacettepe
University. Turkey.

**Background and objectives:** Since their publication, the Three Factor Eating Questionnaire and the Eating Attitude Test 26 (EAT 26) have become the most widely used psychometric tools identifying individual differences in eating attitudes in studies of human eating behaviour. In this context the objective of this work was to examine the association between TFEQ and EAT 26 in adults.

**Methods:** In order to determine participants' eating behaviours, the eating attitude test 26 (EAT 26) and three factor eating questionnaire (TFEQ) were administered by intern dietitians. The TFEQ evaluates 3 dimensions of eating behavior: cognitive restriction (CR), uncontrolled eating (UE), and emotional eating (EE). The responses are measured on a Likert scale ranging from 1 (completely true) to 4 (completely false). Questions on socio-demographic characteristics were also included. The sample comprised 32 women and 14 men, ranged from 19 to 40 years. The questionnaires were analyzed with the statistical program SPSS.

**Results:** According to EAT 26, 8.9% participants had eating disorder. The mean TFEQ score of the participants was 40.59±6.85. There was a significant difference between TFEQ total scores and TFEQ uncontrolled eating scores of participants with and without eating disorders (p <0.05). When this difference was investigated by gender, there was a difference between TFEQ total scores, TFEQ emotional eating scores and TFEQ uncontrolled eating scores of women with and without eating disorder (p <0.05), while no difference was found in men with and without eating disorder. Also there was a positive correlation between EAT 26 scores and TFEQ total scores and TFEQ cognitive restriction scores of women (r=0.409 p=0.020 and r=0.493 p=0.004, respectively).

**Conclusions:** This study showed a positive association between the TFEQ and EAT 26 in participants, especially in women. However, further studies are needed to explore the causes of this association. It would be interesting to investigate genetic and sociocultural causes that affect eating behaviour in a larger sample.

**Keywords:** EAT 26, TFEQ, eating behaviour

(1)Rao, Amruth; (2)Upputuri, Brahmaiah; (2)Hemalatha, R.

(1)Scientist. National Institute of Nutrition. Tarnaka. Hyderabad.
India.; (2)National Institute of Nutrition. Tarnaka. Hyderabad.
India.

**Background and objectives:** Pellagra is a niacin or tryptophan deficiency disorder. Not long ago, the disease was endemic in several parts of the world; including India. The patients affected by the deficiency of Vit-B3 generally suffer from dermatitis. The symptoms begin as an acute eczematous rash distributed over the photo-exposed areas and in chronic situations, the skin becomes rough and chronic eczematous lesions are found. Pellagra is characterized by the three Ds. i.e., Diarrhea, Dermatitis and Dementia. Over the past two decades, only a few pellagra cases have been reported. By the year 2011, Pellagra had almost disappeared due to Public Distribution System but, the clinical features still prevail in Indian subcontinent to some extent. This study clearly recommends that general ration should be regularly distributed.

**Methods:** The case records of patients with clinical diagnosis of pellagra attending the Nutrition Unit of Osmania General Hospital, Hyderabad were retrospectively reviewed between 1992 and 2012. The inclusion criteria were (a) clinical findings consistent with pellagra (photosensitive rash in sun-exposed areas). (b) resolution of symptoms with administration of niacin and (c) exclusion of other diseases. The medical records were reviewed for age, sex, seasonal variation, cutaneous examination findings and associated symptoms. Chronic energy deficiency was calculated based on BMI<18.5kg/m2.

**Results:** 335 patients were included in the study. Table 1 shows the corresponding descriptive data. Mean (SD) age of the study patients was 42.76 ± 11.6 years. CED was present in 63.8% of patients. Over-weight and obesity was uncommon in the study. The commonest age groups affected were middle aged patients and was highest in 30-40years age group followed by 40-50years of age group. Patients <20 years and >60years were uncommon in the study. Peripheral neuritis was present in 3.88% of patients, followed by Protein energy malnutrition, glossitis and tuberculosis in 1.49%, 1.49% and 1.19% of cases

**Conclusions:** Pellagra is a historically old disease, which is not completely eradicated. The decline in the proportion of pellagra patients over the past few decades may be attributed to the implementation of national nutritional programs, National product distribution system and improved nutritional status.

**Keywords:** Pellagra, Dermatitis, niacin, tryptophan deficiency
# THE IMPACT OF REPLACING COW'S MILK WITH GROWING UP MILK ON VITAMIN D AND IRON INTAKES AND ADEQUACY IN IRISH CHILDREN AGED 12 - 36 MONTHS

(¹)Kehoe, Laura; (²)Walton, Janette; (³)McNulty, Breige A.; (⁴)Nugent, Anne P.; (⁵)Flynn, Albert.

(¹)BSc. MSc. Research Nutritionist. School of Food and Nutritional Sciences. University College Cork. Republic of Ireland.; (²)BSc. MSc. PhD. Research Fellow. School of Food and Nutritional Sciences. University College Cork. Republic of Ireland.; (³)BSc. PhD. Lecturer in Nutrition. University College Dublin Institute of Food and Health. University College Dublin. Republic of Ireland.; (⁴)BSc. PhD. Lecturer in Nutrition. University College Dublin Institute of Food and Health. University College Dublin. Republic of Ireland.; (⁵)BSc. PhD. School of Food and Nutritional Sciences. University College Cork. Republic of Ireland.

**Background and objectives:** Growing up milks (GUM) are milk-based drinks with added vitamins and minerals intended for children aged 12 – 36 months. We have previously shown that intakes of vitamin D and iron are low in Irish children and that fortified milks (in particular GUM) are a key determinant of higher intakes. Studies in other countries have shown that replacing cow's milk (CM) with fortified milks can help to improve intakes, adequacy and status of vitamin D and iron in both children and adults.

The objective of this analysis was to investigate the impact of replacing CM with GUM on intakes, adequacy and risk of excessive intakes of vitamin D and iron in young Irish children.

**Methods:** Analyses were based on a sample of children (aged 12 – 36 months) from the Irish National Pre-School Nutrition Survey (www.iuna.net). The sample included children with a daily CM intake ≥300ml (n 146). Dazult software DaDiet© was used to simulate the replacement of 300ml of CM with an equivalent volume of GUM (composition per 100ml: vitamin D; 3.1µg, iron; 1.2mg). The composition of any milk intake >300ml was unchanged from that consumed. Usual intakes were calculated via the NCI-method and the proportion (%) of the population with intakes below the estimated average requirement (excluding energy under reporters) and above the tolerable upper intake limit were calculated.

**Results:** Replacing 300ml of CM with an equal volume of GUM would increase mean intakes of vitamin D (from 6.3 to 13.6µg/d) and iron (from 7.7 to 10.6mg/d). The proportion of the population with inadequate intakes would be significantly reduced from 82 to 17% for vitamin D and from 14 to 0% for iron with no risk (0%) of excessive intakes of either nutrient.

**Conclusions:** This study has shown that replacing 300ml of CM with GUM would result in a substantial reduction in the prevalence of inadequate intakes of vitamin D and completely eliminate inadequate intakes of iron in Irish children aged 12 – 36 months.

**Keywords:** Vitamin D, iron, growing-up-milk, adequate intakes

# PREVALENCE AND FACTORS ASSOCIATED WITH STUNTING IN PRIMARY SCHOOL CHILDREN AND ADOLESCENTS IN THE BURKINABE SAHEL

(¹)Ouedraogo, Ousmane; (²)Coulbaly, Soumaila; (³)Millogo, Tieba;

(²)Garanet, Franck; (³)Kabore, Saidou; (⁴)Zoma, Robert; (⁵)Kouanda, Seni.

(¹)MPH. Institut Africain de Santé Publique. Ouagadougou. Burkina Faso; (²)MD MPH. Institut Africain de Santé Publique. Ouagadougou. Burkina Faso; (³)Msc. Nutrition Direction de la Nutrition. Ouagadougou. Burkina Faso; (⁴)Msc. Demographie Direction des Statistiques Sectorielles. Ministère de la Santé. Ouagadougou. Burkina Faso; (⁵)MD Ph D. Institut Africain de Santé Publique. Ouagadougou. Burkina Faso.

**Background and objectives:** Stunting within students is a real public health and development issue.

However, there are few studies in pupils and adolescents in developing countries.

The objective of the study was to determine the prevalence and factors associated with stunting in primary school children and adolescents in the Burkinabe Sahel.

**Methods:** Descriptive and analytical cross-sectional study carried out in 13 public primary schools in Dori commune in June 2016. Sampling was random in two-stage clusters. The data were collected through anthropometric measurements, blood sampling and the administration of a questionnaire to the students. Individual interviews were conducted at the household level. Prevalences were calculated using the 2007 WHO Growth Standards for Adolescents aged 5-19 years and the associated factors were studied using a multivariate logistic regression on STATA 14.

**Results:** A total of 568 pupils aged 5-15 years were involved. Nearly 50.62% of students were between 10 and 15 years of age. Girls accounted for 52% of students. The prevalence of stunting was 32.92% (95% CI). The coexistence of stunting and acute malnutrition accounted for 13.56% of students - and the cumulative chronic malnutrition and anemia was 29.40%.

Age (OR =1,20), sex (OR =1,53) and anemia (OR =0,61) were statistically associated with stunting (p <0.05). There was no difference between schools. The student's individual dietary diversity and level of household food insecurity were not statistically associated with significant growth retardation.

**Conclusions:** The study shows a high prevalence of stunting within elementary students in Dori.

Age, sex and anemia play major roles.

**Keywords:** Associated factors, stunting, pupils, prevalence, Burkina Faso

**Further collaborators:**

Acknowledgment to the Directorate of Nutrition, the Ministry of Health's Sector Statistics Directorate and the schools and pupils who participated in the study
# WORKING IN NUTRITION: HUMAN RESOURCE CONSTRAINTS THAT AFFECT ACHIEVEMENT OF NATIONAL NUTRITION PLAN GOALS

(1)Pomeroy-Stevens, Amanda; (2)Lamstein, Sascha; (3)Biradavolu, Monica; (4)Adero, Nancy.

(1)MSc. Research and Evaluation Advisor. SPRING Project. John Snow Inc. United States.; (2)Phd. Nutrition Advisor. SPRING Project. John Snow Inc. United States.; (3)Phd. Sociologist. QualAnalytics. United States.; (4)MPH. Technical Advisor. SPRING Project. John Snow Inc. Uganda.

**Background and objectives:** Though countries acknowledge the importance of strengthening human resources to deliver on national nutrition action plans (NNAPs), it is often hard to create sustainable improvements in the nutrition workforce. The USAID-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project produced evidence on why this may be in two countries, Uganda and Nepal.

**Methods:** As part of SPRING's Pathways to Better Nutrition Case Studies, qualitative data were collected in Uganda and Nepal over two years (2013-2015 and 2014-2016, respectively). Six stakeholder groups, six nutrition-related sectors, and three levels of governance were studied through key informant interviews, direct observation, and news content analysis. These data were analyzed in NVivo to identify common themes, including nutrition workforce.

**Results:** Several nutrition workforce issues were mentioned as constraints to successful implementation of Uganda and Nepal's NNAPs. Stakeholders in both countries noted high turnover in key government, donor and UN nutrition positions; for instance approximately 50 percent of all NNAP sector focal positions turned over during the study, with several positions remaining vacant through the end of the study period. Turnover at every level was regularly cited as why planning and spending stalled for nutrition activities. Funding for nutrition coordination positions was also ad-hoc, which may have encouraged transience. Another nearly universal concern was lack of implementing staff trained in nutrition, especially in non-health sectors. The few available district and sub-district nutrition staff were often overwhelmed by responsibilities. Barriers to increasing implementation-level nutrition staff were lack of mentoring and recruitment for district nutritionists (Uganda) and difficulties recruiting for hard-to-reach areas (Nepal).

**Conclusions:** Our recommendations for overcoming these constraints include improving handover protocol for transitions of nutrition focal positions; securing funding for nutrition positions; including nutrition in civil service curricula; and innovating incentives to staff hard-to-reach areas. Recognizing the universality of this challenge, SPRING has developed several resources to help strengthen the nutrition workforce. Our workforce mapping toolkit is designed to identify gaps in training, recruitment, and planning for nutrition services. SPRING's community health worker advocacy toolkit can be also be used to advocate for increased nutrition workforce training and recruitment.

**Keywords:** Nutrition, human resources, workforce, policy, governance

**Further collaborators:** We would like to acknowledge all collaborators on the SPRING Pathways to Better Nutrition Case Studies in Nepal and Uganda.

# PLASMA METABOLOME ASSOCIATED WITH OBESITY IN COMMUNITY DWELLERS: TSURUOKA METABOLOMIC COHORT STUDY

(1)Kurihara, Ayako; (2)Harada, Sei; (3)Takebayashi, Toru; (2)Okamura, Tomonori; (4)Tomita, Masaru.

(1)R.D. MSc. Department of Preventive Medicine and Public Health. Keio University School of Medicine. Japan.; (2)MD. PhD. Department of Preventive Medicine and Public Health. Keio University School of Medicine. Japan.; (3)MD. PhD. MPH. Department of Preventive Medicine and Public Health. Keio University School of Medicine. Japan.; (4)PhD. Keio University Institute for Advanced Biosciences. Japan.

**Background and objectives:** There has been growing evidence of the importance of amino acids for obese metabolism change using metabolome analysis. The aim of this study is to examine the associations of amino acids and other polar metabolites with obese in the Japanese population.

**Methods:** Subjects are 35 to 74 years-old residents enrolled into our cohort study from April to July 2012, as a part of three-year baseline. Of the 11,002 participants, we had performed plasma global metabolomic profiling by capillary electrophoresis-mass spectrometry (CE/MS) in 8414 of the participants by the end of August 2016. We excluded 668 participants for the following reasons: missing information, previous history of cancer, the energy intake above 3,500 kcal or under 500 kcal. The remaining 7,726 participants (3,444 males, 4,282 females) were included in the analysis. 73 polar metabolites were identified and absolutely quantified using CE/MS; amino acids, amines, organic acids, purines and the others (detection rate >90%). Diet, including alcohol intake, was assessed with a semiquantitative food-frequency questionnaire (FFQ). Body mass index (BMI) was calculated with measured height and body weight at recruitment. According to males and females, the participants were divided into four categories according to the quartile of the BMI, we compared the obese group (Q4) to the normal range group (Q2) by partial least squares discriminant analysis (PLS-DA) and pathway analysis using MetaboAnalyst 3.0.

**Results:** The PLS-DA model was fairly developed in both of males and females. The levels of six metabolites in plasma including glutamic acid were associated with obesity (VIP score>1.5), higher in the obese group. The results in the pathway analysis indicated that five pathways were associated with obesity; alanine, asparate and glutamate metabolism, arginine and proline metabolism, pyruvate metabolism, taurine and hypotaurine metabolism and citrate cycle.
**Conclusions:** We found six plasma metabolites and five pathways related to obesity among community-dwelling adults in the north of Japan, with applying metabolomics to a large population-based study. We continue our survey to clarify the causality between the found biomarkers and development of obesity related to diet intake and exercise, and contribute reducing the health risk due to the obesity in future.

**Keywords:** Cohort study, Metabolome, Obese metabolism change, Amino acids

**Further collaborators:**

Tsuruoka metabolomics cohort study team

144/1658

EVALUATION OF THE NATIONAL COMMUNITY-BASED FOOD DISTRIBUTION PROGRAM FOR CHILDREN ON ANTHROPOMETRIC INDICES OF MALNOURISHED OR GROWTH RETARDED CHILDREN IN IRAN: A MIXED METHOD APPROACH

(1)Ghodsi, Delaram; (2)Omidvar, Nasrin; (3)Rashidian, Arash; (4)Eini-Zinab, Hassan; (5)Raghfar, Hossein; (6)Aghayan, Maryam.

(1)PhD. Nutritionist. Department of Community Nutrition. National Nutrition and Food Technology Research Institute. Faculty of nutrition sciences and food technology. Shahid Beheshti University of Medical Sciences. Iran.; (2)PhD. Nutritionist. Department of Community Nutrition. National Nutrition and Food Technology Research Institute. Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Iran.; (3)MD. PhD. Health policy and management. Department of Health Management and Economics. School of Public Health. Tehran University of Medical Sciences. Iran.; (4)PhD. Sociologist. Department of Community Nutrition National Nutrition and Food Technology Research Institute. Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Iran.; (5)PhD. Economist. Department of Economics. Alzahra University. Iran.; (6)BS. Nutritionist. Department of Community Nutrition. National Nutrition and Food Technology Research Institute. Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Iran.

**Background and objectives:** In Iran, multidisciplinary program for improvement of nutritional status of children was initiated in 2005. In supportive section of this program, monthly food ration has been distributed for nourishment of growth retarded/ malnourished children living in deprived family. This study aimed to evaluate the effectiveness of the supportive section of this program on nutritional status of children in two provinces of Iran (Qazvin and Semnan).

**Methods:** An effectiveness evaluation was conducted using mixed methods. Qualitative data gathered from twelve focus group discussions by mothers to determine factors that affect distributed foods consumption by the target child and their nutritional status. Quantitative data collected by quasi-experimental design.

362 children aged 6-72 months under coverage of the program selected as intervention group via multistage sampling. Comparison group included 409 children selected from children 6-72 months under coverage of Primary Health Care System using convenience sampling method. After 6 months, 332 in intervention and 324 in comparison group completed the study. Anthropometric indices of the children were measured at the baseline and 6 month thereafter. Data on child health and household demographic characteristics were collected by a questionnaire. Effectiveness was estimated using difference-in-difference (DiD) estimator.

**Results:** At the end of the study, mean of WAZ, HAZ, and WHZ was increased compared to the baseline in both groups (P<0.001). Differences in WAZ, HAZ and WHZ between two groups were not significantly differ at the end of the study (P=0.62, P=0.91, and P=0.94, respectively). The percentage of children who became normal in underweight, stunt, and wasting increased in both groups after 6 months (34.8% to 41.7%, 57.2% to 57.8%, and 40.1% to 49.6% respectively in intervention children; 58.2% to 66.3%, 65.8% to 69.4%, and 60.4% to 69.9% respectively in comparison children). Mothers reported low income, intra-household food sharing, irregular distribution, quantity and quality of distributed foods, and lack of training and education as the main factors affected distributed food consumption by the target child.

**Conclusions:** Providing foods for nourishment of malnourished children living in low income family could prevent the worse nutritional status. However, it is not effective in improvement of nutritional status without empowerment strategies.

**Keywords:** evaluation, children, malnutrition, food distribution, community based program

144/1663

ANALYSIS OF THE PRESENCE OF FOOD ADDITIVES IN LABELS OF INDUSTRIALIZED FOOD PRODUCTS WITH HOMEMADE TERM COMMERCIALIZED IN BRAZIL

(1)Kanematsu, Liege Regina Akemi; (2)Uggioni, Paula; (3)Schvartz, Aline; (3)da Silva, Brenda Francisco.

(1)Nutritionist. Graduate Student. Nutrition Postgraduate Programme of Federal University of Santa Catarina. Brazil;

(2)PhD. Assistant professor. Department of Nutrition. Nutrition Postgraduate Programme. Federal University of Santa Catarina. Brazil; (3)Graduation student. Department of Nutrition. Federal University of Santa Catarina. Brazil.

**Background and objectives:** Contemporary food has been characterized by the increase in the consumption of industrialized food and the increase in the consumers' interest in traditional food products. Most food products contain additives, which are generally included to increase the shelf life of foods or make them attractive. Term such as homemade and others similars are present in labels of food products commercialized in Brazil. However, according to the Brazilian legislation, food labeling shouldn't have terms that cannot be demonstrated, since they may induce
mester and maternal characteristics with p<0.20 in crude analysis), considering p<0.05 as significance level. All analysis were performed in SPPS v. 20.0.

**Results:** We identified three patterns: Traditional Brazilian (P1); Predominantly Ultra-processed and beef (P2); Integral, fruits, legumes, low fat milk and derivatives (P3). Pregnant women who work outside home had 36% more likely to be in the tercil of greater adherence to P1 (OR 1.36; 95%CI: 1.01-1.82); chance similar to those non-white color (OR 1.35; 95%CI: 1.01-1.82). Not living with a partner increased in 71% the chances of greater adherence to P2 (OR 1.71; 95%CI:1.20-2.44). On the other hand, pregnant women with intermediate schooling (8|-11 years of study), front those with 11 or more years, showed 41% less chances of greater adherence to P3 (OR 0.59; 95%CI: 0.42-0.84); when compared to the economic class B, pregnant women from class C and D/E showed, respectively, 40% and 50% less chances of greater adherence to this pattern (OR 0.60; 95%CI: 0.37-0.95 and OR 0.50; 95%CI: 0.28-0.90).

**Conclusions:** We found associations between work outside home, non-white skin color, not living with a partner, education and socioeconomic classification with adherence to different dietary patterns identified. This knowledge is of extreme importance to the formulation of dietary education interventions with potential for positive impact on maternal and child health.

