# WHICH DIETARY CHANGES TO MOVE TOWARDS NUTRITIONALLY ADEQUATE DIETS WITHOUT INCREASING THEIR IMPACT ON BIODIVERSITY, WATER AND LAND-USE? THE CASE OF TUNISIA

(1)Perignon, Marlène; (2)El Ati, Jalila; (3)Sinfort, Carole; (4)Drogue, Sophie; (5)Darmon, Nicole; (6)Amiot-Carlin, Marie Josephpe; (7)Group, MEDINA-Study.

(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. Environmental Physician. Unité Mixte de Recherche Information, Technologies, Analyse environnementale, Procédés agricoles (UMR ITAP). Montpellier SupAgro. France; (4)PhD. Economist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (5)INRA.

**Background and objectives:** As several Mediterranean countries, Tunisia has experienced an epidemiological and nutritional transition resulting in an increase in overweight, obesity and co-morbidities. In the last decades, food consumption departed from traditional diets towards higher consumption of animal-based and sweet products. Tunisia also faces environmental issues such as water scarcity, soil erosion and biodiversity loss. This growing concern for health issues and climate change has emphasized the need to promote sustainable diets, i.e. nutritionally adequate, affordable, culturally acceptable, and with low environmental impact. The objective was to identify dietary changes needed to move towards nutritionally adequate diets without increasing their environmental impact.

**Methods:** Nutrient intakes were estimated using dietary data from the nationally representative Tunisian study on food consumption (n=7209, 35-70y), and food composition from a Tunisian database and the Food Processor software. Environmental impact of diets was assessed through 6 indicators - water scarcity, biodiversity, and 4 indicators for land-use (erosion resistance, mechanical filtration, groundwater replenishment, biotic production) - estimated for 161 foods. For each gender, two optimized diets respecting all nutritional recommendations from WHO and with minimized departure from the mean observed diet were designed with linear programming under 2 scenarios to fulfill: i) all nutritional constraints (NUTRI) and ii) all nutritional constraints without exceeding observed levels for the 6 environmental indicators (NUTRIENV).

**Results:** Calcium, copper, iron (for women), magnesium and potassium intakes were below their recommendations in the mean observed diets, while sodium and fats exceeded them. Under the NUTRI scenario, i.e. reaching nutritional adequacy without controlling for the environmental impacts, the main dietary changes were the increases of vegetables, starchy foods, fish and dairy products, and decreases of fats and sweet products. All the environmental indicators were impaired, except erosion resistance and biotic

production. Under the NUTRIENV scenario, i.e. when environmental indicators were limited to their observed levels, changes in dairy and starchy products quantities were lower than in the NUTRI scenario. In addition, fruits increased and meat decreased.

**Conclusions:** Environmental impacts should be assessed when identifying food consumption changes to reach nutritional adequacy. Dietary changes identified to move towards more sustainable diets in Tunisia will be translated into action proposals.

**Keywords:** Sustainable diet; Nutritional adequacy; Environmental impact; Tunisia; Diet modeling

**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 Ghraibi (INAT), F Jacquet (INRA), Y Kameli (IRD), F Kefi (CIHEAM), E Kesse-Guyot (INRA), D Lairon (INSERM), Y Martin-Prevel (IRD), C Méjean (INRA), C Mouquet (IRD), S Njoumi (INAT), M Padilla (CIHEAM), M Perignon (INRA), C Sinfort (SupAgro), P Traissac (IRD), E Verger (IRD).

# ANALYSIS OF THE USAGE AND CHARACTERISTICS OF DIETARY SUPPLEMENT CONSUMERS OF URBAN COSTA RICAN POPULATION

(1)Guerrero Calderon, Fabiola; (2)Pacheco Arteaga, Maria Amalia;

(3)Gómez Salas, Georgina.

(1)Bch. Nutritionist. School of Nutrition. University of Costa Rica. Costa Rica; (2)Bch. Nutritionist. School of Nutrition. University of Costa Rica. Costa Rica; (3)MSc. Nutritionist. Department of Biochemistry. School of Medicine. University of Costa Rica. Costa Rica.

**Background and objectives:** Previous studies reveal that dietary supplement (DS) consumption has increased in the Western world in all ages groups and is influenced by gender, age, educational level, socioeconomic status and other factors. In Costa Rica there is no information regarding DS use in the general population. The present study was focused on assessing the prevalence of use and determining the socio-demographic, anthropometric and nutritional characteristics of urban Costa Rican DS consumers, and to explore the reasons for their consumption.

**Methods:** Data were obtained from Latin American Nutrition and Health Study (ELANS), a cross-sectional study including a representative sample of urban population from eight LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela). In Costa Rica 798 participants were asked about DS use, and six months after the first contact a second questionnaire was applied by telephone to subjects who had previously reported DS use, in order to delve on the characteristics and perceptions involved in DS consumption. Chi-square test was used to compare observed and expected frequencies
**Results:** Approximately 6% (n=48) of the population surveyed reported the use of DS, mainly in the form of multivitamins. No significant differences for sex, age, socioeconomic status (SES), educational level and body mass index (BMI) were found for DS intake. DS consumers reflected significantly higher intakes of dietary calcium in both sexes, and dietary vitamins C and vitamin E in women, compared to nonusers. Reasons for consumption of DS focused on health benefits, prevention of illness, improved immunity, and energy boost. Although perceived as beneficial for 58% of the cases, the use was discontinued after six months.