**Keywords:** Pregnancy Nutrition, Maternal Diet, Pregnant Women, Factor Analysis, Dietary Patterns.

**Further collaborators:** This work was supported by the São Paulo Research Foundation (CBG, grant number FAPESP 2014/06865-6 and MH. D'AB, grant number FAPESP 2011/18579-0)

bodia, while 20 channels were monitored 24 hours a day for three months in Dakar, Senegal. The number, frequency and duration of advertisements for BMS and commercially produced complementary foods which aired during this time were reported, along with the proportion of advertisements with nutrition/health claims and instructions for age of use.

**Results:** Ten television channels in Phnom Penh and four in Dakar aired advertisements for BMS. Three and five channels, respectively, aired advertisements for complementary foods. All channels that aired advertisements in Phnom Penh were local, however only international cable channels aired advertisements in Dakar. All BMS products advertisements in Phnom Penh were for children over one year of age. Products for children over one year and 6+ months of age were advertised in Dakar.

BMS advertisements were shown on average 382 times per month in Phnom Penh and 95 times per month in Dakar. Average air time was 189.5 and 29.7 minutes per month, respectively. Advertisements for complementary foods were aired 11 times per month on average in Phnom Penh and 33 times in Dakar, and air time averaged 3.2 minutes per month and 13.6 minutes.

Fewer than half of BMS advertisements and only one-third of complementary food advertisements explicitly stated an age of use for products. Nutrient content, nutrient function, and/or health claims were common in BMS advertisements.

**Conclusions:** This study illustrates the need to adopt, monitor, regulate and enforce legislation prohibiting BMS promotion. Advertisements for complementary foods often fail to state that products should not be fed to infants less than six months of age; this should be done to protect optimal infant and young child feeding.

**Keywords:** nutrition, advertising, breast-milk substitutes, baby food, complementary foods

**Background and objectives:** Promotion of breastmilk substitutes (BMS) can negatively affect breastfeeding and is prohibited by global minimum standards. Promotion of complementary foods is inappropriate if it encourages feeding to children <6 months of age. This study was undertaken to assess the prevalence and content of BMS and complementary food advertisements on selected television channels in Phnom Penh, Cambodia and Dakar, Senegal.

**Methods:** Sixteen television channels were monitored daily from 6:00 a.m. to midnight for 13 months in Phnom Penh, Cam-

**Background and objectives:** Fish intake has been associated with a reduced risk of major chronic diseases, particularly cardiovascular disease. However, data linking fish consumption and mortality are lacking and conflicting. The aim of this study is to examine whether fish consumption is associated with lower risk of mortality in Chinese and US adults.

**Methods:** We investigated the proposed association separately for US and Chinese adults using data from the China Health

<footnote>(1)Champeny, Mary; (2)Kroeun, Hou; (3)Sy Gueye, Ndeye Yaga; (4)Boren, Ly; (5)Diop, El Hadji Issakha; (1)Pries, Alissa; (1)Zehner, Elizabeth;</footnote>

<footnote>(4)Huffman, Sandra.</footnote>

<footnote>(1)Helen Keller International; (2)Helen Keller International. Phnom Penh. Cambodia; (3)Helen Keller International. Dakar. Senegal;</footnote>

<footnote>(4)Consultant to Helen Keller International; (5)Helen Keller International. Africa Regional Office. Dakar. Senegal.</footnote>

<footnote>(1)Zhang, Yu; (2)Jiao, Jingjing; (3)Zhuang, Pan; (4)Wang, Wenqiao.</footnote>

<footnote>(1)PhD. Nutritionist. Department of Food Science and Nutrition. College of Biosystems Engineering and Food Science. Zhejiang University. China.; (2)PhD. Nutritionist. Department of Nutrition. School of Public Health. Zhejiang University School of Medicine. China.; (3)BSc. Department of Food Science and Nutrition. College of Biosystems Engineering and Food Science. Zhejiang University. China.; (4)MD. Department of Nutrition. School of Public Health. Zhejiang University School of Medicine. China.</footnote>
and Nutrition Survey (CHNS, n=14,113) and National Health and Nutrition Examination Survey (NHANES, n= 31,021), including NHANES III conducted in 1988-1994 and continuous NHANES 1999-2010 for this prospective cohort study. Participants with cardiovascular disease or cancer at baseline were excluded.

**Results:** During a median follow-up of 14 and 9.8 years for CHNS and NHANES, 1009 (CHNS) and 4205 (NHANES) deaths were documented. The fish consumption level was higher in China than in the United States. Among Chinese adults, increased fish intake was significantly associated with lower all-cause mortality. As compared with the lowest level of fish intake, the hazard ratios (HRs) across increasing intake levels were 0.44 (95% CI, 0.36-0.56), 0.66 (95% CI, 0.55-0.79), 0.76 (95% CI, 0.63-0.91; P<0.001 for trend), after adjusting for potential confounders. However, fish intake was not associated with total mortality among US adults. The multivariable-adjusted HRs across increasing intake levels were 1.04 (95% CI, 0.92-1.18), 0.91 (95% CI, 0.79-1.05), 0.96 (95% CI, 0.82-1.12; P=0.28 for trend), as compared with the lowest level. We only detected a borderline inverse association between fish intake and risk of death from stroke in NHANES (P=0.06 for trend). Moreover, a positive association with risk of death from diabetes was observed in certain category of fish intake in NHANES. Subgroup analysis showed that the inverse association of fish with all-cause mortality was stronger among participants living in rural compared with those in urban areas in CHNS.

**Conclusions:** In these two independent but similar national cohort studies, fish consumption is associated with a reduced risk of total mortality for Chinese rather than US adults. Future studies may clarify the heterogeneity across races.

**Keywords:** Fish consumption, Mortality, National cohort, CHNS, NHANES

144/1696

AGGREGATION OF CHRONIC DISEASES AND ASSOCIATED FACTORS IN THE MIDWEST REGION OF BRAZIL IN 2012

(1) Pereira, Lídia Pitaluga; (2) Muraro, Ana Paula; (3) Ferraz Moreira, Naiara;

(4) Rodrigues, Paulo Rogério Melo; (5) Ferreira, Márcia Gonçalves.

(1)Msc. Nutritionist. Institute of Public Health. UFMT. Mato Grosso. Brazil.; (2)PhD. Nutritionist. Institute of Public Health. UFMT. Mato Grosso. Brazil.; (3)PhD. Nutritionist. Faculty of Health Sciences. UFGD. Mato Grosso do Sul. Brazil; (4)PhD. Nutritionist. Faculty of Nutrition. UFMT. Mato Grosso. Brazil.; (5)PhD. Nutritionist. Institute of Public Health and Faculty of Nutrition. UFMT. Mato Grosso. Brazil.

**Background and objectives:** Noncommunicable diseases (NCDs) are recognized as a public health issue bringing great impact to the health system in Brazil. Individually, each disease contribute to increased mortality and when aggregated they can multiply this risk. The aim of the study was estimate the aggregation of self-reported chronic diseases and to identify the associated factors.

**Methods:** Cross-sectional study with data from 6,695 individuals aged ≥18 years-old, both sex, collected by Surveillance System

for Protective and Risk Factors for Chronic Diseases by Telephone Survey (Vigitel), at Midwest Region of Brazil in 2012. One resident of each household, with at least one fixed telephone line, was randomly selected from probability samples, subsequently answering the questionnaire. Hypertension, diabetes and obesity were used to create the aggregation of chronic diseases which was classified in zero - individuals with no disease, 1 - individuals with at least one disease and 2 - those with two or more diseases. Sociodemographic and economic data, lifestyle and self-assessment of health status were analyzed such as independente variables. Chi-square test was used in the bivariate analysis. Multinomial logistic regression models were used to evaluate the associated factors with aggregation levels. The complexity of the sample and the effect of the study design were considered in the estimates.

**Results:** The aggregation of two or more diseases was observed in 10.4%, higher among women compared to men (p=0.03) and it was positively associated with increased age (p<0.01). After adjustments, the factors that remained associated with the aggregation were age (p=0.03), formal work p<0.01), alcohol consumption (p=0.05), worsening of self-reported health status (p<0.01), and living at Cuiabá city (p=0.01) and Campo Grande city (p=0.02).

**Conclusions:** The aggregation of chronic diseases in the Midwest Region in Brazil was associated with lifestyle related behaviors, sociodemographic and economic characteristics.

**Keywords:** Chronic disease. Risk factors. Brazil.

144/1698

PREVALENCE OF METABOLIC SYNDROME IN A GHANAIAN POPULATION

(1)Ellahi, Basma; (2)Agbozo, Faith; (3)Dikmen, Derya; (4)Darrah, Samuel; (5)Zotor, Francis.

(1)PhD. Nutritionist. Faculty of Health and Social Care. University of Chester. UK.; (2)MPhil. University of Health and Allied Sciences. Ghana; (3)PhD. Department of Nutrition and Dietetics. Hacettepe University. Turkey; (4)BSc. University of Health and Allied Sciences. Ghana.; (5)PhD. University of Health and Allied Sciences. Ghana.

**Background and objectives:** Abdominal obesity assessed by waist circumference is one of the most important predictor for metabolic syndrome and obesity-related diseases mortality (1). Metabolic syndrome (MetS) prevalence has increased and affects 25% of populations in developed countries (2). However, there is paucity of data on rates in African populations (3,4). The present study aimed to determine the prevalence of the MetS and the associated risk factors among adults living in Ghana.

**Methods:** Adult males (n=354) and females (n=496) above 18 years were recruited using multistage cluster-randomized sampling method in urban and rural areas of Hohoe municipality in the Volta region of Ghana. All subjects had anthropometric variables (BMI, waist circumference, waist hip ratio) related with abdominal obesity measured, in addition to dietary intake, physical activity and blood pressure. Additionally, blood glucose was assessed from a blood sample after overnight fasting. WHO recommendations for body mass index (BMI), waist circumference
cut-off points for overweight and obesity, and factors associated with MetS risk were utilised for analysis.

**Results:** The mean age for the 850 participants was 47.26±16.13 years. Fasting blood glucose levels were higher in men (5.4±1.46 mmol/L) when compared with women (5.2±1.37mmol/L) (p>0.05). Mean waist circumference was 79.8 cm in men and 85.5 cm in women (p=0.00). BMI was significantly higher in women (26.10 kg/m2) when compared with men (22.46 kg/m2). The subjects' diastolic and systolic blood pressure levels were high in both genders (normal 26.6%, pre-hypertensive 37.4% and hypertensive 36%). The prevalence of MetS was 8.7% and significantly higher (p<0.05) in women (13.5% versus 7.9% in men). Increased age, waist circumference, raised blood pressure, and BMI were all correlated with MetS (p<0.05).

**Conclusions:** This is among the few studies which highlights the prevalence of MetS in Ghana. Abdominal obesity predictors, in particular waist circumference, are the main causative factor for MetS. Dietary adjustments, regular physical activity and weight loss should be the main focus points for MetS management.

**Keywords:** Waist circumference, waist-hip ratio, hypertension, BMI

**Further collaborators:**

1. WHO. Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008.

2. Spalding A, Kernan J, Lockette W (2009) The metabolic syndrome: a modern plague spread by modern technology. J Clin Hypertens (Greenwich) 11(12): 755–760.

3. Kruger, Maritza J., and Theo A. Nell. "The Prevalence of the Metabolic Syndrome in a Farm Worker Community in the Boland District, South Africa." BMC Public Health 17 (2017): 61.

4. George, Jaya A. et al. "The Association of 25 Hydroxyvitamin D and Parathyroid Hormone with Metabolic Syndrome in Two Ethnic Groups in South Africa." Ed. Robert J. Wilkinson. PLoS ONE 8.4 (2013): e61282.

144/1706

PANORAMA OF NUTRITION LANDSCAPE IN
EAST AFRICAN COMMUNITY

Ouma, Cyprian.

WFP.

**Background and objectives:** The focus of nutritional challenges in the East African region has been on under nutrition measured through stunting, wasting and underweight levels in young children. There has been little correlational analysis on the emerging globalization and diet shifts, with the nutritional deficiencies the region faces. We explored the inter-relationships and trends of nutritional outcomes in children under 5 years.

**Methods:** We investigated the availability of food and nutrition data collected in DHS surveys for the last 20 years. The data was aggregated, standardized and harmonized. Assessment of the Quality of data and analysis was done in SPSS vs 24.

**Results:** Kenya registered an improvement in prevalence of wasting t from 7% to 4% over 6 years with Rwanda having the

lowest levels. Highest proportions of mothers who practiced exclusive breastfeeding was in Rwanda while Kenya showed an improvement from 31.9% to 61.4% over 6 years. The levels of stunting in Burundi decreased from 63% in 2000 to 57.5% in 2010, wasting levels rose to 9% in 2005 but fell to 6.1% in 2010. In Kenya, Stunting levels decreased from 35% to 26%; and the proportion of underweight children dropped from 16% to 11%. In Rwanda, percentage of stunted children decreased from 57% to 38% from 1992 to 2015 and wasting reduced from (8%) in 2000 to 2.2% in 2015 and prevalence of underweight children gradually decreased to 9% from 23.7%.

In Uganda over 10 years, stunting and underweight prevalence levels in children decreased to 33% from 45% in 2000. Tanzania's stunting levels in the last 5 years remained the same but alongside Rwanda reported a spike in the number of overweight cases while Kenya recorded a positive trend with the number of overweight cases reducing by 36,000.

**Conclusions:** Multiple forms of malnutrition coexist in EAC and vary across countries, regions and groups. Malnutrition is not decreasing at the required rate and is affecting the majority of the EAC population. The changing burden of disease should be tracked and included in development plans.

**Keywords:** EAC, Malnutrition

144/1708

NUTRITION INEQUALITIES IN EAST AFRICA

Ouma, Cyprian.

World Food Programme (WFP). Kenya.

**Background and objectives:** Food and nutrition inequalities in the East Africa Community region are characterized by high prevalence rates of malnutrition. Although the region is characterized by high rates of undernutrition, the nutrition dynamics are rapidly shifting into obesity, making the region face a double burden of malnutrition.

**Methods:** Country profiles data sources, indicators and dimension of inequality data were sourced from publicly available demographic and health Surveys (DHS), localized SMART assessments, NGO and UN reports, multiple indicator cluster surveys (MICS) and institutional websites WHO, EAC, AU. The use of large-scale, nationally representative household surveys that collect data through standardized, face-to-face interviews in low- and middle-income countries was applied. Inequality Nutrition data was disaggregated into three dimensions, economic status, sex and place of residence. The wealth index was used to calculate the economic status at household level by using country specific indices to show the ownership of certain assets and access to certain services, after which quantiles were created.

**Results:** Disaggregation by place of residence shows that high levels of stunting in all the EAC countries are found in rural areas than in urban dwellings. Low levels of stunting are seen among wealthy families and high prevalence of stunting among the poor households. Rural living children are more likely to be underweight in comparison to urban children. Overall these shows that
more nutrition inequality if found among poor rural households who have low access to essential health services, suffer chronic food insecurity and have low purchasing power that leads to inadequate food consumption and insufficient dietary diversity.

**Conclusions:** Nutrition inequalities exists in the region and because of the harmful effects of malnutrition over the life cycle, inequalities exemplify other household and communal disadvantages creating a circular relationship. Identifying the data gaps that hinder action on equity and inequalities and targeting expansions in services specifically towards the most disadvantaged may be more successful and cost effective than using limited resources to create across-the-board increases in services.

**Keywords:** Nutrition, Inequality, EAC

144/1712

DEVELOPING THE NEXT GENERATION OF PACKAGED FOODS: A FRAMEWORK TO ADDRESS MULTI-STAKEHOLDER REQUIREMENTS

**Background and objectives:** The demand for foods and beverages with improved nutritional composition has increased in the past decade. Governments, academics, and consumers have different expectations of what is a 'healthy' product. Here we present the development of a 'nutrition innovation framework' which could be used as a guidance to improve the nutritional composition of a product category and its application in two case studies: breakfast drinks and sweet biscuits.

**Methods:** The framework is divided in three steps: 1. Definition of product positioning, i.e. the targeted food category or eating occasion. 2. Definition of nutritional targets/requirements based on the latest dietary recommendations and regulated definitions of 'healthy' (e.g. front-of-pack labeling). 3. Testing the extended to which the proposed targets identify best-in-class nutritional composition using the Mintel Global New Product Database branded food composition data.

**Results:** The framework was applied to two product categories, breakfast drinks and sweet biscuits, falling respectively under the 'breakfast' and 'snacks' eating occasions. In both cases, food based dietary guidelines and regulatory definitions of 'healthy' focused on low sugar content (added and total), no addition of salt, low saturated fat content and a high nutrient density. Wholegrain, protein, complex carbohydrates and fruit and vegetable content were clearly prioritized. For breakfast drinks a Mintel extract showed that only 10% (n=9/95) of the existing products would meet external definitions of 'healthy'. In the case of biscuits, no products would meet all external definitions and there was a need for interim nutritional targets to successfully stimulate innovation.

Proposed interim targets were achieved by 7 products out of 2072 products analyzed.

**Conclusions:** This novel framework uses the latest available evidence and data to guide the food industry towards more nutritious products while addressing the requirements of public health officials and regulators. Further research is needed to assess the applicability/ feasibility of this framework across companies' portfolios. In particular, there is a need to clearly define the product categories in which such (re)formulation guidelines could operate and to develop a comprehensive scoring algorithm to track improvements in nutrient composition and compare between products.

**Keywords:** Food reformulation, breakfast, snacks, packaged foods

**Conflict of Interest Disclosure:** All authors are employed by Nestec Ltd

144/1717

PLASMA MAGNESIUM AND RISK OF DIABETES. THE PREVENTION OF RENAL AND VASCULAR END-STAGE DISEASE STUDY

**Background and objectives:** Low circulating magnesium has been found to be associated with prevalence of diabetes in cross-sectional studies. Such associations can be due to reverse causation. We therefore aimed to investigate the association of plasma magnesium with risk of developing diabetes.

**Methods:** We examined 5673 subjects aged 28-75 years without diabetes at baseline in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective population-based cohort study. Diabetes was defined as fasting glucose level ≥7.0 mmol/l, non-fasting glucose level ≥11.1 mmol/l or anti-diabetic drug use. The association of plasma magnesium with risk of diabetes was studied using Cox models. We adjusted multivariable models for age, sex, race, body mass index, educational level, smoking, alcohol consumption, cholesterol, hypertension, history of stroke and coronary heart disease, family history of diabetes, kidney function (eGFR CKD-EPI), plasma levels of potassium, calcium, sodium and albumin, and use of diuretics and proton pump inhibitors.

**Results:** During a median follow-up of 11.2 (IQR: 7.1-11.8) years, 448 (7.9%) subjects developed diabetes. Mean age was 49.1±12.1 years, 48.1% were male. Mean plasma magnesium was 0.81±0.05 mmol/L, and plasma magnesium was inversely associated with risk of diabetes after multivariable adjustment (HR 0.79; 95% CI 0.63-0.99 per 0.1 mmol/L). We observed a significant interaction by age (Pinteraction<0.01). In age-stratified analyses (based on equal number of events in both groups), we observed no association of plasma magnesium with risk of diabetes in subjects

<footnote>(1)Masset, Gabriel; (2)Vlassopoulos, Antonis; (2)Gomez Alvarez, Pilar;</footnote>

<footnote>(2)Potter, Monika; (2)Lehmann, Undine.</footnote>

<footnote>(1)PhD Nutritionist. Consumer Science & Applied Nutrition. Institute of Material Sciences. Nestle Research Center; (2)Nutrient Profiling. Consumer Science & Applied Nutrition. Institute of Material Sciences. Nestle Research Center.</footnote>

<footnote>(1)Schutten, Joelle; (2)Gomes Neto, António; (3)Gansevoort, Ron; (3)de Borst, Martin; (3)Navis, Gerjan; (3)Bakker, Stephan J.L.</footnote>

<footnote>(1)MSc. Department of internal medicine. University Medical Center Groningen. The Netherlands.; (2)MD; (3)MD-PhD.</footnote>
aged <55 years (HR 0.94; 95% CI 0.67-1.32 per 0.1 mmol/L). In
contrast, we observed an inverse association of plasma magnesium
with risk of diabetes in subjects aged ≥55 years (HR 0.65; 95% CI
0.52-0.83 per 0.1 mmol/L). Adjustment for potential confounders
did not materially alter the association (HR 0.66; 95% CI 0.48-0.90
per 0.1 mmol/L).

**Conclusions:** Plasma magnesium is inversely associated with risk of diabetes. This association appears particularly present in subjects aged ≥55 years. Magnesium might therefore play a role in the prevention of diabetes, in particular in the older population.

**Keywords:** magnesium, diabetes, epidemiology

(1)Fox, Elizabeth; (1)Downs, Shauna; (2)Fanzo, Jessica; (1)Rieder, Travis.

(1)Berman Institute of Bioethics. Johns Hopkins University. USA;

(2)Berman Institute of Bioethics. Johns Hopkins University. School of Advanced International Affairs. Johns Hopkins University. USA.

**Background and objectives:** With global food production accounting for 19-29% of total global carbon emissions, it is reasonable to ask whether we could eat more sustainably than we currently do. A carbon tax on food is estimated to reduce greenhouse gas emissions by 8.6-9.3% and has been proposed as a way to encourage consumers to adopt a more sustainable diet. However, the details of such a proposal are morally significant.