**Conclusions:** The prevalence of DS usage was lower than reported by other studies in the field. A pattern similar to that described in the literature (BMI <25 kg/m2, physically active, healthy lifestyles and favorable socio-demographic backgrounds) was not found in this study.

**Keywords:** dietary supplements; consumers; perceptions, Costa Rica

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

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

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## SELF-REPORTED ADVERSE EVENTS DURING LONG-TERM VITAMIN D SUPPLEMENTATION: DATA FROM A RANDOMIZED CONTROLLED TRIAL (VITAMIN D ASSESSMENT STUDY)

(1)Malihi, Zarintaj; (2)Lawes, Carlene M.M; (3)Waayer, Debbie; (4)Toop, Les; (5)Khaw, Kay-Tee; (6)Camargo Jr., Carlos A.; (7)Scragg, Robert.

(1)Msc. PhD student. Department of Epidemiology and Biostatistics. School of Population Health. Faculty of Medical and Health Sciences. University of Auckland. New Zealand;

(2)MBChB. PhD.School of Population Health.The University of Auckland. Auckland. New Zealand; (3)MEd. School of Population Health.The University of Auckland. Auckland. New Zealand;

(4)MBChB. MD.Department of Public Health & General Practice. The University of Otago. Christchurch. New Zealand; (5)MBBChir. MSc.Department of Public Health. University of Cambridge. Cambridge. England; (6)MD.DrPH. Department of Emergency Medicine. Massachusetts General Hospital. Harvard Medical School. Boston. USA; (7)MBBS.PhD. School of Population Health. The University of Auckland. Auckland. New Zealand.

**Background and objectives:** Many randomized controlled trials (RCTs) are examining the health effects of long-term vitamin D supplementation. To date, there are limited data on long-term

adverse events (AEs); recently published RCTs briefly reported on AEs, without undertaking a detailed assessment. Many earlier studies of vitamin D supplementation had small sample sizes and/or short follow-up periods. The main purpose of this study was to assess self-reported non-serious AEs during long-term monthly 100,000 IU vitamin D3 supplementation in 2558 participants in the vitamin D arm, compared to 2550 participants in the placebo arm.

**Methods:** We analysed data from the vitamin D assessment study (ViDA) trial's monthly-to-4-monthly questionnaire over four years of follow-up to assess the incidence rate of the first reported AE, and first event in each category of the AE, including pain, respiratory illnesses and infection, gastrointestinal problems, tiredness, dizziness, skin-related symptoms and complications related to other health conditions. SAS package 9.4 was used for data analysis.

**Results:** There was no significant difference between the treatment arms for the first reported AE. 358 (14.0%) participants from vitamin D arm versus 337 (13.2%) participants from the placebo arm said they had AEs after taking the assigned capsule. Including repeated events by the same individuals, there were a total of 1153 AEs (627 and 526 in the vitamin D and placebo arms, respectively). However, only 559 participants (288 in the vitamin D and 271 in the placebo arm) explained the type of event. The incidence rate of any first event in participants of vitamin D arm was 5.1 versus 4.9 in the placebo arm with an attributable risk of 0.23 (P=0.56). Further regression analysis showed that being from minority ethnic groups (Māori, Pacific, South Asian; p<0.0001), a non-drinker or monthly drinker (p=0.011), or being a non- or ex-smoker (0.004) were associated with more AE reporting.

**Conclusions:** Monthly supplementation of 100,000 IU vitamin D3 did not increase participants' self-reported AEs in the ViDA study.

**Keywords:** Vitamin D3, supplementation, RCTs, adverse-events

**Conflict of Interest Disclosure:** The main study (ViDA) was supported with a New Zealand Health Research Grant (10/400) and by the accident corporation compensation of New Zealand (R.S., C.A.C., A.W.S., L.T., C.M.M.L., K,-T.K.) Funders had no role in the design, conduct, and analysis, interpretation of data or the preparation of this abstract. ZM is funded by a University of Auckland doctoral scholarship.
# THE IMPORTANCE OF THE EVALUATION OF COMPETENCES OF A COOK OF A FOOD AND NUTRITION UNIT OF A CANCER HOSPITAL

(1)Sandoval, Ana Paula; (2)Cardenas, Thais de Campos; (3)Araujo do Nascimento, Ivanice; (4)Toscano Ferreira, Rosana.

(1)Nutrition'Student. Nutrition of Department. São Camilo University Center. São Paulo. Brazil.; (2)MSc. Nutritionist. Nutrition of Department. Brazilian Cancer Control Institute - IBCC. São Paulo. Brazil.; (3)Nutritionist. Nutrition of Department. Brazilian Cancer Control Institute - IBCC. São Paulo. Brazil.; (4)MSc. Nutritionist. Nutrition of Department. São Camilo University Center. São Paulo. Brazil.