**Methods:** We used an ethics framework to assess the moral risks of a carbon tax on food commodities, and particularly on red meat. We completed a policy analysis to develop carbon tax scenarios that could ethically mitigate carbon emissions from foods.

**Results:** A carbon tax on foods does not meet a justice requirement. It exacerbates the burden on those who have contributed the least to the problem and who would be most negatively affected from the perspectives of nutrition, socioeconomic and vulnerability to climate change. Additionally, insufficient attention has been placed on evaluating meat alternatives, the amounts of those alternatives that would be needed to account for energy and nutrient loss associated with not eating meat, and the production requirements and environmental impacts of those alternatives. However, there are ways that a carbon tax could be implemented in an ethically just way. It could be implemented in wealthy countries with strong social protections and in countries that have disproportionately high levels of red meat consumption. A carbon tax on food could also be ethically applied to specific foods (e.g. red meat), instead of all foods or all animal-sourced foods. This would allow for alternatives with a lower environmental footprint to remain available and affordable to certain populations to meet their dietary needs.

**Conclusions:** The discussion moving forward should focus on how to make environmental gains from altering consumption

habits without exacerbating existing vulnerabilities. A food tax
must be carefully constructed so as to not benefit the privileged
at the expense of the vulnerable. We cannot permissibly tackle the
injustices of climate change by creating and exacerbating injustices
elsewhere.

**Keywords:** climate, ethics, justice, food, carbon

(1)Akik, Chaza; (2)Ghattas, Hala; (3)Sharara, Eman; (4)Makhlouf Obermeyer, Carla.

(1)DrPH. Research Associate. Center for Research on Population and Health. American University of Beirut. Lebanon.; (2)PhD. Assistant Research Professor. Center for Research on Population and Health. American University of Beirut. Lebanon; (3)MPH. Research Assistant. Center for Research on Population and Health. American University of Beirut. Lebanon; (4)DSc. Professor. Center for Research on Population and Health. American University of Beirut. Lebanon.

**Background and objectives:** Some of the highest prevalenc-
es of overweight and obesity have been reported in the Arab re-
gion; a consequence of the global nutrition transition, and ensuing
alterations in diet and lifestyles. Globally, increases in weight have
been shown to be greater among women, and it is likely that cul-
tural factors exacerbate these gender differentials in the Arab re-
gion. We therefore aimed to review evidence for the female excess
in weight among adults in countries of the Arab world.

**Methods:** We searched MEDLINE and Social Sciences Citation Index (SSCI) databases for articles published between January 2000 and October 2016, and hand-searched bibliographies of retrieved articles. We included studies that reported adult overweight or obesity prevalence; were conducted among residents of Arab League countries; described study design and methods and specified sample size. Data on prevalence of overweight, obesity and central obesity were extracted by gender. Male- to-female ratios (M/F) of each excess weight indicator were computed. Qualitative data on cultural factors that contribute to excess weight were also extracted.

**Results:** Out of 1,734 articles retrieved, 339 articles met inclusion criteria and 213 provided data. Data from nationally representative studies showed high overall prevalence of overweight (ranging between 28.2% to 37.9%) and obesity (ranging between 14.5% and 43.7%). A clear gender difference in overweight was observed, with 41/56 studies having M/F ratio exceeding 1. However, females were more likely to be obese and centrally obese with M/F ratios of less than 1 in 72/77 studies and 35/37 studies respectively. Explanations for these gender differences included higher levels of physical inactivity among females due to cultural barriers, reduced efforts from women to take care of their body shape after getting married and having children, and preference for plumpness as a sign of feminine beauty among traditional societies.
**Conclusions:** In a region where overall levels of obesity are among the highest globally, we find that prevalence of overweight is higher among men, whereas obesity and abdominal obesity are more prevalent among women. It is likely that gender norms specific to the region amplify these differentials.

**Keywords:** Excess weight, obesity, overweight, gender, Arab region

144/1727

TEMPORAL TRENDS IN FOOD GROUP AVAILABILITY AND CANCER INCIDENCE IN AFRICA: AN ECOLOGICAL ANALYSIS

(1)Aglago, Elom Kouassivi; (2)Bray, Freddie; (3)Zotor, Francis; (4)Slimani, Nadia; (5)Ferrari, Pietro; (5)Gunter, Marc.

(1)Nutrition and Metabolism Section. International Agency for Research on Cancer (IARC). France; (2)PhD. Scientist. Cancer Surveillance Section. International Agency for Research on Cancer. Lyon. France; (3)PhD. Nutritionist. University of Health and Allied Sciences. Ho. Volta Region. Ghana; (4)Independent researcher. France.; (5)PhD. Scientist. Nutrition and Metabolism Section. International Agency for Research on Cancer. Lyon. France.

**Background and objectives:** Many African countries are experiencing an unprecedented epidemiological transition characterized by an increase in incidence of non-communicable diseases including various cancers, and fueled by the uptake of a Western-type diet and increased sedentary behavior. Nevertheless, data linking specific changes in diet and lifestyle with cancer incidence in Africa are extremely limited and there are few population-based cancer studies available. We aimed to evaluate at the country level the relation between food group availability as a proxy for individual level consumption and trends in cancer incidence across Africa.

**Methods:** Recent age-standardized rates for breast, prostate, colorectal, oesophageal, thyroid and pancreatic cancer were obtained from the African Cancer Registry Network, for 18 countries. National availability data for red meat, animal fats, cereals, starchy roots, vegetables/fruits, alcoholic beverages from kg/capita/year, and energy in Kcal/capita/day were retrieved from the Food and Agriculture Organization of the United Nations (FAO) databases. Food availability values were considered for four hypothetical times of exposure: time of collection of cancer incidence data (T0) and 5, 10, 15 and 20 preceding years (T-5, T-10, T-15, T-20). Ecological partial correlation coefficients with adjustment for potential confounders were calculated for the relation between cancer incidence and food availability.

**Results:** There was a significant increase in the availability of energy and all the major food groups for over the 20 years considered in this analysis (T-20 vs. T0, p<0.05). In multivariate analyses, red meat (r-5=0.495, p=0.002) and animal fats (r-10=0.450, p=0.007) availability were significantly positively correlated with colorectal cancer incidence in both men and women. In contrast, starchy roots were negatively correlated with colorectal cancer (r-

10=-0.359, p=0.034) and thyroid cancer (r-20=-0.331, p=0.052). Alcoholic beverages were also positively correlated with colorectal cancer (r-20=0.314, p=0.066) and oesophageal cancer (r-15=0.624, p=0.001).

**Conclusions:** This analysis provides ecological support for an impact of Westernization, marked by higher consumption of animal products and lower consumption of starchy roots, on the development of certain cancers in Africa over the past decades. Further research on the impact of diet and lifestyle with cancer development in Africa through high-quality epidemiological studies are urgently needed.

**Keywords:** Cancer. Food availability. Nutrition transition. Africa. Ecological analysis

144/1730

ENVIRONMENTAL SUSTAINABILITY IN FOOD AND NUTRITION UNITS - ROLE OF NUTRITIONIST?

(1)Oliveira, Halsia Stefane; (2)Martins da Silva, Háquila Andrea; (3)da Silva Neves, Sherida; (4)dos Santos, Antônio Marcos.

(1)MSc. Nutritionist. Federal Institute of Education Science and Technology of Ceará campus Crato. Crato. Brazil; (2)MSc. Nutritionist. Federal University of Ceará. Fortaleza. Brazil; (3)MSc. Nutritionist. University of Fortaleza. Fortaleza. Brazil; (4)MSc. Docent. Federal Institute of Education Science and Technology of Ceará campus Crato. Crato. Brazil.

**Background and objectives:** Studies indicate that only few undergraduate courses in nutrition include disciplines focused on environmental issues in their curricular matrices, in despite of the fact that food production be responsible for the considerable generation of solid waste and consumption of water, energy and raw materials. The objective was to know the opinion of responsible technical nutritionists (RT) of food and nutrition units (UANs) about the role of the nutritionist in implementation of the sustainability practices focused on the production of meals.

**Methods:** This is a qualitative study, with intentional sampling. Online questionnaires sent to RT of different UANs. There were interviewee nutritionists from hospital cooking, school meals, both representatives of the municipal public service, federal educational institutions and private companies. Professionals should answer the questions: "Have you received any training on sustainability practice at UAN?" and "Is the nutritionist the most appropriate practitioners working in environmental sustainability at UAN?".

**Results:** 11 nutritionists answered the questions. Regarding their participation in training aimed at sustainability practice at UAN, 63.6% of nutritionists denied, 18.2% confirmed and two (18.2%) professionals reported their participation in generalized content training. Regarding their opinion on nutritionists as the most appropriate practitioners working in this issue, 36.4% disagreed and 63.6% favored it. Disagreement was justified by the large number of attributions of the RT nutritionist and the lack of training / capacity building for this responsibility, suggesting
the partnership with a trained professional. Those agree said that
nutritionist knows and keep up with the whole routine of the unit,
establishes procedures, plans menus and supervises the execution
process. They must to be trained in this area.

**Conclusions:** Among the researched nutritionists, most of them reported that they did not have the training to work for sustainability at UAN and acknowledged that the nutritionist was the most suitable professional for this task, showing the need for changes in the training of this professional.

**Keywords:** Sustainability; Nutritionist; Nutrition and Sustainability; Food and Nutrition Security

(1)Bénard, Marc; (2)Baudry, Julia; (3)Méjean, Caroline; (4)Lairon, Denis; (5)Virecoulon-Giudici, Kelly; (6)Etilé, Fabrice; (6)Reach, Gérard;

(7)Hercberg, Serge; (2)Kesse-Guyot, Emmanuelle; (2)Péneau, Sandrine.

(1)MSc. PhD candidate. Equipe de Recherche en Epidémiologie Nutritionnelle. Centre de Recherche en Epidémiologie et Statistique Sorbonne Paris Cité. Insem 1153. Inra 1125. Cnam. Université Paris 13. France; (2)PhD. Equipe de Recherche en Epidémiologie Nutritionnelle. Centre de Recherche en Epidémiologie et Statistique Sorbonne Paris Cité. Inserm 1153. Inra 1125. Cnam. Université Paris 13. France; (3)PhD. INRA MOISA UMR1110. France; (4)PhD. Nutrition Obésité et Risque Thrombotique (NORT). Inserm UMR S 1062. Inra 1260. Aix Marseille Université. France; (5)PhD. Paris School of Economics and INRA. UMR1393 PjSE. France; (6)MD. PhD. Service d'Endocrinologie. Diabétologie. Maladies Métaboliques. Hôpital Avicenne. France; (7)MD. PhD. Equipe de Recherche en Epidémiologie Nutritionnelle. Centre de Recherche en Epidémiologie et Statistique Sorbonne Paris Cité. Inserm 1153. Inra 1125. Cnam. Université Paris 13. France.

**Background and objectives:** Organic food intake has risen in many countries during the past decades. Even though motivations associated with such choice have been studied, psychological traits preceding these motivations have rarely been explored. Consideration of future consequences (CFC) represents the extent to which individuals consider future versus immediate consequences of their current behaviors. Consequently, a future oriented personality may be an important characteristic of organic food consumers. The objective was to analyze the association between CFC and organic food consumption in a large sample of the adult general population.

**Methods:** In 2014, a sample of 27,789 participants from the NutriNet-Santé cohort study completed the CFC questionnaire and an Organic-Food Frequency questionnaire. For each food group (17 groups), non-organic food consumers were compared to organic food consumers across quartiles of the CFC using multiple logistic regressions. Moreover, adjusted means of proportions

of organic food intakes out of total food intakes were compared between quartiles of the CFC. Analyses were adjusted for socio-demographic, lifestyle and dietary characteristics.

**Results:** Participants with higher CFC were more likely to consume organic food (OR quartile 4 (Q4) vs. Q1 = 1.84, 95% CI: 1.58, 2.15). Overall, future oriented participants were more likely to consume 15 food groups. The strongest associations were observed for starchy refined foods (OR = 1.75, 95% CI: 1.60, 1.91), fruits and vegetables (OR = 1.71, 95% CI: 1.55, 1.88), and non-alcoholic beverages (OR = 1.70, 95% CI: 1.58, 1.84). The contribution of organic food intake out of total food intake was 33% higher in the Q4 compared to Q1. More precisely, there was a significant increase of the contribution of organic food consumed for 16 food groups. The highest relative differences between Q4 and Q1 were observed for starchy refined foods (22%), non-alcoholic beverages (21%), and dairy products (20%). Seafood was the only food group without a significant difference.

**Conclusions:** This study provides information on the personality of organic food consumers in a large sample of adult participants. Consideration of future consequences could represent a significant psychological determinant of organic food consumption.

**Keywords:** Organic Food Consumption. Nutrition. Consideration of Future Consequences. Psychology

(1)Arnaiz, Pilar; (2)Soto-Sanchez, Johana; (3)Saavedra, Juana;

(4)Dominguez De Landa, Angélica; (5)Rozowski, Jaime; (6)Iriarte,

Laura; (7)Cantwell Wood, Jennifer; (8)Mardones, Francisco.

(1)MD. Department of Pediatrics. ontificia Universidad Catolica de Chile. Chile.; (2)PhD. Department of Physical Education. School of Exercise Science and Sport. University of Playa Ancha. Chile.; (3)BSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (4)BSc. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (5)PhD. Department of Nutrition. Pontificia Universidad Católica de Chile. Chile.; (6)Nutritionist. MSc. International Life Sciences Institute (ILSI Sur Andino). Santiago. Chile.; (7)Nutritionist. MSc. Family Nutrition of the Triad. LLC. Greensboro. NC. USA.; (8)MD. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.

**Background and objectives:** Chile is in an advanced stage of the nutritional transition, which means that there is an increased prevalence of obesity, notably in children. A 4-month pilot study tested the suitability of a physical activity intervention for first graders (children ages 6 and 7) in a public school in Santiago, Chile.

**Methods:** This intervention was done in the classroom twice a day. Teachers were trained to deliver the program in the classroom during the school day. Teachers were surveyed to determine if this intervention fit within their curriculum and classroom routines
and they reported in a focus group that it was suitable for them. All children actively participated in the program and positive changes in their attitudes towards physical activity were observed by their teachers. Anthropometrics, blood pressure, and hand grip strength were measured in the students.

**Results:** Of the 89 students studied, 54 were male and 35 were female, with an average age of 6.44 years (SD±0.39, 5.82-8.00 years). A significant reduction was observed in children with high waist circumference ≥90th percentile, and in mean systolic blood pressure. However, statistical power values for those comparisons were rather low. Anthropometry and hand grip strength were not modified.

**Conclusions:** The latter calculations and the lack of a control group are showing the weaknesses of this pilot study and that further research with a larger sample size and an experimental design are strongly needed.

**Keywords:** children, physical activity, blood pressure, waist circumference

**Conflict of Interest Disclosure:** This study was funded by the International Life Sciences Institute (ILSI Sur Andino), which had no influence in the presented results.

144/1737

ARE NUTRIENTS INTAKE ASSOCIATED WITH
COPD?: A CROSS SECTIONAL SURVEY IN MO-
ROCCO

**Background and objectives:** Diet represents an important source of micro and macronutrients. Several studies demonstrated the existing evidence that they have a series of antioxidant, anti-allergic and anti-inflammatory properties, which can have a protective effect against COPD risk in the population.

Objective: to investigate the dietary intake of micro and macro-nutrient with the COPD prevalence in a representative sample of adults Moroccan in Fez City.

**Methods:** A cross-sectional study carried out in Fez as part of the BOLD study. The relationships between dietary intake and spirometrically defined chronic obstructive pulmonary disease (COPD) were investigated in 767 adults. Post-bronchodilator spirometry was performed for all participants using a Micro Spirometer. The dietary information was obtained by food frequency questionnaire(FFQ). From the food diary results, nutrients and energy intake were calculated using Food composition table analysis. Comparison of micro and macro nutrient intake between two subgroups with an without COPD was performed using Mann-Whitney and kruskal-wallis non parametric test.

**Results:** From 767 subjects. 56.7% were female. Mean age was 55.6±10.9 years old. The prevalence of COPD was 12.6%. 38.1% of the participants were overweight, and 31.2% were obese. Among all subjects, 25% were current or ex-smokers. Intakes of Vitamin C, Vitamin A, Carbohydrate, Calcium, Protein and total Energy Intake were low in person with COPD (P=0.03; P=0.04 ; P=0.02; P=0.02 ; P=0.05; P=0.05 ; P=0.02 respectively)

**Conclusions:** This study has shown the lower intake in several macro and micronutrients as a potential risk factor of COPD. Appropriate trials are needed to establish the real impact of nutrient intake on COPD in Morocco

**Keywords:** Micronutrient, macronutrients, COPD, Morocco

144/1745

BODY MASS INDEX TRAJECTORIES OF INDIGE-
NOUS INDIAN ADULT POPULATION AND IN RE-
LATION TO DIET, PHYSICAL ACTIVITY AND SO-
CIOECONOMIC FACTORS

**Background and objectives:** Indigenous population in India constitutes 8.6% of the total population. Limited cross sectional studies indicate increase in the prevalence of overweight and obesity even in Indian indigenous population, which were known for high physical activity and low body mass index (BMI) levels. The objective of the study is to quantify BMI trajectories among indigenous Indian adult population 20 years and above and also to identify factors associated with increase of overweight and obesity in this population.

**Methods:** It was a periodical longitudinal National study on 'diet and nutritional status of indigenous population', carried out by the National Nutrition Monitoring Bureau (NNMB) during the years

<footnote>(1)Benslimane, Abdelilah; (2)Najdi, Adil; (3)Kinany, Khaoula; (3)Khalis, Mohammed; (3)Mint Sidi Deoula, Meimouna; (4)Nejjari, Chakib;</footnote>

<footnote>(5)Benjelloun, Mohammed Chakib; (6)Bour, Abdellatif; (7)Garcia Larsen, Vanessa; (8)Elrhazi, Karima.</footnote>

<footnote>(1)PhD Student. Nutritional epidemiology. Department of epidemiology, clinical research and public health. Faculty of Medecine of Fez. Morocco; (2)Assistant Professor. public health. School of Medecine of Tangier. Morocco; (3)PhD student. Nutrition and public health. Department of epidemiology, clinical research and community health. Faculty of Medicine. Fez.; (4)Professor. public health. Mohammed VI international University. Casablanca. Morocco; (5)Professoren. Pneumology. Head of Department of Pneumology. Hassn II Hospital School of Fez. Morocco; (6)Professor. Nutritional and dietary Transition team. Laboratoire of Biologic & health assay. Departement of Biology. Faculty of Sciences. University Ibn Tofail Kenitra. Morocco; (7)PhD. Assistant Professor. International Health (Primary). Division: Human Nutrition. Imperial College London. London; (8)Professor. Public health. Department of epidemiology. Clinical research and community health. Faculty of Medicine. Fez.</footnote>

<footnote>(1)Laxmaiah, Avula; (2)Balakrishna, Nagalla; (3)Arlappa, Nimmathota;</footnote>

<footnote>(3)Meshram, Indrapal; (4)Harikumar, Rachakulla.</footnote>

<footnote>(1)MBBS. MPH. PhD. Scientist F. Division of Community studies. National Institute of Nutrition. ICMR. Hyderabad. India; (2)PhD. Scientist E. Division of Biostatistics. National Institute of Nutrition. ICMR. Hyderabad. India; (3)MD. Scientist E. Division of Community studies. National Institute of Nutrition. ICMR. Hyderabad. India; (4)MBBS. DPH. Scientist E. Division of Community studies. National Institute of Nutrition. ICMR. Hyderabad. India.</footnote>
1985-87, 1998-99, and 2008-09 by covering 9,753, 21,334, 28,730 adults in the respective years. The BMI trajectories among adult indigenous population was assessed by mixed models and according to BMI categories for both men and women and multiple Logistic regression analysis was computed to identify associated factors.

**Results:** The prevalence of overweight and obesity among Indian indigenous adult population at baseline was 1.2% and 1.6% among men and women, respectively in 1985-87 and it was increased to 3.6% and 3.8% in 1998-99 and 7% and 8% in 2008-09. The trajectories of BMI was 0.52kg/m2 (CI: 0.47 - 0.56) in men and 0.47 (CI: 0.43 - 0.51) in women. The trajectories were more in normal BMI categories than CED and overweight and obesity categories. The results were consistent with less rapid increased rates of BMI for adults who had lower intakes of sugar and sugar sweetened beverages, oils and fats and those engaged in moderate and severe physical activities and it was more rapidly increased in adults who belonged to high socioeconomic and high per capita monthly income.

**Conclusions:** The overweight and obesity is a significant problem even among indigenous tribal population and there is an urgent need to educate the population on the rapid increase and consequences of overweight and obesity on health of the individuals.

**Keywords:** Indigenous population, Body mass index, adults, trajectories, National study

Dias, Marcia Regina Messaggi Gomes; Fritz, Camilla Kapp; Porchat de Leão, Andreia Araújo; Mascarenhas, Luis Paulo; França, Suzana Nesi.

Federal University of Paraná.

**Background and objectives:** Type 1 diabetes mellitus (DM1) is a disease characterized by the destruction of the beta cells, which can lead to an insulin deficiency. Through a balanced diet, one can obtain better glycemic control. Objective: To investigate the influence of dietary intake patterns on glycemic control and cardiometabolic risk in children and adolescents.

**Methods:** Descriptive cross-sectional study with children and adolescents between 9 and 17 years of age, with DM1. Anthropometric parameters (body weight, height (h), waist circumference (WC), body mass index (BMI), score z (h/age) and (BMI/age), blood pressure measurement and biochemical tests (lipid profile, fasting glycemia and glycated hemoglobin). A questionnaire was used to evaluate the level of physical activity and food consumption was estimated by a 3-day food diary. Patients were classified as having metabolic syndrome (MS) or not, when more than 3 risk factors were identified.

**Results:** The sample consisted of 31 individuals (55% female). Inadequate food intake was identified, regardless of gender, age or disease duration. Only 14% of the population reached the daily energy requirement and only 10% of the children had adequate intakes

of protein, carbohydrate and lipid. The population consumed in excess carbohydrate and cholesterol and presented low consumption of monounsaturated fats. The mean value of glycated hemoglobin was high (Hb1Ac 9.49%) and there was a better glycemic control in the population that presented higher energy expenditure and lower lipid consumption. Of the total sample, 25% of children and adolescents had MS. However, this was not related to food quality and physical activity level. The most prevalent factors were fasting glycemia; high triglycerides and low HDL levels, and large abdominal circumference than expected. Both the MS and non-MS groups presented inadequate diet and sedentary lifestyle.

**Conclusions:** The present study showed an inadequate dietary intake of the sample and that these DM1 individuals tend to present an elevated cardiovascular risk. The findings suggest that strategies should be created to promote healthy eating and continuous follow-up, favoring the link between health professionals and patients and increasing adherence to prescribed treatments.

**Keywords:** diabetes mellitus, cardiometabolic risk, metabolic syndrome, glycemic control, food consumption.

**Background and objectives:** Dating gestational age (GA) of pregnant women is essential for assessing age of pregnancy and intra-uterine fetal growth. Obstetric ultrasound (USG), the gold standard for establishing GA, is not available in most low-income countries. Dating last menstrual period (LMP) and measuring symphysis pubis-fundal height (SFH) offer potential as cheaper alternatives.

The objective is to compare the accuracy of gestational age (GA) estimated by reported last menstrual period (LMP) and measured symphysis-pubis fundal height (SFH), with the ultrasound estimates (USG) as a reference, in a cohort of pregnant women in rural Nepal.

<footnote>(1)Shrestha, Robin; (2)Andrews-Trevino, Johanna Y; (3) Acharya, Sudikshya;</footnote>

<footnote>(4)Lamichhane, Ashish; (5)Pokharel, Ashish; (6)Davis, Dale; (7)Baral, Kedar Prasad; (8)Paudel, Krishna; (9)Webb, Patrick; (10)Ghosh, Shibani.</footnote>

<footnote>(1)MD/MS. Project Manager. Feed the Future Innovation Lab for Nutrition. Tufts University. United States; (2)Assistant Researcher. Nutrition Innovation Lab. Tufts University. United States; (3)Data Manager. Nutrition Innovation Lab. Helen Keller International. Nepal; (4)Research Coordinator. Nutrition Innovation Lab. Helen Keller International. Nepal; (5)Research Manager. Nutrition Innovation Lab. Helen Keller International. Nepal; (6)Country Director. Helen Keller International. Nepal; (7)MD.Professor.Patan Academy of Health Sciences. Nepal; (8)MD.Head of Department. Kanti Children's Hospital. Nepal; (9)PhD. Director.Nutrition Innovation Lab. Tufts University. United States; (10)PhD. Associate Director. Nutrition Innovation Lab.Tufts University. United States.</footnote>
**Methods:** Data derive from pregnant women and their newborn infants from a USAID-supported birth cohort study in Banke district of Nepal. GA was assessed using three separate methods between 18 to 26 weeks of pregnancy. A total of 717 women were assessed using USG, 712 with reported LMP, and 614 women with SFH. Paired t-tests were used to assess differences in GA estimated by LMP or SFH compared to USG. A concordance correlation coefficient (CCC) was calculated to quantify agreement among the three methods.

**Results:** The median GA using USG was 275 days, 278 days by LMP (p<0.0003 compared to USG) and 268 days by SFH (p<0.0000 compared to USG). The concordance correlation coefficient for GA estimates for LMP and US was 0.35, and between SFH and USG was 0.40. Percent women with GA estimates at delivery within +/- 7 days comparing LMP to USG were 18%, and 77% within +/- 14 days. In contrast, the percent women with GA estimates within +/- 7 days at delivery comparing SFH and USG were 19%, but only 62% within +/- 14 days.

**Conclusions:** There were small but significant differences in the median GA estimates obtained by the three methods. The degree of agreement between LMP and SFH were poorly concordant. No significant differences in accuracy between the measures were observed. However, GA estimates were found to be more accurate than SPH in LMP compared to USG (within +/-14 days). This finding suggests that LMP should be used instead of SFH in the absence of USG.

**Keywords:** gestational age estimates, pregnant women

144/1766

## FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT IN RURAL MALI USING BIRTH WEIGHT RECALLED FROM MOTHER'S MEMORY OR BIRTH WEIGHT REPORTED FROM A HEALTH CARD. (2013)

(1)Fortin, Sonia; (2)Moya Alvarez, Violeta; (1)Kameli, Yves; (3)Le Port, Agnes; (1)Adubra, Laura; (4)Kodjo, Niamke Ezoua; (5)Martin-Prével, Yves; (2)Savy, Mathilde.

(1)MSc. UMR 204 Nutripass - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Montpellier. France;

(2)MSc, PhD. UMR 204 Nutripass - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Montpellier. France;

(3)MSc, PharmaD, PhD. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Dakar. Senegal.; (4)MSc. World Food Programme. Bamako. Mali;

(5)MSc, MD, PhD. UMR 204 Nutripass - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Montpellier. France.

**Background and objectives:** It is widely known that low birth weight (LBW) is associated with increased risk of neonatal death and impaired cognitive development. However, in developing countries, estimating LBW can be challenging due to the absence of official documents. Moreover, causes of LBW are multifactorial. The objectives of the present work are: (1) to compare the profiles of mothers reporting birth weight from memory vs.

mothers who provide a document indicating birth weight in rural West Mali; (2) to identify the determinants of LBW depending on the method birth weight is reported.

**Methods:** In 2013, we conducted a cross-sectional survey among randomly selected mothers of 12-42 months old children (n = 1254) in the district of Kayes, Mali. We collected birth weights during the survey from either an official health card (HC) or from mother's memory (MM), as well as potential determinants of LBW such as socioeconomic characteristics, pregnancy details, mother's anthropometry and household food insecurity. Definition of LBW was a weight under 2500g. Relationships between LBW and potential determinants were assessed using logistic regressions.

**Results:** The prevalence of HC-LBW was significantly lower than the MM-LBW prevalence (11% vs. 16%, p = 0.04). Mothers reporting birth weight from memory were less educated (p < 0.01), poorer (p = 0.03) and attended fewer prenatal visits (p < 0.01) than mothers who reported birth weight from HC.

Factors associated with MM-LBW included mother's profession, skilled person who attended delivery and household food insecurity (respectively: p <0.01, p <0.01, p = 0.03). Factors associated with HC-LBW were mother's education, antenatal care and place of delivery (p < 0.01). House occupancy status was associated with both HC-LBW and MM-LBW (p < 0.01), while mother's anthropometry was not, neither with HC-LBW nor MM-LBW.

**Conclusions:** LBW prevalence estimates and determinants depend on the method used to report birth weight data (HC vs. MM); the method of reporting is itself highly influenced by socioeconomic characteristics of mothers.

**Keywords:** Memory reported birth weight, documented birth weight, low birth weight, Rural Mali.

144/1768

## EFFECTIVENESS OF A CULTURALLY APPROPRIATE LIFESTYLE MODIFICATION PROGRAMME IN IMPROVING BODY COMPOSITION IN URBAN SRI LANKAN WOMEN WITH PREDIABETES

(1)Waidyatilaka, Indu; (2)lanerolle, Pulani; (3)Wickramasinghe, Rajitha;

(4)Atukorala, Sunethra; (5)de Silva, Angela.

(1)MBBS, MSc, PhD. Department of Biochemistry and Molecular Biology. Faculty of Medicine. University of Colombo. Sri Lanka.; (2)BSc, PhD. Department of Biochemistry and Molecular Biology. Faculty of Medicine. University of Colombo. Sri Lanka.;

(3)MD, PhD. Department of Public Health. Faculty of Medicine. University of Kelaniya. Ragama. Sri Lanka.; (4)BSc, MSc, PhD. Department of Biochemistry and Molecular Biology. Faculty of Medicine. University of Colombo. Sri Lanka.; (5)Department of Physiology. Faculty of Medicine.University of Colombo. Sri Lanka.

**Background and objectives:** Lifestyle interventions are the keystone of prevention and treatment for non-communicable diseases. Effectiveness of interventions rests on cultural relevance. Increased fat mass (FM) and abdominal obesity has been suggested as a possible cause for increased cardiometabolic risk
and improvement of body composition status may have a positive effect on dysglycemic status. This abstract presents data on the effectiveness of a lifestyle modification programme in improving body composition among newly diagnosed prediabetic Sri Lankan women.

**Methods:** Urban women (n=1500) aged 30-45 years from Colombo Municipal Council area were screened for prediabetes and 130 newly diagnosed prediabetics were recruited randomly to intervention and control groups. Using a participatory approach an intervention programme was developed and implemented for 4 months in the intervention group (goal: 5% weight loss and 150 minutes of physical activity/week). Control group received regular advice and print material only. Weight, waist, glycosylated haemoglobin (HbA1c), body composition (bioelectrical impedance analysis using a population specific equation) were assessed. Independent sample t- test and paired t- test were used.

**Results:** The final sample was 101 women (intervention n=51, control n=50) with no significant difference in baseline parameters between responders and non-responders or between groups. Following intervention, 52.9% of the intervention group achieved the weight loss goal compared to the control group (2%) and a significant (P < 0.001) reduction in mean waist circumference (0.88 ± 1.2 cm) was observed in the intervention group. In the intervention group, there was a reduction in both FM and fat free mass (FFM) post intervention compared to baseline (P < 0.05) and also a reduction in weight (2.6 ± 2.0 kg) (P < 0.001). Hence a concurrent reduction in FM% and an increase in FFM% were observed. In the intervention group, there was a reduction (P < 0.05) in HbA1c (0.2±0.24%) and FPG (20.6±11.6 mg/dl) and 37.3% became normoglycaemic, with none among controls. In the control group no changes were seen in any parameter post intervention.

**Conclusions:** Improvement in body composition and reversal of dysglycaemia were achieved through a goal- based, culturally sensitive intervention programme of four months duration.

**Keywords:** Lifestyle modification, Prediabetes, body composition

## COMPLEMENTARY FEEDING INTERVENTIONS AND ITS EFFECT ON MORBIDITY OF CHILDREN UNDER 5 YEARS

**Background and objectives:** Complementary feeding using fortified blended food supplements in poor households is one of the intervention for improving nutrients intakes and reducing the incidence of diseases in children under 5 years. We assessed the impact of this vital child survival programme in Rutsiro and Nyamagabe districts.

**Methods:** A cross-sectional study was conducted to collect data on the targeted population in the two districts between August and September 2016. Two stage sample stratification by district and wealth category was done. Final sample size was 3700 aged 6-59 months. Morbidity was assessed based on two weeks recall questionnaire. The child caretaker was the main respond. Key indicator symptoms assessed were cough, fever and diarrhoea.

**Results:** Children enrolled in the complementary feeding receiving fortified food supplement were slightly less likely to be affected by combination of 2-3 symptoms (46.5%) as compared to those not enrolled in the programme (48.4%).

**Conclusions:** The complementary feeding using fortified blended food supplement reduces the prevalence of morbidity and reinforces the impact of the nutrition infection cycle on child malnutrition. Undertaking appropriate food supplementation is encouraged for future nutrition programmes.

**Keywords:** complementary feeding, fortified blended food, Morbidity

## MAPPING OF SCHOOL MEAL NUTRITION GUIDELINES AND STANDARDS IN LOW AND MIDDLE-INCOME COUNTRIES

**Background and objectives:** Poverty eradication, health, education, food security and nutrition continue to be the pillars of sustainable development. Schools can make a sizeable, lasting impact on these determinants through various access points. One such access point is the provision of meals through globally widespread school-based programmes. Key actors have proposed that many of these programmes can benefit from a stronger emphasis on the quality, adequacy and nutritional composition of the meals provided, primarily through the enforcement of nutrition guidelines and standards (NGS). The objective of this study was to conduct a mapping of school meal NGS in low and middle-income countries, and to identify implications from school food programmes (SFP).

**Methods:** This study used a triangulation of methods for data collection and analysis including survey administration, complemented with official laws, regulations and policies, scientific articles, and through direct follow-up with key respondents. The inclusion criteria to select countries, encompassed being classified as a low or middle-income country, and having a government-owned or transitioning SFP targeting primary schools.

**Results:** Survey responses were received from 33 countries (59% response rate). A further 10 countries, which did not re-

<footnote>(1)Mahamadou, Tanimoune; (2)Ouma, Cyprian; (3)Oman, Allison;</footnote>

<footnote>(4)Kimani, Alex.</footnote>

<footnote>(1)Eng. Phn. Nutritionist World Food Programme; (2)Nutritionist World Food Programme; (3)Senior Nutritionist World Food Programme; (4)Intern Nutritionist World Food Programme.</footnote>

<footnote>(1)Vargas Araya, Melissa; (2)Hernandez-Garbanzo, Yenory; (3)Islas Ramos, Ana.</footnote>

<footnote>(1)MSc. International Nutrition Consultant. Food and Agriculture Organization of the United Nations. Italy.; (2)PhD. Nutrition Officer. Food and Agriculture Organization of the United Nations. Italy.; (3)EdD. Nutrition Officer. Food and Agriculture Organization of the United Nations. Italy.</footnote>
spond to the survey, were then included, using information from the above-mentioned sources. Overall, identified SPF nutrition objectives, beneficiaries, food procurement and preparation modalities, varied widely between countries as they obey to different nutrition priorities, possibilities and contexts. Out of the 43 sample countries, 17 were found to have some general recommendations to guide the composition of the SFP meals, while 13 (mostly from Latin America) had official NGS for school meals and 10 were in the process of development. The majority of the identified NGS included both nutrient (great emphasis on energy and protein) and food-based standards, determined by using different nutrition requirements. Food-based standards were not always explicitly aligned with national food-based dietary guidelines. Many tend to be complex and change according to SPF modality.

**Conclusions:** These preliminary results underscore that SFP characteristics have important implications which should be considered for the development and feasibility of NGS. More attention is needed to the development process, context, easiness and flexibility of application, and training for end implementers.

**Keywords:** nutrition guidelines and standards; school meals; school food programmes

**Background and objectives:** During the adolescence, they acquire and consolidate stylelife habits. Physical inactivity and low fruit and vegetables consumption are frequent habits in all age. These represent health risk factors and for NCDs.

The objective was evaluate the association between fruits and vegetables consumption with being physically active in adolescents in the Southern Cone, based on of the Global School Based Student Health Survey (GSHS) of Uruguay and Argentina (2012) and Chile (2013).

**Methods:** Cross-sectional descriptive study with an analytical component in adolescents between 13 and 17 years of age based (GSHS). The association between being physically active and consumption of five fruits and vegetables was studied. Control variables were age, sex, alcohol consumption, smoking habit, sedentary lifestyle, and condom use. Relative frequencies and means with 95% CI were used. The comparison of categorical and dichotomous variables was performed using the Pearson Chi square hypothesis test (2 K). The risk of being physical inactive was estimated with a multivariate analysis that was expressed in Odd Ratios with a 95% CI. An alpha (α) was considered of 0.05.

**Results:** Only 29.4% (28.9 - 29.9) of the adolescents were active. Males in the Southern Cone were more active than females 37.6 (36.8 - 38.4) and 22.4 (21.8-23.1), respectively. (P <0.001) The consumption of 5 servings or more of fruits and vegetables was low (18.7%); only 13.5% consumed more than 3 vegetables and about one third (38%) 2 or more fruits daily. Consumption of less than 2 fruits, less than 3 times vegetables and less 5 or more servings of fruits and vegetables was significantly associated with being less active. (P<0.001) The risk of being less active was 1.50 times higher in those who did not consume the 5 or more servings of vegetables and fruits per day. The condition of being a woman also double this risk OR: 2.06 (1.96 - 2.17).

**Conclusions:** The low fruits and vegetables consumption, and increased risk of being physical inactivity that have these adolescents; it reveals need to consider strategies that to address both issues together to achieve synergies to improve health in the short and long term

**Keywords:** Physical activity. Fruits. Vegetables. Adolescence.

**Background and objectives:** Recent dietary guidelines for Americans recommended replacing saturated fats with plant-derived monounsaturated fats as evidence showed the preventive effect of monounsaturated fatty acids (MUFA) on cardiovascular diseases. However, studies investigating the association of MUFA intake with mortality are limited. We aim to assess and compare the association between dietary intake of MUFA and mortality between Chinese and US adults.

**Methods:** We used data from the China Health and Nutrition Survey (CHNS, n=14,113) and National Health and Nutrition Examination Survey [NHANES, 1988-1994 (III), continuous 1999-2010 (n=36,032)]. Dietary intake of MUFA was assessed using a 24-h dietary recall in NHANES and 3-day 24-h dietary recalls in CHNS.

**Results:** A total of 4826 deaths occurred during 378,359 person-years of follow-up in NHANES and 1009 deaths accrued during 199,091 person-years in CHNS. Total MUFA intake was significantly associated with lower risk of overall mortality in CHNS. After adjustment for confounders, the hazard ratios (HRs) across increasing quartiles of MUFA intake were 0.85 (95% confidence interval [CI], 0.70-1.02), 0.69 (95% CI, 0.55-0.87), 0.83 (95% CI, 0.60-1.15); P=0.02 for trend), as compared with the first quartile.

<footnote>(¹)Delgado D'Agostini, Silvia Mónica; (²)Kristeller, Jean; (³)Bove, Maria Isabel.</footnote>

<footnote>(¹); (²)MCs. Nutricionista. Facultad de enfermería y tecnologías de la salud. Unviersidad Católica del Uruguay. Uruguay; (³)PhD. Nutricionista. Instituto de Salud y Bienestar. Universidad Católica del Uruguay. Uruguay.</footnote>

<footnote>(¹)Zhuang, Pan; (²)Jiao, Jingjing; (³)Wang, Wenqiao; (¹)Chen, Jingnan.</footnote>

<footnote>(¹)BSc. Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science. Zhejiang University. China.; (²)PhD. Nutritionist. Department of Nutrition. School of Public Health. Zhejiang University School of Medicine. China.;</footnote>

<footnote>(³)MD. Department of Nutrition. School of Public Health. Zhejiang University School of Medicine. China.</footnote>
Total MUFA intake was also inversely but weakly associated with mortality in NHANES. As compared with the first quartile, the HRs across increasing quartiles of MUFA intake were 1.00 (95% CI, 0.90-1.11), 0.89 (95% CI, 0.77-1.04), 0.83 (95% CI, 0.67-1.02; P=0.06 for trend). Importantly, increased MUFA intake was related to lower risk of death from stroke [fourth quartile versus first quartile: 0.25 (95% CI, 0.12-0.52); p=0.02 for trend] in NHANES. Analyses of specific MUFA showed that the association of palmitoleic acid with mortality was inverse in CHNS (P=0.002 for trend) but null in NHANES. As the main type of MUFA, oleic acid intake was also weakly associated with mortality in NHANES (P=0.06 for trend) whereas the association seemed U-shape in CHNS.

**Conclusions:** Total MUFA intake was associated with reduced risk of mortality for both Chinese and US adults, though the association was strong in CHNS but weak in NHANES. Our findings provide epidemiological evidence for formulating the recommended nutritional intake of MUFA for Chinese and American people.

**Keywords:** Monounsaturated fatty acids, Palmitoleic acid, Mortality, CHNS, NHANES.

## ACTUALIZATION OF THE CONTENT OF ADDED FOOD SUGARS IN THE SPANISH FOOD COMPOSITION DATABASE (BEDCA).

**Background and objectives:** Food composition databases (FCDB) are important tools for food and nutrition professionals (Pennington, 2007). Food composition data can be obtained from various sources. Different proposals to evaluate the quality of these data (Martínez-Victoria, et al., 2015).

The necessity of distinguishing from added sugar (AS) and naturally occurring sugars (NS) in foods has been growing since there are a lot of scientific information that shows the connection between AS and metabolic syndrome, as well as other related diseases. Because of that, the FDA has implemented the new Nutrition Facts label for packaged foods. Due to changes in some recipes provided by food companies, the sugar data added in the USDA database have been withdrawn.

This situation generates a growing interest in information on the content of sugars in food, in the consumer and in health professionals.

The content in sugars will serve for the new nutritional labeling, mandatory in accordance with European Union legislative ready, so it is important to have this data in the Spanish FCDB (BEDCA) (www.bedca.net).

**Methods:** We were implemented the method proposed by JCY Louie et al. (2015) in order to establish a differentiation of sugar content of most of food that make up BEDCA and has searched analytical data from primary sources like scientific papers and laboratories associated with intent to add it up to the nutrients list of foods that do not have sugar content previously.

**Results:** The foods in BEDCA have been divided in two groups: "100% AN" or "100% NS" and added sugar data that our group found in their search for foods that does not have any sugar data.

The next step (already started) is to compile a recipe list of all food that have a mix of AS and NS to obtain the real sugar content of that to include in our database.

BEDCA is currently the only FCDB developed in Spain with compiled and documented date, according to EuroFIR (www.eurofir.org).

**Conclusions:** BEDCA (950 foods, 48 components, 310 methods and associated references) will allow users and professionals of Nutrition and Public Health to use online quality food composition data.

**Keywords:** Sugar; added sugars; food composition; nutrition label; food composition database.

**Conflict of Interest Disclosure:** None of the authors have any conflicts of interest to declare.

BEDCA has been funded by the Spanish Agency of Consumption, Food Safety and Nutrition (AECOSAN), Ministry of Health, Social Services and Equality (http://www.aecosan.msssi.gob.es/AECOSAN/web/seguridad_alimentaria/subseccion/composición_alimentos_BD.shtml)

## SETTING OF CUT-OFF SCORE FOR ASSESSING THE COUNSELING COMPETENCY OF FILIPINO VILLAGE NUTRITION WORKERS ON INFANT AND YOUNG CHILD FEEDING (IYCF) BASED ON SENSITIVITY AND SPECIFICITY

**Background and objectives:** Five instruments for assessing the counselling competency of Filipino village nutrition workers on infant and young child feeding (IYCF) were developed and

<footnote>(1)Martínez-Burgos, Mª Alba; (2)Moreno, Ángela; (2)Martínez de Victoria Muñoz, Ignacio; (3)Yago, Mª Dolores; (3)Mañas, Mariano;</footnote>

<footnote>(3)Martínez de Victoria Muñoz, Emilio.</footnote>

<footnote>(1)PhD. Institute of Nutrition and Food Technology. Center of Biomedical Research. Technological Park of Health Sciences. Department of Physiology. Faculty of Pharmacy. University of Granada. Granada. Spain; (2)MSc. Institute of Nutrition and Food Technology. Center of Biomedical Research. Technological Park of Health Sciences. University of Granada. Granada. Spain. (3)PhD. Institute of Nutrition and Food Technology. Center of Biomedical Research. Technological Park of Health Sciences. Department of Physiology. Faculty of Pharmacy. University of Granada. Granada. Spain.</footnote>

<footnote>(1)Sacdalan-Africa, Leila Sacdalan-Africa; (2)Mansyur, Muchtaruddin;</footnote>

<footnote>(3)Muslimatun, Siti; (4)Barba, Corazon.</footnote>

<footnote>(1)Associate Professor. Institute of Human Nutrition and Food. College of Human Ecology. University of the Philippines Los Baños. Philippines; (2)Director. Southeast Asian Ministry of Education Organization. Regional Center on Food and Nutrition. Universitas. Indonesia; (3)Faculty Member, Indonesia International Institute for Life Sciences. Indonesia; (4)Professor Emeritus. Institute of Human Nutrition and Food. College of Human Ecology. University of the Philippines Los Baños. Philippines.</footnote>
validated. These included: (1) 28-item knowledge test(KNO); (2) 10-item attitude test(ATT); (3) 18-item worker's skills self-assessment(CSW); (4) 18-item supervisor's instrument for assessing worker's skills(CSS); and (5) 17-item activity checklist for IYCF counselling client(CSM). These were combined into competency assessment instruments KAS-COM(1,2,3,4,5); KAS-WOR(1,2,3); KAS-SUP(1,2,4) and KAS-MOM(1,2,5). To establish the composite distribution for knowledge(KNO), attitude(ATT), and skills(CSW, CSS, CSM) in the competency score calculation and to set the cut-off score based on sensitivity and specificity, this study was undertaken.

**Methods:** Using the receiver operating characteristic(ROC) analyses, 28 possible combinations of composite distributions (30-30-40; 25-25-50; 20-20-60; 15-15-70; 25-15-60; 25-10-65; 20-10-70) for knowledge, attitude and skills, with corresponding passing score of 60%, 65%, 70%, 75% were tested.

**Results:** The best area under curve (KNO=0.86; ATT=0.81; CSW=0.77; CSS=0.94; CSM=0.81) was the 20-10-70 percent distribution for knowledge, attitude and skills, respectively with 75% cut-off score. Among the constructs, CSS had the highest area under curve (0.94) and using 51% as cut-off score, it was a good test (0.92) to identify the skilled workers on IYCF counselling. The tests for knowledge, attitude, CSW, and CSM with 63%, 79%, 80%, and 89%, respectively as cut-off scores were fair enough in identifying the knowledgeable workers, those with better attitude; and were skilled to do the IYCF counselling. The setting of cut-off score for each assessment instrument (KAS_WOR, KAS Sup, KAS_MOM and KAS_COM) resulted to areas under curve ranging from 0.83 (good) to 0.92 (excellent). Using 50% and 80% as cut-off values, the sensitivity for the instruments with supervisor and client as assessors of skills was excellent (1.0 and 0.96) while specificity was fair (0.78 and 0.76). The cut-off score for self-assessment instrument KAS_WOR (75%) was fairly sensitive and specific. The cut-off score for the combined instrument (KAS_COM) is 65%.

**Conclusions:** The use of ROC curve in identifying the cut-off score and the composite distribution for knowledge, attitude and skills provided a sound basis for identifying competent BNS in terms of IYCF counselling.

**Keywords:** composite distribution of competency score, setting of cut-off score, ROC curve, sensitivity and specificity, IYCF counselling

**Background and objectives:** Environmental enteric dysfunction is defined by abnormal intestinal morphology resulting in reduced absorptive capacity, inflammation, and poor growth. While the causes of EED warrant further investigation, it has been linked to unsanitary environmental conditions, especially repeated exposure to enteric pathogens. The main objective of this study is to determine if household water quality is a risk factor for EED in children living in southwestern Uganda.

**Methods:** This cross-sectional assessment was a sub-study of the Uganda Birth Cohort study, undertaken from 2014-2015. 385 children who met the inclusion criteria were randomly selected for participation. Data on water quality and sex of the household head, mother's education level, and mother's age were extracted from the 6 month infant age time point. Water quality was assessed using the Aquagenx CBT for detecting and quantifying E.coli bacteria. EED was assessed at 12-16 months using a lactulose: mannitol (L:M) test. For the L:M test, children consumed 20 ml. of solution containing 5 grams of lactulose and 1 gram of mannitol. All urine was collected for a minimum of four hours, and 1.5 ml. aliquots were stored at a minimum of -20°C. Levels of the two sugars were analyzed using validated LC-MS methods. Funding was provided by USAID (grant AID-OAA-L-1-00006).

**Results:** Of the 385 children, 49.4% were male and 50.7% were female, and the median age was 15.0 months [14.1, 15.7]. Among the households, 43.8% had “safe” water, 13.5% had “probably safe” water, 12.2% had “probably unsafe” water, and 30.5% had “unsafe” water. The median L: M score was 0.27 [0.16, 0.41], with 20.26% having no EED (L:M <0.15), 57.4% having moderate EED (0.15 <= L: M <= 0.45), and 22.34% having severe EED (L:M > 0.45). The association between water quality and EED was assessed using linear regression. The L:M scores of children consuming water deemed “unsafe” were 0.08 points higher (99% confidence interval [CI]: 0.02, 0.15) compared to water deemed “safe”.

<footnote>(1)Lauer, Jacqueline; (2)Duggan, Christopher; (3)Ausman, Lynne;</footnote>

<footnote>(4)Griffiths, Jeffrey; (3)Webb, Patrick; (5)Ghosh, Shibani.</footnote>

<footnote>(1)MS MPH. PhD Candidate. Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Tufts University. Boston, MA. United States.; (2)PhD MPH. Professor. Department of Nutrition. T.H. Chan School of Public Health. Harvard University. Boston, MA. United States.; (3)PhD. Professor. Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Tufts University. Boston, MA. United States.; (4)MD MPH&TM. Professor. Department of Public Health and Community Medicine. Tufts University School of Medicine. Boston, MA. United States.; (5)PhD. Assistant Professor. Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Tufts University. Boston, MA. United States.</footnote>
**Conclusions:** Household water contamination may be an important risk factor for EED, which is consistent with previous findings but requires further study.

**Keywords:** environmental enteric dysfunction, malabsorption, water quality, child health

(¹)Perignon, Marlène; (²)El Ati, Jalila; (³)Drogue, Sophie; (⁴)Darmon, Nicole; (¹)Amiot-Carlin, Marie Josephpe; (⁴)Sinfort, Carole.

(¹)PhD. Nutritionist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France;

(²)PhD. Nutritionist. Institut National de Nutrition et de Technologie Alimentaire. Tunisia.; (³)PhD. Economist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (⁴)PhD. Environmental Physician. Unité Mixte de Recherche « Information, Technologies, environnemental Analysis, agricultural Processes » (UMR ITAP). Montpellier SupAgro. France.

**Background and objectives:** Environmental impacts of national diets are often analyzed through Carbon emissions. Nevertheless, with a life cycle vision, other impacts are to be considered and new methods and data are now available to compute water deprivation and land use impacts (Pfister et al., 2016; Vidal-Legaz et al., 2016). The objective of this study was to use an hybrid method combining economical statistics data to production ones and compute environmental potential impacts due to water deprivation and land use for the French and Tunisian diets.

**Methods:** National nutritional enquiries were merged with the international custom data base UNComtrade and the FAOstat one. For animal products, feed composition and origin were also considered. Characterization factors for the water deprivation were the WSI factors from Pfister et al. (2009). Land use impacts were computed from the occupied surface including land occupied by animal feed crops. Then LANCA characterization factors (Beck et al., 2011; Bos et al., 2016) were applied to compute land use potential impacts. Biodiversity impacts from land use were obtained from Chaudhary et al. (2015).

**Results:** Potential impacts were computed for the total equivalent amount of food of one person during one year in France and Tunisia. Impacts are generally one order higher (roundly 5 to 15 times) for the Tunisia diet than for the French one but food production in Tunisia has positive impacts on erosion and biotic production. Comparing food groups show the prevailing importance of the group “meat/fish/eggs”.

**Conclusions:** The hybrid approach allowed to consider the origin of each product in the French and Tunisian diets and to differentiate environmental potential impacts due to water deprivation and land use for each country and for each food family.

**Keywords:** national diet, life cycle assessment, land use, water deprivation

**Further collaborators:**

FINANCIAL SUPPORT: This work was funded by the French Research Agency (ANR-12-TMED-0004). The Tunisian dietary data were collected in the framework of the “Transition And Health Impact in North Africa” project financed by the EU (Contract Number: ICA3-CT-2002-10011)

FURTHER COLLABORATORS: The MEDINA Study Group: MJ Amiot (INRA), N Achir (CIRAD), L Alouane (INNTA) J El Ati (INNTA), S Bellagha (INAT), PM Bosc (CIRAD), M Broin (Agropolis), N Darmon (INRA), C Dhuique-Meyer (CIRAD), MC Dop (IRD), S Drogué (INRA), S Dury (CIRAD), A Ferchoui (INRA), C Gaillard (CIRAD), Z Ghrabi (INAT), F Jacquet (INRA), Y Kameli (IRD), F Kefi (CIHEAM), E Kesse-Guyot (INRA), D Lai-ron (INSERM), Y Martin-Prevel (IRD), C Méjean (INRA), C Mou-quet (IRD), S Njoumi (INAT), M Padilla (CIHEAM), M Perignon (INRA), C Sinfort (SupAgro), P Traissac (IRD), E Verger (IRD).

(¹)Modem, Sai leela; (²)Vadarevu, Sony.

(¹)Associate Professor. St.Joseph's college for Women (Autonomous). Visakhapatnam. India.; (²)Assistant Professor. St.Joseph's college for Women (Autonomous). Visakhapatnam. India.

**Background and objectives:** Diabetes Mellitus proves to be major cause of morbidity and mortality around the world and contribute largely to healthcare costs. Deshpande (2008) points that the risk of death of patients with DM is twice that of the population of the same age without DM. Seema et al (2010) opine that DM poses significant healthcare burdens on both families and society. Adiseshiah (2005) suggests that multidisciplinary interventions help in management of DM patients and delay the onset of complications which are usually life threatening and affect the quality of life.

**Objective:** To understand and trace out the critical factors haunting the DM patients selected from an urban population.

**Methods:** The study of 51 hospitalised DM patients was undertaken in Visakhapatnam city in the Andhra Pradesh state of India. The secondary data in the form of patients' case history was collected and primary data of family, socio-economic status, anthropometry, diet and physical activity were obtained. BMI was calculated.

**Results:** The hospitalised DM patients were aged from 41 to 90 years, that is late middle age to old age. The males and females were equally affected by the disease and its complications. The maximum affected were in the age group 61-70 years. The disease had a toll on people of all walks of life and with active lifestyle. The diet followed by the affected over a period of time was analysed. However no concrete diet pattern could be arrived at as causative factor. The diet counselling was undertaken.

**Conclusions:** The study revealed very pathetic situation as the people affected with DM were in productive age. The burden of the disease the quality of life and the economic condition of the patients.
**Keywords:** Diabetes Mellitus (DM), anthropometry, BMI, hospitalised, disease burden, diet counselling, lifestyle, quality of life.

**Conflict of Interest Disclosure:** The co-author was my Grad student and the work is a dissertation undertaken in my supervision.

(1)Lobo, Adriana; (2)Assis, Maria Alice Altenburg De; (2)Leal, Danielle;

(2)Hinning, Patrícia; (3)Kupek, Emil; (4)Bellisle, France.

(1)MSc. Nutritionist. Postgraduate Program in Nutrition. Health Sciences Center. Federal University of Santa Catarina. Florianopolis. Santa Catarina. Brazil.; (2)PhD. Postgraduate Program in Nutrition. Health Sciences Center. Federal University of Santa Catarina. Florianopolis. Santa Catarina. Brazil; (3)PhD. Postgraduate Program in Public Health. Health Sciences Center. Federal University of Santa Catarina. Florianopolis. Santa Catarina. Brazil; (4)PhD. Université Paris 13. Equipe de Recherche en Epidémiologie Nutritionnelle. Centre de Recherche en Epidémiologie et Statistiques. Inserm (U1153). Inra (U1125). Cnam. COMUE Sorbonne Paris Cité. F-93017 Bobigny.rm.s Cité. F-93017 Bobigny. France.

**Background and objectives:** Although the identification of dietary patterns is important to support dietary interventions, there are few studies in Brazilian children, none of them using Latent Profile Analysis (LPA). The aim of this study is to apply LPA to identify dietary patterns in pupils of public schools participating in the Web-CAAFE 2013-2015 surveys, in Florianopolis, Brazil.

**Methods:** The Web-CAAFE Survey is an annual cross-sectional school-based survey designed to help public health and education professionals to evaluate schoolchildren from 2nd to 5th grade regarding nutritional status, food consumption and physical activity. Data for the present study were collected in the years 2013, 2014 and 2015 and included 6,379 schoolchildren from Florianopolis (southern Brazil). Data was obtained using the questionnaire Web-CAAFE (Food Intake and Physical Activity of Schoolchildren), a web-based self-administered questionnaire that examines food consumption and physical activity during the previous day. Latent profile indicators were the frequency of consumption of 32 food/beverages items, in number of times per day. LPA was used to assign the children to the most likely latent profiles based on their food consumption.

**Results:** Three latent profiles were identified: 1) Traditional pattern (39.7% of the children), with a significantly elevated probability of consuming rice, vegetables, green leaves, beans, manioc flour, meat, fruits, bread and biscuits and dairy products; 2) Monotonous pattern (39.3% of the children), with a significant probability of consuming pasta, instant noodles and pizza/hamburger/hot-dog, and 3) High diversity pattern (21% of the children), with a significantly higher probability of eating a variety of foods, healthy or not, such as corn and potatoes, French fries, breakfast cereals, soda, sweets, chips snacks, vegetables, green leaves, milk, yoghurt

and fruits. A higher proportion of boys presented a Monotonous dietary pattern (43.6% CI 95% 41.9-45.3 vs 35.0% CI 95% 33.3-36.6) and a higher proportion of girls presented a Traditional pattern (45.0% CI 95% 43.2-46.7 vs 34.5% CI 95% 32.9-36.2).

**Conclusions:** The present study offered insights about the use of LPA for describing the eating patterns of Brazilian schoolchildren. Three patterns were identified: Traditional, Monotonous and High diversity.

**Keywords:** dietary patterns, Latent Profile Analysis, schoolchildren.

(1)De Miguel Etayo, Pilar; (2)Santabárbara, Javier; (3)Martín-Matillas, Miguel; (4)Marti, Amelia; (5)Campoy, Cristina; (6)Marcos, Ascensión;

(7)Garagorri, Mª Jesús; (8)Moreno, Luis A.

(1)PhD. GENUD (Growth, Exercise, NUtrition and Development) Research Group. Instituto Agroalimentario de Aragón (IA2). Instituto de Investigación Sanitaria Aragón (IIS Aragón). Universidad de Zaragoza. Spain. CIBERobn (Biomedical Research Centre in Physiopa; (2)PhD. Department of Preventive Medicine and Public Health. University of Zaragoza. Spain; (3)PhD. Department of Physical Education and Sport. School of Sport Sciences. Ctra. Alfacar s/n. University of Granada. Granada. Spain PROFITH (PROmoting FITness and Health through physical activity) Research Group. Universidad de Granada. Granada. Spain.; (4)PhD. Department of Food Sciences. Nutrition and Physiology. Universidad of Navarra. Pamplona. Navarra. Spain CIBERobn (Biomedical Research Centre in Physiopathology of Obesity and Nutrition). Carlos III Institute of Health. Madrid. Spain.; (5)PhD. Department of Pediatrics. School of Medicine. University of Granada. Granada. Spain EURISTIKOS Excellence Centre for Paediatric Research. Biomedical Research Centre. Parque Tecnológico de Ciencias de la Salud. Universidad de Granada. Granada. Spain.; (6)PhD. Immunonutrition Research Group. Department of Metabolism and Nutrition. Institute of Food Science and Technology and Nutrition (ICTAN). Spanish National Research Council (CSIC). Madrid. Spain; (7)PhD. MD. GENUD (Growth, Exercise, NUtrition and Development) Research Group. Instituto Agroalimentario de Aragón (IA2). Instituto de Investigación Sanitaria Aragón (IIS Aragón). Universidad de Zaragoza. Zaragoza. España.; (8)PhD. MD. GENUD (Growth, Exercise, NUtrition and Development) Research Group. Instituto Agroalimentario de Aragón (IA2). Instituto de Investigación Sanitaria Aragón (IIS Aragón). Universidad de Zaragoza. Zaragoza. España. CIBERobn (Biomedical Research Center). Spain.

**Background and objectives:** Overweight and obesity have achieved high rates in children and adolescents across the world. A diet quality index (DQI) is a useful tool that provides an overall
score of an individual's dietary intake when assessing compliance with food-based dietary guidelines. Moreover, family life plays an important role in developing eating behaviors and dietary intake in children and adolescents. This study was aimed to assess the associations between DQI and family meals in adolescents included in a comprehensive therapy for obesity.

**Methods:** Multi-intervention approach (diet, physical activity and psychological support in a family-group-based treatment-EVASYON) was implemented within a one-year intervention in 13-to-16-year-old overweight or obese Spanish adolescents. A total of 67 adolescents, 31 females, were included in the present study, whose energy intake and BMI had been measured at baseline. In the EVASYON study, diet quality index was calculated from food frequency questionnaire at baseline, 6 and 13 months of follow-up. Family meal was assessed from dietary history reported from parents at baseline, 2, 6 and 13 months of treatment. In the present study, we evaluate the diet quality index and family meals after 6 months of intervention. Data are shown as means and SD for continuous variables and frequency and percentages for categorical variables). U-Mann Whitney and Chi-squared tests were performed. Signification level was established at p<0.05. All statistical analyses were performed by using SPSS STATISTICS v.20 (IBM Corp., New York, NY, USA, 2010).

**Results:** 67.2% adolescents had family meals and showed DQI score of 71.16±8.94 after 6 months. Males had lower DQI values than females, meanwhile similar percentage of family meals was observed (69.4% vs 64.5%). However, there was only a significant relationship between DQI and family meal in females (p=0.036).

**Conclusions:** It is important to create a comfortable atmosphere in order to reach a better diet quality index in adolescents with obesity. Males need to be instructed in food and health related issues. The efforts in obese adolescents should be directed to really achieve healthier behavioral changes, including family, in order to improve their DQI.

**Keywords:** Adolescents, family-involvement, family-group-based, multi-intervention approach, diet quality index

## INCENTIVE VALUE OF CASH IN A CONDITION-AL CASH TRANSFER PROGRAM FOR MATERNAL AND CHILD HEALTH AND NUTRITION IN MALI

(1)Le Port, Agnes; (2)Zongrone, Amanda; (3)Savy, Mathilde; (4)Fortin, Sonia; (5)Kameli, Yves; (6)Diatta, Ampa D; (6)Sessou, Eric; (7)Kodjo, Niamke Ezoua; (8)Martin-Prével, Yves; (9)Ruel, Marie.

(1)MSc, PharmD, PhD. Poverty Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Senegal.; (2)MPH, PhD. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Senegal.; (3)MSc, PhD. UMR204 'Nutripass' - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). France.; (4)MSc. UMR204 'Nutripass' - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). France.; (5)UMR204 'Nutripass' - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). Mali.; (6)MSc. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Senegal.; (7)MSc. World Food Program (WFP). Bamako. Mali.; (8)MSc, MD, PhD. UMR204 'Nutripass' - IRD-UM-Supagro. Institut de Recherche pour le Développement (IRD). France.; (9)MSc, PhD. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). USA.

**Background and objectives:** The “Cash for Nutrition Awareness” (CNA) component of the community-based intervention “Santé Nutritionnelle à Assise Communautaire à Kayes” (SNACK) was implemented in Mali by the World Food Program (WFP-Mali) in 2013 for a duration of 3 years. The conditional cash transfer program aimed at improving child nutrition outcomes by increasing maternal and child attendance at community health centers (CHCs) through the distribution of a small amount of cash (~$3.00-$12.00 USD), during antenatal visits, delivery, vaccination and monthly growth monitoring visits starting at 6 months, covering the “1000 days” period (i.e. from pregnancy to 23 months of age of the child). The objective of this study was to explore the incentive value of the cash for beneficiaries to attend CHCs.

**Methods:** We conducted a process evaluation two years after the start of the program, using a purposive sample of 12 CHCs and their catchment area. We collected data using semi-structured interviews with frontline workers (n=76) and mothers (n=24), semi-structured observations of cash distributions and services delivered in 11 CHCs (twice for each CHC, n=22), and free listing with groups of up to 10 mothers gathered outside the CHCs (n=24 groups). Data were analyzed using thematic analysis along the program impact pathway (from service delivery to beneficiaries’ receipt and use of cash).

**Results:** We identified various implementation issues, including difficulties for program workers to supply the cash to the CHCs due to a challenging implementation environment (namely long travel distances to deliver cash to the CHCs and high workloads). In addition, some mothers returned home empty-handed, as the total amount of cash available was often insufficient to pay all women attending the CHC in the same day. In some CHCs, cash was also delivered on different days than the days they provided services. Beneficiaries identified maternal and child health
as their main motivation to attend activities at the CHCs and cash only as a benefit, mainly used to buy food.

**Conclusions:** Implementation issues and a potentially insufficient amount of cash may have decreased the incentive value of the cash to increase attendance at CHCs. The research was funded by UNICEF, EC (IFAD) and CGIAR (A4NH).

**Keywords:** implementation research; conditional cash transfer; health attendance; children; nutrition

**Background and objectives:** While multiple agencies maintain databases with a variety of programmatic data, there is a need for greater alignment and harmonization to achieve more uniform global monitoring of the state of, and progress in fortification; programmatic decision making and accountability; and advocacy. A global repository of key program-related indicators for multiple food vehicles (maize flour, oil, rice, salt, wheat flour) will help fill this niche and will provide a resource for governments, donors, and implementing agencies to make data-driven decisions about fortification policies and programs.

**Methods:** We implemented a process that entailed reviewing existing databases, developing a core set of indicators, and outlining a process for continuous collection and aggregation of updated data. These processes and outcomes were reviewed at each stage through a consultative process implemented in a food fortification community of practice comprising over thirty organizations/actors operating at national and global levels [the Global Fortification Technical Advisory Group (GF-TAG)].

**Results:** A set of core indicators covering aspects related to demand, supply, and the enabling environment for fortified stable foods were defined based on data available within existing databases. Examples include the status of fortification legislation, regulations, monitoring, compliance, and coverage. Proxy indicators were also crafted where the ideal indicator is not available across all countries and fortified food vehicles. Data stewards were identified for each food vehicle to serve as gatekeepers to ensure optimal data inclusion and quality. A repository prototype was developed with assistance from Camber Collective and TenPoint7

that includes existing data from the core indicators within an interactive data visualization platform and was publically launched in June 2017. Data stewards streamlined data collection processes with countries and technical partners to ensure timely data updates and inclusion of additional indicators over time to address user needs.

**Conclusions:** As food fortification programs are scaled up in countries, it is imperative to track progress and establish standard indicators to assess performance, impact and sustainability. This effort has underscored the need for broader improvements in fortification data, including improvements in data collection that require continued collaboration across all GF-TAG member organizations.

**Keywords:** Food Fortification, Data Collection, Data Repository, Evidence-Based Decision Making, Data Visualization

**Background and objectives:** Overweight and obesity are growing health problems in many developing countries. Rising obesity rates are the result of changes in people's diets and life-styles. Income growth and urbanization are factors that contribute to these changes. Modernizing food retail environments may also play a certain role. For instance, the rapid spread of supermarkets in many developing countries could affect consumer food choices and thus nutritional outcomes. However, concrete evidence about the effects of supermarkets on consumer diets and nutrition is thin. A few existing studies have analyzed related linkages with cross-sectional survey data. To our knowledge, we are the first to use panel data in this setting.

**Methods:** Panel data from households and a total of 1,199 adult individuals was collected in urban Kenya in the years 2012 and 2015. Panel regression models with individual fixed effects plus other controlling factors were employed.

**Results:** Our results show that shopping in supermarkets significantly increases adults' body mass index (BMI). Regarding impact pathways we did not find that supermarkets contribute to net increases in total calorie consumption. However, our panel data models revealed significant shifts in dietary composition. Supermarket shopping contributes to a sizeable decrease in energy consumption from unprocessed staples and from fresh fruits and vegetables. We found significant increases of supermarket shopping on energy consumption from dairy, vegetable oil, processed meat products (sausages etc.), and highly processed foods (bread, pasta,

<footnote>(1)Luthringer, Corey L.; (2)Codling, Karen; (3)Garrett, Greg S.;</footnote>

<footnote>(4)Martinez, Homero; (5)Pachón, Helena; (6)Gorstein, Jonathan.</footnote>

<footnote>(1)MPH. Food Fortification. Global Alliance for Improved Nutrition. USA.; (2)Iodine Global Network. Thailand; (3)MSc. Director. Food Fortification. Global Alliance for Improved Nutrition. Switzerland;</footnote>

<footnote>(4)MD, PhD. Micronutrient Forum. Micronutrient Initiative. Canada; (5)Food Fortification Initiative; (6)PhD. Executive Director & Associate Professor. Iodine Global Network & Department of Global Health. University of Washington. USA.</footnote>

<footnote>(1)Demmler, Kathrin Maria; (2)Ecker, Olivier; (3)Qaim, Matin.</footnote>

<footnote>(1)PhD. Agricultural Sciences. RTC; (2)PhD. Research Fellow. Development Strategy and Governance Division. International Food Policy Research Institute. Washington, DC. USA.; (3)Prof. International Food Economics and Rural Development. University of Goettingen. Germany.</footnote>
snacks, soft drinks etc.). These shifts towards processed and highly processed foods lead to less healthy diets, with higher sugar, fat, and salt contents, and probably lower amounts of micronutrients and dietary fibers.

**Conclusions:** The observed changes in dietary composition could explain the increasing effect on BMI, even without a rise in total calorie consumption. These results confirm that the retail environment affects people's food choices and nutrition. However, the effects depend on the types of foods offered. Rather than thwarting modernization in the retail sector, policies that incentivize the sale of more healthy foods – such as fruits and vegetables – in supermarkets may be more promising to promote desirable nutritional outcomes.

**Keywords:** Dietary choices, overweight, supermarkets, panel data, developing countries

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## THE ROLE OF THE NUTRITIONIST IN THE PUBLIC HEALTH SYSTEM OF SPAIN

(1)López-Plaza, Bricia; (2)Bermejo, Laura M; (3)Morato-Martinez, Marina; (3)Valero-Perez, Marlhyn; (4)Palma-Milla, Samara; (5)Gomez-Candela, Carmen.

(1)PhD. Nutrition Researcher. Nutrition Department. La Paz University Hospital. Hospital La Paz Institute for Health Research (IdiPAZ). Autonomous University of Madrid (UAM). Spain; (2)PhD. Nutrition Researcher. Nutrition Department. La Paz University Hospital. Hospital La Paz Institute for Health Research (IdiPAZ). Autonomous University of Madrid (UAM). Spain.; (3)BSc. Nutritionist. Nutrition Department. La Paz University Hospital. Hospital La Paz Institute for Health Research (IdiPAZ). Autonomous University of Madrid (UAM). Spain.;

(4)MD. Endocrinologist. Nutrition Department. La Paz University Hospital. Hospital La Paz Institute for Health Research (IdiPAZ). Autonomous University of Madrid (UAM). Spain.; (5)MD. PhD. Endocrinologist. Nutrition Department. La Paz University Hospital. Hospital La Paz Institute for Health Research (IdiPAZ). Autonomous University of Madrid (UAM). Spain.

**Background and objectives:** The figure of the nutritionist is well recognized around the world. The nutritionist's intervention not only improves the health of the patient but also reduces the associated health cost. Even though there is accumulated evidence of the role of the nutritionist in the prognosis of a person's health status, in Spain, its inclusion in health systems has not been achieved. For this reason the main objective is to introduce the role of nutritionist in the public health system of Spain and the strategies to give visibility to these health professionals.

**Methods:** It is now known that for every euro spend on dietary counseling from Nutritionists, society gets a net 63€ in return: 56€ in terms of improved health, 3€ net savings in total health care costs and 4€ in terms of productivity gains. However in the Spanish Health System, the nutritionist is not considered. Taking into account the importance of the incorporation of nutritionists in the

health system, the Autonomous University of Madrid through the Clinical Nutrition Education and Research the Chair of the Teaching Sponsorship (UAM-VEGENAT) have set in motion measures to spread the importance of nutritionists in health institutes.

**Results:** As a result of this necessity, the first congress of Dietitians-Nutritionists, an absent health professional, has been done. This congress has been supported by the Nutrition Department of La Paz University Hospital, in order to give more visibility to this group of professionals. Topics of special interest as the current situation of this collective and its functions within a hospital have been presented. Nutritionists from Spain and other countries put in evidence the urgent need to carry out national policies that promote the incorporation of the nutritionist in the Public Health Systems of Spain. There was an exploration through the different areas, besides the sanitary one, where the role of the nutritionist takes on special importance as in research centers, universities, companies, etc.

**Conclusions:** The lack of nutritionists in the Spanish Public Health System should be resolved. Events of diffusion such as this Congress serve to give visibility of these health professionals.

**Keywords:** Nutritionist, Spanish Public Health System

144/1869

## DRIVERS AND BARRIERS OF SCHOOL FEEDING PROGRAMS IN THE PHILIPPINES

(1)Glas, Maria Gracia; (2)Funke, Anette; (2)Breyhan, Barbara; (3)Chávez Zander, Ursula; (3)Krawinkel, Michael.

(1)M.Sc.Nutritionist.Institute of Nutritional Sciences. Justus-Liebig-University of Giessen; (2)Kindermissionswerk. Die Sternsinger. Germany; (3)Institute of nutritional sciences. Justus-Liebig-University of Giessen. Germany.

**Background and objectives:** School feeding programs (SFP) are an important strategy to prevent and tackle malnutrition in low and middle income countries. The SFP intervention studied was implemented in ten public elementary schools in the Victorias City, in the province of Negros Occidental (Philippines), an area with an estimated 40% of children (5-10 years) being underweight. The objective of the study was to identify drivers and barriers of the SFP.

**Methods:** A qualitative research approach was applied to gain insights into participants' experiences with the SFP. The participant groups consisted of school authorities, teachers, and mothers or caregivers. Six focus group discussions, two for each participant group, were conducted with question guides and analyzed with a QDA-Software. Additional data were collected through informal conversations and observations while visiting the schools.

**Results:** Drivers as well as facilitators of the SFP were the motivation of the participants, awareness, promotion for parents and caregivers, good management, including monitoring activities, adequate targeting, and the implementation of hygiene education as part of the school curriculum. Awareness promotion through the SFP activities enhanced hygiene and nutrition practices of parents and children, however this was limited to environments with
supportive infrastructure. Further, school vegetable gardens were
important drivers for a successful SFP. Identified barriers were lack
of parental involvement and of linkages between SFP and national
policies and related activities. Another aspect that hindered the
effectiveness of the SFP was the lack of complementary nutrition
sensitive activities aligned to the SFP as well as insufficient infra-
structure and equipment.

**Conclusions:** Participant motivation and active participation of community members, parents, and school staff members played a key role in the success and sustainability of the SFP. School veg- etable gardens displayed an important part of the SFP, but they cannot sustain stable food production for the SFP throughout the whole school year. Improvement in management skills, funding, and investments in adequate infrastructure and necessary condi- tions such as kitchen equipment, handwashing and toilet facilities, and separate dining spaces, are required to enhance the effective- ness of the SFP in the study area.

**Keywords:** school feeding, focus-groups, school health, moti- vation, participation

144/1874

OBJECTIVELY MEASURED LEVELS OF PHYSICAL ACTIVITY IN FIRST GRADE CHILDREN OF BUENOS AIRES. DATA FROM MINISALTEN STUDY

**Background and objectives:** Global Recommendations on Physical Activity for 5-17 years old, of the World Health Organization (WHO), are to invest at least 60 minutes a day in moderate to vigorous physical activity (MVPA). The study aim was to objectively assess levels of physical activity (PA) in a sample of first grade children of Buenos Aires and to examine differences according to gender.

**Methods:** This data correspond to the baseline assessment (June to November 2015) of MiniSALTEN Study (obesity prevention program targeting first grade children at public primary schools). All children of first grade attending to the 12 public primary schools from the city of Buenos Aires participating in MiniSALTEN were invited to participate. The levels of PA were measured using ActiGraph wGT3X-BT accelerometers for 7 consecutive days (24 hours). Outcomes were: time in light, moderate and vigorous PA and sedentary time (minutes/day) determined by Evenson et al.'s cut points. Time in MVPA (minutes/day) was also

determined. Accelerometer data were analyzed using the ActiLife 6.11.8 software. Descriptive statistical analyzes of the variables measured for the total and by sex were made. Data were processed using IBM SPSS Statistic 18.

**Results:** 185 children (mean age = 6.7 years, 94 girls and 91 boys) wore accelerometers. The total sample spent 354.4 minutes/ day in PA light, 47.9 minutes/day in PA moderate, 17.8 minutes/ day in PA vigorous and 937.7 minutes/day in sedentary time. Children spent 65.7 minutes of the day in MVPA. 55.7% of the total sample don't meet the PA guidelines of the WHO. According to gender, boys invest significantly more time in MVPA than girls (74.7 vs. 57.1 minutes/day) (p = 0.000). 60.6% of the girls don't meet the recommendation while 72.5% of the boys exceed the recommendation.

**Conclusions:** This is the first Argentine study that objectively describes the PA levels in a sample of children starting primary school from Buenos Aires. Considering it shows that the majority of children don't meet the PA recommendation, nor for active time neither for sedentary time, lots of preventive efforts should be considered when planning public health policies.

**Keywords:** Physical activity, Sedentary time, Accelerometer, Children.

**Conflict of Interest Disclosure:** The source of funding for the research is the Coca-Cola Foundation. The authors declare that they have no competing interests. The funding source had no role in study design, data collection and analysis, decision to publish, or preparation of manuscripts.

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

144/1881

NEW MULTISECTORAL TOOLS TO ADDRESS ANE- MIA AT THE NATIONAL AND DISTRICT LEVELS

**Background and objectives:** Anemia is caused by multiple factors, and it can be difficult for decision-makers to prioritize anemia actions for their context. Collaborating with country implementers, the SPRING Project developed two tools for use at the national and district level, to encourage stakeholders to gather and interpret data related to anemia and anemia programs. We cover the theoretical rationale, design, and testing of the tools.

**Methods:** The “Guidance for Conducting a Landscape Analysis for Anemia” was designed to help provide stakeholders a broad understanding of the national anemia situation, and the “District

<footnote>(1)Indart Rougier, Paula; (2)De Gregorio, Maria Jose; (1)Zonis, Luciana Noemi; (1)Favieri, Andrea Lorena; (3)Rausch Herscovici, Cecile;</footnote>

<footnote>(4)Kovalskys, Irina.</footnote>

<footnote>(1)BSc. Nutritionist. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina;</footnote>

<footnote>(2)BSc. Sociologist. Department of Anthropological Sciences. University of Buenos Aires. Buenos Aires. Argentina.; (3)PhD. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.; (4)MD. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.</footnote>

<footnote>(1)Fisseha, Teemar; (2)Sakar, Danya; (3)D'Agostino, Alexis; (4)Harvey, Philp; (5)Moorthy, Denish; (6)Namaste, Sorrel.</footnote>

<footnote>(1)MPH. Monitoring and Evaluation Officer. SPRING Project. John Snow Inc. USA.; (2)MHS. Nutrition Specialist. SPRING Project. John Snow Inc. USA.; (3)MPP. Monitoring and Evaluation Specialist. SPRING Project. John Snow Inc. USA.; (4)PhD. Nutritionist. Independent Consultant. USA; (5)MBBS. MS. Nutritionist. SPRING Project. John Snow Inc. USA.; (6)MHS. DrPH. Nutritionist. SPRING Project. Helen Keller International. USA.</footnote>
Assessment Tool for Anemia (DATA)” to enable districts to understand anemia and prioritize actions. The anemia landscape tool was developed based on experiences assessing the anemia situation in Ghana, Uganda, and Sierra Leone and validated by receiving input from 34 content-specific experts. The DATA tool was also developed with input from multiple stakeholders and field tested in a district in Ghana. A revised tool was piloted in a district in Nepal and Uganda.

**Results:** The landscape analysis tool guides the user through a four-step process to assess the anemia situation: characterize anemia prevalence, establish causes of anemia, and review and assess existing anemia policies and interventions. An accompanying Excel-based tool allows users to aggregate and present data. Using similar content as the national tool, the DATA tool is an Excel-based tool that guides a two-day facilitated workshop. During the workshop district-level stakeholders from multiple sectors discuss and complete questionnaires and the data generated is automatically translated into output dashboards. The DATA tool underlines the importance of local contextual factors, identifies enablers and barriers to address these factors, and assists district stakeholders to prioritize anemia actions.

**Conclusions:** An effective multisectoral effort to combat anemia requires insights from multiple data sources and an understanding of data gaps and their implications for implementation. These resources guide stakeholders through the collection and use of such information. The extent to which the findings generated from using these tools will be used to inform planning and program design remains to be seen. An important next step will be to scale-up and evaluate these tools.

**Keywords:** anemia multisectoral tools decision-making planning

**Methods:** This analysis used data from cross-sectional baseline survey of 184 mothers with children (6 to 36 mo) participating in Nutrition Links, a 5-y project to improve rural health and economic well-being in the Upper Manya Krobo district of Ghana. The survey included questions regarding socio-demographic characteristics, agriculture production (including dark green leafy vegetables, orange-flesh sweet potatoes and fruits), and maternal and child dietary intake. Dietary diversity score (DDS), computed as consumption of up to eight food groups for mothers (7-day recall) and up to seven food groups for children (24-hour recall), were dichotomized as “good” (met recommendation of ≥5 for women and ≥4 for children) or as “poor” (did not meet recommendation). Bivariate analyses and linear regression were used to determine associations and predictors, respectively of child dietary diversity.

**Results:** The mean ages of mothers and their children were 27.2 ± 7.2 y and 12.4 ± 6.3 mo, respectively. Approximately 60% of households cultivated at least one type of nutrient-dense vegetable or fruit on their farms. The mothers' mean DDS was 4.5 ± 1.2 and children's mean DDS was 3.2 ± 1.9, with a significant positive correlation (r=0.36, P<0.01) between the two DDS. Younger children (6-12 mo) were more likely than older children (12-36 mo) to have a “poor” DDS (70.5% vs. 29.5%; P<0.001). Children from households cultivating at least one nutrient dense crop were more likely to have “good” DDS compared to those from households not cultivating these crops (57.7% vs. 42.3%; P=0.03) but no association was noted with mothers’ DDS. Mothers’ DDS (P=.002), household nutrient dense crop cultivation (P=0.025) and child age (P<0.001) independently predicted child DDS.

**Conclusions:** Mothers need support to improve their children's diet diversity during early complementary feeding. The positive association between household crop cultivation and child DDS supports use of agricultural interventions focused on nutrient rich crops to improve child nutrition.

**Keywords:** dietary diversity, children, maternal, agriculture, dietary intake

**Background and objectives:** Households with restricted income may sell nutrient-dense produce they cultivate at the expense of their own nutrition. We assessed whether household cultivation of nutrient-dense vegetables was associated with mothers and children's dietary diversity indicators.

<footnote>(1)Colecraft, Esi; (2)Marquis, Grace; (3)Aryeetey, Richmond;</footnote>

<footnote>(4)Bannerman, Boat; (5)Thompson-Colon, Theresa; (6)Atuobi-Yeboah, Afua.</footnote>

<footnote>(1)University of Ghana. Ghana; (2)PhD. Nutritionist. School of Dietetics and Human Nutrition; (3)PhD. Nutritionist. School of public Health. University of Ghana. Ghana; (4)MSc. Data Analyst. Nutrition Links Project. University of Ghana. Ghana; (5)PhD. Research Associate. School of Dietetics and Human Nutrition. McGill University. Canada; (6)MPhil. Nutritionist. Nutrition Links Project. University of Ghana. Ghana.</footnote>
# FOOD-BASED DIETARY PATTERNS AND NUTRITIONAL QUALITY OF MEALS IN BRAZIL (2008-2009)

(1)Machado, Priscila Pereira; (2)Louzada, Maria Laura da Costa;

(3)Andrade, Giovanna; (3)Ricardo, Camila; (4)Levy, Renata.

(1)PhD candidate. Graduate Program in Nutrition in Public Health, School of Public Health. University of São Paulo. Brazil. Center for Epidemiological Research in Nutrition and Health (NUPENS/USP). School of Public Health. University of São Paulo, Brazil.; (2)PhD. Nutrition Course. Federal University of São Paulo. Brazil. Center for Epidemiological Research in Nutrition and Health (NUPENS/USP). School of Public Health. University of São Paulo, Brazil.; (3)MSc. Department of Preventive Medicine. School of Medicine. University of São Paulo. Brazil. Center for Epidemiological Research in Nutrition and Health (NUPENS/USP). School of Public Health. University of São Paulo, Brazil.; (4)PhD. Department of Preventive Medicine. School of Medicine. University of São Paulo. Brazil. Center for Epidemiological Research in Nutrition and Health (NUPENS/USP). School of Public Health. University of São Paulo, Brazil.

**Background and objectives:** It has been observed the declining in the consumption of traditional meals based on freshly prepared dishes, and its replacement by the ultra-processed food and drink products. However, evidence on the composition and nutritional profile of each main meal from low and middle-income countries is still scarce. This study aimed to identify food-based dietary patterns at lunch and dinner and assess the nutritional quality of these patterns in Brazil.

**Methods:** Cross-sectional analysis based on individual-level dietary data from 32,898 individuals aged ≥10 years in Brazil, collected as part of the 2008–2009 National Household Budget Survey. Food consumption was evaluated by two 24-hour food records. Lunch and dinner were identified as the most caloric meals in the periods between 11 a.m. and 5:59 p.m. and between 6 p.m. and 11:59 p.m., respectively. Food items were classified into three food groups and subsequent subgroups according to the extent and purpose of the processing they undergo. Exploratory factor analysis was applied to identify food-based meals patterns. We used linear regression analyses to evaluate the association between quintiles of the foods patterns' scores and nutritional indicators of the meals.

**Results:** We identified three food-based meals patterns for lunch and dinner. The first pattern, labeled ‘ready meal’, was positively associated with bakery products, ready meals and other processed and ultra-processed products, and negatively associated with unprocessed and minimally processed food such as rice, beans and meats. The second pattern, labeled ‘snack’, included butter, milk, coffee and tea, processed breads and margarine. The third pattern, labeled ‘traditional meal’, was positive for unprocessed or minimally processed foods (like fruits/fruit juices, roots/tubers and fish), and negative for meats and soda. For lunch and dinner, the nutritional indicators of unhealthy diet increase significantly across quintiles of the ready meal and snack patterns,

while nutritional indicators for healthy diet increase significantly across quintiles of the traditional meal pattern.

**Conclusions:** This study suggests that the adherence of traditional meals and the avoidance of ready meals and snacks patterns may be an effective way to improve the nutritional quality of Brazilian diets.

**Keywords:** Dietary pattern. Diet quality. Meals. Food processing. Household Budget Survey.

**Further collaborators:**

Source of funding: São Paulo Research Foundation/Grant FAPESP 2015/14900-9

# OBESITY, INSULIN RESISTANCE AND TYPE 2 DIABETES MELLITUS IN FEMALE ADOLESCENTS, LIMA – PERÚ

(1)Pajuelo Ramírez, Jaime; (2)Bernui, Ivonne; (3)Sánchez González, José; (3)Arbañil Huamán, Hugo; (4)Miranda Cuadros, Marianella;

(5)Cochachin Henostroza, Omaira; (5)Aquino Ramírez, Anthony.

(1)MSc.Medical Doctor. Instituto de Investigaciones Clínicas. Universidad Nacional Mayor de San Marcos. Perú. MSc.Medical Docotr. Instituto de Investigaciones Clínicas. Universidad Nacional Mayor de San Marcos. Perú; (2)MSc. Biologist. Centro de Investigación de Bioquímica y Nutrición. Universidad Nacional Mayor de San Marcos. Perú; (3)MD. Servicio de Endocrinología. Hospital Nacional Dos de Mayo. Perú; (4)MSc. Nutritionist. Centro Nacional de Alimentación y Nutrición. Instituto Nacional de Salud. Perú; (5)Pre-graduate student. School of Nutrition. Universidad Nacional Mayor de San Marcos. Perú.

**Background and objectives:** The prevalence of obesity in adolescents at the national level was 3,2% in 2010 and this figure was more than double for the year 2014 (7,5%). This increase is alarming because of the complications obesity causes, including type 2 diabetes mellitus (DM2), dyslipidemia and hypertension. The objective was to determine the prevalence of IR in an obese adolescent population and to identify the presence of DM2.

**Methods:** In 1206 female adolescents were evaluated with BMI for age. Obesity at BMI/A ≥ 95p was defined using the WHO standards. In the obese patients, insulin, glucose, and lipid profile were determined using the Matthew equation (Insulin uUI/mL * glycemia mmol/dL/22.5). HOMA-I was calculated using a value ≥ 3,16, to define insulin resistance (RI). To identify dyslipidemia the cut-off points were: hypercholesterolemia ≥ 200 mg/dL, low HDL-C ≤40 mg/dL, high LDL-C ≥ 130 mg/dL and hypertriglyceridemia ≥ 150 mg/dL. Obese women with IR were given a glucose tolerance test (PTG) by choosing the criteria of the American Diabetes Association, between 140 and 199 mg/dL intolerant to glucose and 200 mg/dL and more as diabetics.

**Results:** Obesity was present in 25.1% of the study population. In this group of obese adolescents, 28.1% had IR. When comparing the group of obese with RI with obese without RI, it was observed that the difference of the means of the biochemical variables presented statistical significance, except the HDL-C.
In the same way the differences between the prevalences of the
dyslipidemias were significant with the exception of HDL-C. RI
had an OR of 16.2 (6.3-41.9), 12.1 (4.9-30.1), and 7.6 (3-19.5) with
hypertriglyceridemia, hypercholesterolemia, and C -LDL, respec-
tively. PTG showed 3.3% intolerant and none diabetic.

**Conclusions:** Obese adolescents were identified with a high risk of becoming diabetic over time and presenting with cardiovascular problems and that this is exacerbated by the presence of them at a young age.

**Keywords:** Obesity; Insulin resistance; glucose tolerance; adolescent

144/1891

THE LATIN AMERICA AND THE CARIBBEAN IN-
TERVENTIONS THAT FOSTERING NUTRITIONAL
WELL-BEING: OPPORTUNITIES TO STRENGTH-
EN NUTRITION PUBLIC POLICIES

(1)Rios-Castillo, Israel; (2)Molina, Veronika; (3)Mejicano, Gabriela;

(2)Alfaro, Norma; (3)Rivas, RoseMarie; (4)Hernandez-Garbanzo, Yenory.

(1)MSc. Nutritionist. Regional Nutrition Officer for Latin America and the Caribbean. Sub Regional Office for Mesoamerica. Food and Agriculture Organization of the United Nations (FAO).

Panama; (2)MSc. Nutritionist. Institute of Nutrition for Central America and Panama (INCAP). Guatemala City. Guatemala;

(3)Nutrition Specialist. Food and Agriculture Organization of the United Nations (FAO). FAO Representation in El Salvador.

San Salvador. El Salvador; (4)PhD. Nutritionist. Nutrition Officer.

Food and Agriculture Organization of the United Nations (FAO).
Headquarter. Rome. Italy.

**Background and objectives:** Latin America and the Caribbean Region is currently in a transition between two key periods in its development. In the last 20 years, the region has made progress in hunger and undernutrition control and prevention. However, overweight and obesity as well as non-communicable chronic diseases are rapidly increased affecting across the entire region. The present study aimed to identify and analyze national experiences to support nutritional well-being in Latin America and the Caribbean.

**Methods:** The Information was obtained from primary and secondary sources in the 33 participating countries, from Febru ary through August 2016.

**Results:** Two hundred and four interventions were identified in the three sub-regions covered by the study. Most interventions seek to prevent or reduce malnutrition due to deficiencies, or promote healthy lifestyles among vulnerable groups. Seventeen interventions were selected to conduct in-deep interviews in Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Jamaica, Mexico, Paraguay, Trinidad and Tobago, and Uruguay. According to the results, the main success factors for the interventions were: political endorsement; targeting actions for the identification of beneficiaries and coverage at the national level; adequate and

timely budget; sufficient, trained and committed staff; monitoring and evaluation; work in partnerships with the public and private sector as well as international cooperation; community participation and empowerment of beneficiaries.

**Conclusions:** There is significant potential for the strengthening of nutrition public policies to promote comprehensive interventions that foster nutritional well-being in LAC that is currently facing the double burden of malnutrition and the NCD epidemic. Implementation of a regional nutrition public policies framework could complement the UN Decade of Actions on Nutrition ongoing commitment to fight against the double burden of malnutrition in LAC.

**Keywords:** nutrition, malnutrition, food security, nutrition policy, Latin America and the Caribbean.

**Further collaborators:**

Israel Rios have further collaboration with other academic institutions

144/1909

METABOLIC SYNDROME AND RISK FACTORS
ASSOCIATED WITH LIFESTYLE

(1)Pistoni, Martha Pistoni; (2)Cappelen, Liliana Cristina; (2)Cejas Rey, Valeria.

(1)Msc Nutritionist. National Center for Nutrition Research. Salta.
Argentina; (2)Nutritionist. National Center of Nutrition Research.
Salta. Argentina.

**Background and objectives:** Metabolic syndrome (MS) is a term that has been used to define a group of risk factors that include: visceral obesity, hypertension, hyperglycemia and atherogenic dyslipidemia, which predispose the individual to develop cardiovascular disease and type 2 diabetes mellitus, becoming one of the main problems of public health in the 21st century. The objective of this study was to determine the prevalence of metabolic syndrome in the adult population and its relationship with some risk factors related to lifestyle.

**Methods:** Case - control study nested in a cross - sectional study of a representative sample of adults (175) from households of Salta city, Argentina. Weight, height, waist circumference, blood pressure measurement, food consumption, physical activity (IPAQ) and laboratory tests were performed. Metabolic syndrome was diagnosed according to the criteria of Adult Treatment Panel III (ATP-III). Excel, WHO software Antro v.1.0.4 Plus, EPI 7 programs were used.

**Results:** MS prevalence was 21.1%, significantly higher in males (28%) than in females (17.8%); OR = 1.95; 95% CI: 1.15 to 3.3. MS risk is higher in the overweight population (OR = 179; 95% CI: 11.1 to 2884); it is 2.6 times higher when the energy adequacy is excessive compared to normal caloric intake (95% CI: 1.58 to 4.43); Is 5.5 times higher with daily intake of sugary beverages (95% CI: 3.1 to 9.7) and 65 times higher when fiber adequacy in the diet is deficient (95% CI: 16.1 To 262.7). The consumption of saturated fatty acids was higher in the population with MS (21.5 ± 20.7 vs 17.6 ± 13.9) but without statistical significance. High cho-
lesterol intake (> 200 mg / day, according to ATPII) triples the risk of MS (95% CI: 1.87 to 4.8) and low levels of physical activity increase 1.5 times the risk of developing it.

**Conclusions:** The composition of the diet: high in calories, saturated fat, cholesterol and reduced in fiber added to low levels of physical activity, are predisposing risk factors of MS.

**Keywords:** metabolic syndrome, diet, physical activity

144/1912

## EXPLORING THE FOOD AND NUTRITION SECURITY IMPACT OF THE SOCIAL PROTECTION POLICY "PROSOLI" AMONG ELDERLY BENEFICIARIES IN DOMINICAN REPUBLIC

(1)Rios-Castillo, Israel; (2)Hernandez-Garbanzo, Yenory; (3)Mota-Modeste, Sevil; (4)Fulcar, Altagracia Maria; (5)Then-Paulino, Amarilis; (6)Medina-Disla, Hector; (7)Suriel, Altagracia.

(1)MSc. Nutritionist. Regional Nutrition Officer for Latin America and the Caribbean. Sub Regional Office for Mesoamerica. Food and Agriculture Organization of the United Nations (FAO). Panama; (2)Phd. Nutritionist. Nutrition Officer. Food and Agriculture Organization of the United Nations. Headquarter. Rome. Italy; (3)MD. Nutrition Consultant. Food and Agriculture Organization of the United Nations. Representation in the Dominican Republic. Santo Domingo. Dominican Republic; (4)Nutritionist. World Food Programme of the United Nations. Country Office in the Dominican Republic. Santo Domingo. Dominican Republic.; (5)MPH. MD. Nutrition Division. Ministry of Public Health; and Public Health Division. Universidad Autonoma de Santo Domingo (UASD). Santo Domingo. Dominican Republic.; (6)Statistician. Cabinet of the Social Policy Coordination "Progresando con Solidaridad (PROSOLI)". Vice Presidency of the Dominican Republic. Santo Domingo. Dominican Republic.; (7)Directorate. Cabinet of the Social Policy Coordination "Progresando con Solidaridad (PROSOLI)". Vice Presidency of the Dominican Republic. Santo Domingo. Dominican Republic.

**Background and objectives:** Food security and nutrition- al well-being are important elements for elderly people living in social and economic vulnerable situations in the Dominican Re- public. The present study aimed to compare food security and nutritional outcomes at household and individual level of elderly beneficiaries and non-beneficiaries of the Dominican Republic so- cial protection policy "Progresando con Solidaridad (PROSOLI)".

**Methods:** A cross-sectional study of 335 elderly people (50% beneficiaries) was conducted to compare food security and nutri- tional outcomes in beneficiary and non-beneficiary groups. Data was collected from June-December 2016 in ten geographically-dis- persed regions at national level in the Dominican Republic. The Latin America and the Caribbean Food Security Scale (ELCSA) and the food diversity index at household level were conducted. Data analysis included anthropometric, dietary intake and so- cio-demographic data and rand univariate parametric or non-par-

ametric statistical analyses using Wilcoxon Mann-Whitney, t tests and proportional test.

**Results:** Median age and interquartile range (iqr) of partic- ipants was 74.1(13.0) years; 51% were women. Sixty percent re- ported moderate or severe household food insecurity, however, the prevalence was significantly higher in non-beneficiaries (65%) compare to beneficiaries (55%) (Proportional test, p<0.05). A sig- nificantly higher prevalence of wasting (BMI<23kg/m2) was also found in non-beneficiaries (44%) compare to beneficiaries (34%) (Proportional test, p<0.05). For dietary intake, geometrical mean and standard deviation of dietary calcium intake was 396 mg (125- 1255) in beneficiaries and 292 mg (74-1146) in non-beneficiaries (ttest, p=0.0280); and saturated fatty acids were 8.5mg (2.7-27.0) in beneficiaries and 6.2mg (1.6-23.9) in non-beneficiaries (ttest, p=0,0241); no such difference was observed with other macro or micronutrient intake.

**Conclusions:** Results suggest that nutrition-sensitive social pro- tection policies such as PROSOLI may significantly influence the food security situation and nutritional status of their elderly bene- ficiaries. This underscores the need of capitalizing on the strengths of nutrition sensitive social protection policy and program meas- ures to support in an integrated manner efforts that aim to promote healthy eating habits and better nutrition among elderly.

**Keywords:** malnutrition, elderly, dietary assessment, Social Protection, Food Insecurity

**Conflict of Interest Disclosure:** the authors declare no con- flicts of interest. Mr. Medina and Ms. Suriel are employees of the Vice presidency of the Dominican Republic, Social Protection "PROSOLI"

**Further collaborators:** Israel Rios-Castillo will submit others collaborations

144/1914

## SIMULATIONS OF THE IMPACTS OF BIOFORTIFIED CROPS ON VITAMIN A INTAKE OF YOUNG CHILDREN AND IRON INTAKE OF WOMEN OF REPRODUCTIVE AGE IN CAMEROON

(1)Luo, Hanqi; (2)Stewart, Christine; (3)Vosti, Stephen; (4)Guintang Assiene, Jules; (5)Brown, Ken; (6)Engle-Stone, Reina.

(1)PhD candidate. Program in International and Community Nutrition. University of California Davis. USA.; (2)Associate professor. Department of Nutrition. University of California Davis. USA.; (3)Adjunct Professor. Agricultural and Resource Economics. University of California Davis. USA.; (4)MS. Nutrition Deputy Program Manager. Helen Keller International. Cameroon.; (5)Senior Program Officer and Initiative Lead. Nutrition Global Development. Bill & Melinda Gates Foundation; (6)Assistant professor. Department of Nutrition. University of California Davis. USA.

**Background and objectives:** Biofortification to increase the micronutrient content of staple crops may reduce the burden of micronutrient deficiencies, but effectiveness relies on food con-
sumption patterns, which may vary spatially. Dietary intake data
can be used to estimate the potential impacts of biofortification.

**Methods:** We completed 24-hour dietary recalls among women (n = 912) and children 12 - 59 month of age (n = 883) during a national survey in Cameroon, with representative sampling for three geographic strata (North, South, and Yaoundé/Douala). We simulated the impacts of pro-vitamin A biofortified sweet potato, maize, and cassava on the adequacy of vitamin A intake of children, and the impacts of iron-biofortified rice, beans, millet, and sorghum on adequacy of iron intake of women, under optimistic assumptions of full replacement of the non-biofortified varieties. We calculated “reach” as the proportion of the population that consumed a biofortified food on the previous day, and “effective coverage” as the proportion of the population with inadequate micronutrient intake that achieves dietary adequacy following biofortification.

**Results:** The baseline prevalence of inadequate vitamin A intake among children varied by region (South: 33%; North: 71%; Yaoundé/Douala: 48%). Effective coverage was the highest for maize (~20%), which had the greatest reach in the North region, and the lowest for sweet potato (~8%), because of infrequent consumption of sweet potato. Inadequate iron intake was common among women (South: 88%; North: 63%; Yaoundé/Douala: 82%; adjusted for absorption). Millet and sorghum were only consumed in the North (~45% and ~8% reach, respectively); hence, effective coverage was only 17% and 2%, respectively, in the North and near zero elsewhere. Beans and rice were consistently consumed in all regions (~15% and ~30% reach, respectively). However, amounts consumed and estimated iron absorption were low, so the effective coverage was less than 5% for both.

**Conclusions:** Among children, maize was consumed more commonly in regions with the highest prevalence of vitamin A inadequacy, so biofortified maize may be more effective than other crops for increasing dietary adequacy. Among women, several iron-biofortified crops would increase iron intake, but the prevalence of inadequacy is likely to remain high.

**Keywords:** biofortification, dietary modeling, vitamin A, iron

**Background and objectives:** Food security exists when all people in all social and economic contexts have capacity to get enough and of high quality nutrient foods to cover their nutritional needs. There are clear evidences about the relation of food security and dietary diversity with a better nutritional status. The present study aimed to evaluate household food insecurity and dietary diversity index (HDDI) among mothers of children under two years old in Panama.

**Methods:** A cross-sectional study of 273 household was conducted in four geographically dispersed health regions (San Miguelito, Panama Centro, Cocle and Veraguas). This study was part of a national project aimed to develop Food Based Dietary Guidelines for children under two years in Panama. Household food insecurity was assessed using the Latin America and the Caribbean Food Security Scale (ELCSA) considering the previous three months, and dietary diversity index, which included twelve food groups in the last 24 hours. The statistical data description comprehend frequency and percentage, mean and standard deviation (SD), and median and interquartile range (iqr).

**Results:** Mean age and SD for mother was 27.3±7.4 years, for children was 9.1±5.7 months (51% female). Nineteen percent of households reported moderate or severe food insecurity; the median HDDI and iqr was 8 (7 – 10) points. The less-consumed food groups were fish (19%), eggs (56%), vegetables (56%), fruits (64%) and pulses (66%).

**Conclusions:** Moderate and severe food insecurity is mainly present in families with children under two years at risk of poverty and social exclusion, which remains as concern for public health and agricultural sectors in Panama; HDDI shows lowest consumption of high quality nutrients foods such as fish, vegetables and fruits. Comprehensive nutritional interventions should be put in place to fight against malnutrition, especially in early stage of life.

**Keywords:** food security, malnutrition, dietary diversity, Panama

<footnote>(1)Escala, Lisbeth; (2)Rios-Castillo, Israel; (3)Jimenez-Acosta, Santa;</footnote>

<footnote>(4)Vergara, Eira; (5)Gonzalez, Elka; (6)De Leon, Jose.</footnote>

<footnote>(1)MBA. Nutritionist. Sub Regional Office for Mesoamerica.
Food and Agriculture Organization of the United Nations (FAO). Panama; (2)MSc. Nutritionist. Regional Nutrition Officer.
Food and Agriculture Organization of the United Nations. Sub Regional Office for Mesoamerica. Panama City. Panama.; (3)MD. pediatrician. Nutrition Division. National Institute of Hygiene.
Epidemiology and Microbiology (INHEM) of Cuba. Havana.
Cuba.; (4)MPH. Nutritionist. Nutrition and Dietetic Department.
Medicine School. University of Panama. Panama City. Panama.
(5)MSc. Nutritionist. Nutrition Division. Ministry of Health.
Panama City. Panama; (6)MPH. Nutritionist. Nutrition Division
Head. Ministry of Health. Panama City. Panama.</footnote>
# EVALUATION OF A SCHOOL FEEDING PROGRAM IN A REAL SETTING

(1)Chichizola, Nuria; (2)Saravi, Agustina; (3)Moyano, Daniela; (4)Perez, Laura; (5)Arroyo, Susana; (6)Mario, Virgolini; (2)Britos, Sergio.

(1)Centro de Estudios sobre Políticas y Economía de la Alimentación. Universidad Nacional de Entre Ríos. Argentina;

(2)Centro de Estudios sobre Políticas y Economía de la Alimentación. Universidad Nacional de Buenos Aires. Argentina;

(3)Universidad Nacional de Córdoba. Argentina; (4)Universidad Nacional de Salta. Argentina; (5)Nutritionist Universidad Isalud. Argentina; (6)BSc. Ministerio de Salud. Argentina.

**Background and objectives:** School age is an opportunity to build lasting healthy habits. In Argentina, overweight and multiple deficiencies of essential nutrients, affects 34.5% and 38%, respectively.

The objective of the study was to characterize the nutritional quality of school feeding in six jurisdictions of Argentina and the contribution of the school cafeteria and kiosk in it.

**Methods:** A team of nutritionists made 24-hour food records in a sample of 1108 scholars and registered two days of food service in 61 schools and the sale in 24 school kiosks. Intake of Kcal and critical nutrients was compared to FAO/WHO 2004 requirements and WHO 2003 recommendations. Adequacy indicators, main dietary sources and quality nutritional of school feeding program were analyzed.

**Results:** The median energy intake was 1958 kcal; 31% comes from the school meals, 10% from the kiosk and 59% from home. The 97% of children exceed the recommendation of discretionary calories and 79% of added sugars; 99% of school breakfasts are high in sugars and 24% of lunches in saturated fats. Almost half of the discretionary calories and sugars are provided by school. Home diet is monotonous and the school meal reinforces this monotony. Breakfast is the more inadequate school offer; only 15% of them contain at least one portion of dairy. Home diet and breakfasts are the most responsible of the observed inadequacies.

**Conclusions:** The nutritional redesign of school feeding programs is urgently needed, prioritizing breakfast and the provision of food nutritional quality.

**Keywords:** evaluation, nutritional quality, school feeding.

# A NEW INSTRUMENT TO MONITOR GLOBAL DIET QUALITY

(1)Herforth, Anna; (2)Ballard, Terri; (3)Rzepa, Andrew; (4)Diego-Rosell, Pablo; (5)Webb, Patrick.

(1)PhD. Nutritionist. Agriculture and Food Security Center. Columbia University. USA.; (2)DrPH. Independent Consultant. Italy.; (3)JD. Gallup, Inc. UK.; (4)PhD. Gallup, Inc. Spain.; (5)PhD. Friedman School of Nutrition Science and Policy. Tufts University. USA.

**Background and objectives:** Dietary risks have been identified as the most significant contributor to the global burden of disease. However, there is no global mechanism for monitoring dietary quality in a standardized way across countries. This paper defines the need for monitoring dietary quality on a global basis, and outlines steps needed for the design and testing of a survey module suitable for global implementation.

**Methods:** A review commissioned by Gallup, Inc. was carried out to identify, characterize, compare and contrast widely-used definitions of diet quality (DQ) and dietary recommendations at global and national levels. An expert consultation was held to discuss results and identify possible mechanisms for data collection at global level, with the aim of defining what should be measured and how.

**Results:** Based on assessments of international and national dietary recommendations/food based dietary guidelines and epidemiological meta-analyses, there are several operational definitions of DQ. The technical advisory group (TAG) came to a consensus that in all contexts, a healthy diet (a) achieves sufficient nutrient adequacy and (b) reduces the risk of diet-related NCDs such as cardiovascular disease and type II diabetes. Key elements of a universal definition and set of metrics linked to these positive health outcomes across countries and regions are (a) adequate dietary diversity, (b) abundant consumption of diverse plant foods, such as fruits, vegetables, legumes, nuts, seeds and whole grains; and (c) low consumption of ultra-processed foods (UPFs), such as sugar-sweetened beverages and processed meat products. In order to operationalize the nutrient adequacy and health-protective diet components into a concise questionnaire module, the TAG recommended modifying the questionnaire for the minimum dietary diversity for women (MDD-W) to include 23 items. The TAG affirmed that Gallup World Poll (GWP), which implements a nationally representative survey in 160 countries annually, would be an appropriate mechanism for implementing a diet quality survey.

**Conclusions:** Diet quality is a critically important health and nutrition policy issue that should be measured globally. There is concordance on the key elements of diet quality that could feasibly be monitored on a regular basis, and survey modules are under preparation for piloting within the context of GWP.

**Keywords:** Diet quality, dietary assessment, diet-related non-communicable diseases (NCDs), MDD-W
NUTRIENT PROFILE, GAPS AND DIFFERENTIAL
PRICING OF PROCESSED FOODS IN ARGENTINA

(1)Borg, Ayelén; (2)Simonetti, Cecilia; (3)Oliver, Emilce; (3)Britos, Sergio.

(1)Bsc. Nutritionist. Centro de Estudios sobre Política y Economía de la Alimentación. Universidad de Buenos Aires. Argentina;

(2)Nutritionist Student. Centro de Estudio sobre Política y Economía de la Alimentación. Argentina; (3)Bsc. Nutritionist. Centro de Estudio sobre Política y Economía de la Alimentación. Universidad de Buenos Aires. Argentina.

**Background and objectives:** In a context of high prevalence of overweight and obesity the discussion about the incidence of food in the high intake of critical nutrients has gained relevance. The purpose of this study is to analyze the nutritional profile of processed food which have significant contribution in saturated fat, free sugar and sodium intake to know their quality gaps and the difference in the price between different nutritional qualities.

**Methods:** A sample of 1179 products grouped in 11 categories of foods which represent around 42% and 47% of the total intake of nutrients to limit was analyze. The nutrient content of each category was compared with a corresponding standard which was were determined according to the critical nutrient density value of the category adjusted to total calories of a healthy diet with ponderance of high nutrient density foods

It was calculated a nutritional score with the NRFI method to compare the price per kcal according to nutritional quality. The price of the products were registered from the website "Precios Claros".

**Results:** The 15% of the products of the sample have a higher content than the standard for saturated fat, 27% for free sug- ar and 29% for sodium. Processed meats, Sausages, salty cookies and dressings are the categories with the greatest inadequacy in sodium. Sodas and sweet snacks have the most inadequacy in free sugar.

The price per calories is 47% higher in products of the two quintiles with better nutritional quality in relation to the two of lower quality.

**Conclusions:** The excesses in the consumption of critical nu- trients are concentrated in eight categories of products. Never- theless there are a lot of processed products which their content in critical nutrition does not have an incidences in the excesses intake. It is necessary to design an appropriate nutrient profile sys- tem at the local level.

**Keywords:** Nutritional profiles; Critical nutrients; Nutritional quality; Price of food; Processed food.

CHARACTERIZATION OF STREET FOOD CON-
SUMPTION AND HYGIENIC-SANITARY PERCEP-
TION OF STREET FOOD STALLS IN PARAGUAY

(1)Gonzalez Cespedes, Laura Elizabeth; (2)Fretes Centurión, Gabriela;

(3)Raimondo, Emilia; (4)Alonso Torres, Jairo; (5)Durán Aguero, Samuel;

(6)Arboleda, Luz Marina; (7)Cordón, Karla; (8)Gonzalez, Elka; (9)Lima, João; (10)Agazzi, Beatriz.

(1)Departamento de Investigación en Nutrición. Facultad de Ciencias Químicas. Universidad Nacional de Asuncion. Paraguay;

(2)Unidad de Prevención de la Obesidad. Dirección de Vigilancia de Enfermedades No Transmisibles. Ministerio de Salud Pública y Bienestar Social. Paraguay; (3)Facultad de Ciencias de la Nutrición. Universidad Juan Agustín Maza. Argentina.; (4)Universidad autónoma de Chile. Facultad de Ciencias de la Salud.

Universidad San Sebastián. Chile; (5)Facultad de Ciencias de la Salud. Universidad San Sebastián. Chile; (6)Escuela de Nutrición y Dietética. Universidad de Antioquia. Colombia; (7)Facultad de Ciencias Químicas y Farmacia. Universidad de San Carlos de Guatemala; (8)Departamento de Salud Nutricional. Ministerio de Salud de Panamá; (9)Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. Portugal; (10)Asociación de Nutricionistas y Dietistas del Uruguay.

**Background and objectives:** The sale of food on the street is a common practice around the world. The nutritional quality of food and hygienic-sanitary conditions of street food stalls varies between countries, and may have implications for certain health-related events. The objective of this study was to characterize the consumption of street food and the perception of the hygienic-sanitary conditions of the street food stalls in Paraguay.

**Methods:** As part of a multicenter study conducted in 11 Iber-oamerican countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Panama, Paraguay, Peru, Uruguay and Portugal), we applied a structured online survey with 12 questions related to sociodemographic characteristics, the street food consumption frequency, perception of hygiene of the street food stalls and epi-sodes of vomiting or diarrhea following after the consumption of these foods.

**Results:** 525 people were surveyed, 51.8% (n = 272) reported consumption od street food in the last 3 months. We found that 79% were women, 61,8% were between 18 and 30 years old, 49,3% had university studies and 36,8% were postgraduates, also 66.5% worked or studied in the health or food area. During the last 3 months 33.8% consumed some type of food on the street every week. The most frequently consumed foods were: chipa (cassa- va flour bread) (40.6%), meat patties (40%), brochets (36.8%), sandwich (36.7%) and fruits (40%). The availability of these foods (38.6%), lack of time to prepare meals (25%) and the fact that they are tasty foods (23.5%) are the main reasons for consump- tion. Only 11.4% of people had the perception that the food street stalls were clean or hygienic and 14.7% reported having diarrhea or vomiting after consuming some food at these stalls.

**Conclusions:** Despite the high educational level of the popula-
tion surveyed and the perception of poor hygienic-sanitary condi-
tions in the street food stalls, the consumption of unhealthy food on public places is highly frequent. Given that availability is a key conditioning factor of consumption, promotion of fruit consumption could be a valid strategy.

**Keywords:** Street food. Consumption. Public Health Policies. Hygienic-sanitary conditions

**Further collaborators:**

María Nessier. Universidad Católica de Santa Fe. Argentina. Débora Cabanes. APAN. Associação Paulista de Nutrição. Brasíl. Marli Brasioli. APAN. Associação Paulista de Nutrição. Brasíl. Ángela Velásquez. Facultad Ciencias de la Salud. Universidad Católica de Oriente. Colombia. John Velásquez. Escuela de Nutrición y Dietética. Universidad de Antioquia. Colombia. Juan González. Facultad de Ciencias de la Salud. Universidad Católica de Oriente. Rionegro. Antioquia. Colombia. Sonia Ivankovich. Colegio de Profesionales en Nutrición. Costa Rica. Saby Mauricio. Facultad de Ciencias de la Salud. Universidad Privada del Norte. Perú. Johanna Léon. Fresko. Perú. Ada Rocha. Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. Alfonso Ortiz. Asociación de Nutricionistas y Dietistas del Uruguay. Uruguay

144/1945

PHYSICAL ACTIVITY, NUTRITIONAL STATUS
AND METABOLIC SYNDROME IN ADULTS

(1)Pistoni, Martha Pistoni; (2)Cappelen, Liliana Cristina; (2)Gomez Augier, Virginia.

(1)Msc Nutritionist. National Center for Nutrition Research. Salta. Argentina; (2)Nutritionist. National Center of Nutrition Research. Salta. Argentina.

**Background and objectives:** Physical inactivity is the fourth most important risk factor for mortality in the world according to the World Health Organization and its prevalence is increasing in many countries, which has a significant influence on the increase of chronic nontransferable diseases and on health of the world's population. The objective of this study was to estimate levels of physical activity and its association with metabolic syndrome and nutritional status in the adult population.

**Methods:** Cross-sectional study, descriptive of a representative sample of households in the capital of the province of Salta, Argentina. The short version of the International Physical Activity Questionnaire (IPAQ) was used as a valid measure to estimate the categories of physical activity. Nutritional status was assessed through Body Mass Index and Metabolic Syndrome classification was performed according to ATP-III. Excel, WHO software Antro v.1.0.4 Plus, EPI 7 programs were used.

**Results:** The sample was 175 people. The mean age of the studied population was 44.4 ± 13.6 years. 21.1% of adults had metabolic syndrome. Regarding the categories of physical activity: 27.4% were low, 40.6% moderate and 32% intense. In the evaluation of nutritional status, only 23.4% of the population were anthropometrically normal, 4.6% presented underweight, 29.7% were

overweight and 42.3% were obese. This high prevalence of altered nutritional status allows us to assume that the intensity of physical activity declared is only of the last time, so no association was observed between levels of physical activity, nutritional status and metabolic syndrome.

**Conclusions:** In the linear correlation there is no statistically significant finding, among the levels of self-reported physical activity, with anthropometric and biochemical variables.

**Keywords:** Physical activity. Metabolic Syndrome. Nutritional status

144/1950

A GLOBAL OVERVIEW OF FOOD-BASED DIE-
TARY GUIDELINES

(1)Herforth, Anna; (2)Arimond, Mary; (3)Coates, Jennifer; (4)Álvarez, Cristina; (5)Christianson, Karin; (6)Muehlhoff, Ellen.

(1)PhD. Nutritionist. Agriculture and Food Security Center.
Columbia University. USA.; (2)MSc. Nutritionist. UC Davis. USA.;

(3)PhD. Associate Professor. Friedman School of Nutrition Science and Policy. Tufts University. USA; (4)MSc. Nutritionist. FAO. Italy.;

(5)MSc. Friedman School of Nutrition Science and Policy. Tufts University. USA; (6)PhD. Nutritionist. FAO. Italy.

**Background and objectives:** Food-based dietary guidelines (FBDG) are an attempt to translate the evidence base regarding relationships between foods, diet patterns, and health into specific and culturally appropriate recommendations. This objective of this study is to assess similarities in FBDG across countries in order to identify whether there are commonalities that could serve as the basis for global dietary guidelines.

**Methods:** Recently, FAO completed a major update of their online repository of FBDG and associated resources. All FBDG available in this repository as of 2016 were reviewed. Organization of messages into themes involved an iterative and primarily inductive process. Key messages were organized by major food group/ type, and analyzed for their relationship to existing WHO dietary recommendations. The main graphics were organized into a typology, globally and by region.

**Results:** FBDG were available for 82 countries (Africa: 5; Asia and the Pacific: 15; Near East: 3; Europe: 32; Latin America and the Caribbean: 25; North America: 2). Graphics showed that most countries divide foods into 3-5 food groups (starchy staples; fruits, vegetables; dairy, and other "protein foods"). Few countries specified recommended amounts or types of "protein foods." Messages about fats were mixed, some countries advocating less fat consumption in general, and others specifying healthy vs. unhealthy fats. The single most common type of message (95% of countries in key messages; 100% of countries in graphic images) was encouragement of consumption of fruits and vegetables. A majority of countries also had messages on limiting salt (70%), various fats/fatty foods (63%), and sugars (51%).

**Conclusions:** While countries vary in their groupings of foods and the specific foods included in food groups, there is widespread
concordance on encouraging consumption of fruits and vegetables, and limiting foods high in salt, sugar, and certain fats. Multiple ways are recommended across countries to meet protein needs in accordance with food culture. These points are aligned with existing WHO global guidance (including the lack of guidance about optimal ways to achieve protein intake), as well as other epidemiological evidence about diet patterns that reduce risk of diet-related diseases. This review underscores international agreement about some universal components of a healthy diet.

**Keywords:** food-based dietary guidelines (FBDG), global dietary guidelines, diet quality, dietary recommendations

**Background and objectives:** Introduction: Obesity is a multifactorial disorder. According to the survey of cardiovascular risk factors in 2011, the percentage of physical inactivity in the population is 74.5%. There are no previous studies in Paraguay about the pattern of consumption of these beverages in children.

**Objective:** To estimate the prevalence of overweight obesity and physical inactivity and to evaluate the pattern of consumption of energetic beverages in children and adolescents from Asuncion, Central and Caaguazú in 2015.

**Methods:** We used a probabilistic cohort stratified by age (7-19 years) and by conglomerates (schools in Asunción, Central and Caaguazú). Size sample: 2.300 subjects. A 24 hours reminder used for repeat samples. Cluster (schools). INTA Questionnaire was applied for measuring physical activity. Overweight and obesity was calculated with BMI Z score (WHO). Analysis by ANOVA and T Test. Significance: p< 0,05.

**Results:** Entered the study 2300 children and adolescents, average age was 11 years (2,89 years SD). The prevalence of overweight was 26.81% and obesity was 18.60% in Asuncion, Central and Caaguazú. The 50% of the study population said to spend 60 min daily sitting in front of the TV, with a rank from 0 to 120 minutes, 50% performed physical activities. The pattern of beverages consumption was: Volume. Median 1950 ml (RQI 1450-2600): Water 766 ml (RQI 491-1191); Milk and derivatives: 362 (RQI 255-471), Infusions 200 (RQI 141-450), Natural juices: 425 (RQI 300-600), Artificial juices 300 (RQI 200-500), Nectar 200 (RQI 200-350), Carbonate beverages 416 (RQI 300-616). %

**Conclusions:** The prevalence of malnutrition by excess is high. Half the population stated to performed physical activities outdoors for 30 minutes per day. The consumption pattern of these beverages

in children and adolescents is characterized by a less consumption of dairy products and more consumption of sugared beverages.

**Keywords:** obesity, physical activity, fluids intake, children

**Background and objectives:** Worldwide, rates of non-communicable diseases (NCDs) are on the rise. Dietary risk factors increasingly contribute to this surging global burden. This is also more and more the case in low- and middle-income countries, including South Africa. Since unhealthy diets are predominantly driven by unhealthy food environments, comprehensive actions by governments are crucial. Although a detailed plan currently exists for achieving specific NCD-related targets in South Africa, this has yet to be translated into concrete actions and/or policies.

The aim of this study is to benchmark public sector policies impacting food environments in South Africa by assessing government policies on food environments against achievable, well-defined benchmarks.

**Methods:** 1. Collection of relevant policy documents and policy scan to gather evidence

2. Validation of evidence document with government officials

3. Expert rating workshops: rating the extent of government policy implementation, identify gaps in these policies, and proposing concrete actions

4. Prioritization of proposed policy actions by experts

5. Feedback of results to experts, government officials, and the public

**Results:** An evidence report that was validated by a low number of government officials was generated. Workshops with experts were convened during which the evidence was rated and actionable steps identified. Ratings were generally low, with the lowest ratings being given to policies in the areas of 'food trade & investment' (1.00/5) and 'food retail' (1.03/5). Gaps in these areas included the absence of regulation of trade and investment in unhealthy foods, and the lack of consideration of informal vendors, respectively; with proposed actionable steps including policies to support investment in healthier food options, and the relaxation of zoning restrictions and provision of subsidies for the provision of healthy foods for informal vendors. The highest ratings were given in the areas of 'leadership' (2.71/5), 'food consumption' (2.26/5), and 'governance' (2.11/5).

<footnote>(1)Sanabria, Marta; (2)Aguilar, Gloria; (2)Estigarribia, Gladys;</footnote>

<footnote>(2)Sanabria, Gabriela; (2)Muñoz, Sergio; (2)Kawabata, Anibal;</footnote>

<footnote>(3)Feferbaum, Rubens; (2)Rolon, Rolando; (2)Rios, Patricia.</footnote>

<footnote>(1)MsD; (2)National University of Caaguazu. Paraguay; (3)University of Sao Pablo. Brazil.</footnote>

<footnote>(1)Spires, Mark; (2)Sanders, David; (3)Swart, Elizabeth Catherina.</footnote>

<footnote>(1)MPH. Researcher. School of Public Health, University of the Western Cape. South Africa; (2)MBChB. Emeritus Professor. School of Public Health. University of the Western Cape. South Africa.; (3)PhD. Professor. Department of Nutrition and Dietetics. University of the Western Cape. South Africa.</footnote>