**Background and objectives:** The hospital is an organization specialized in prevention, recovery and maintenance of the health of the community. Understanding hospital activity as a business and balancing with its mission requires business management. The food service indirectly constructs and maintains the positive or negative image of the hospital, becoming the indicator of the service provided. Given this, food workers are required not only to prepare quality meals, but to develop their cognitive potential and the fundamental role of communication, participation and leadership in order to achieve the proposed objectives, increase productivity, minimize Efforts and costs. It is fundamental that the cook for the exercise of his activities present competences according to the requirements of the position. To evaluate the competences of the cook within a Food and Nutrition Unit of a cancer hospital.

**Methods:** This is a cross-sectional observational descriptive study with primary data collection. It was performed in March 2017 in a hospital UAN, administered by self-management located in the eastern region of the city of São Paulo. The study was carried out with a collaborator, the cook, who was responsible for the meals of the patients, and the data collection took place during three days from the observation of the daily routine by means of a check list elaborated on the basis of the literature and the internal rules of the hospital Containing 26 competencies required for that position. An unstructured interview was conducted in order to contribute to the data collection.

**Results:** The cook presented a 70% adequacy, being a responsible and attentive professional with the team and the patients, but was verified 30% of inadequacy, mainly in relation to the leadership, demonstrating difficulty in conducting the team in an efficient and satisfactory way.

**Conclusions:** The employee does not present all the competencies required for the position, mainly in relation to the leadership in relation to the team, being necessary to implement training program in order to promote the development and potentialization of its leadership spirit, contributing to personal and professional growth And therefore improvement in interpersonal relationships, with positive results for the UAN hospital and for the patients attended.

**Keywords:** Competencies. UAN Hospitalar. Cook.

# AN EXPLORATION OF CHINESE CONSUMERS' UNDERSTANDING OF EARLY AGE NUTRITION

(1)Conroy, Denise; (2)Smith, Sandy.

(1)PhD. Marketing. Consumer Behaviourist. University of Auckland Business School. New Zealand; (2)PhD. Marrketing. University of Auckland. New Zealand.

**Background and objectives:** China is potentially a large export market for New Zealand, particularly for milk products, yet little is understood about the Chinese consumer's understanding of nutrition. Most insight to date has been gained by taking a product focused perspective, but such research has yielded many failures and few successes for New Zealand companies trying to gain traction in the Chinese market. Consequently, this research has a different aim. It focuses on exploring the consumers' understanding, knowledge, attitudes, emotions and cognitive reactions regarding a general category, and the nutritional benefits sought from this category, rather than a specific product. Importantly, the research also includes an exploration of the environment, culture and political scape in which consumer understanding is derived and purchase decisions are made. The category for this project is supplementary infant and toddler foods. By supplementary foods we mean foods which are fed to a child either to support breast milk or instead of breast milk, weaning foods, and foods given to a child in addition to regular, shared family foods.

**Methods:** 14 in-home interviews were conducted in Shanghai, China. Participants were parents of infants between 2 months and 12 months of age. The interviews were conducted in Mandarin and an instantaneous translator was present to translate. 4 focus groups were also undertaken with mothers of toddlers ranging from 2 years to 5 years. A thematic analysis was undertaken utilising NVivo and a complimentary corpus analysis was also conducted.

**Results:** Emergent themes revealed a serious lack of basic understanding of nutrition, together with enormous trust in overseas milk powders and weaning food, and a total lack of trust in any Chinese products.

**Conclusions:** Policy makers in China have significant work to do to engage the trust of citizens and protect their dairy industry.

For NZ exporters insight into trust of foreign brands and the need for simple, clear labeling will be of benefit, together with insight into promotion

**Keywords:** Chinese consumers, early age nutrition

**Further collaborators:**

Funded by NZ Government project High Value Nutrition
# STRUCTURE AND NUTRITIONAL QUALITY OF FRENCH ADULT DIETS ACCORDING TO THEIR GREENHOUSE GAS EMISSIONS - FINDINGS FROM THE BIONUTRINET PROJECT

(1)Seconda, Louise; (2)Baudry, Julia; (3)Allès, Benjamin; (4)Galan, Pilar;

(5)Hercberg, Serge; (6)Langevin, Brigitte; (7)Lairon, Denis; (8)Poitereau, Philippe; (2)Kesse-Guyot, Emmanuelle.

(1)MSc. Epidemiologist. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France
ADEME Angers. France; (2)PhD. Epidemiologist. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France; (3)Equipe de Recherche en Epidémiologie Nutritionnelle. Centre de Recherche en Epidémiologie et Statistiques. Inserm (U1153). Inra (U1125). Cnam. Université Paris 13. COMUE Sorbonne Paris Cité. Bobigny. France.; (4)PhD. MD. Assistant director. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France;

(5)Pr. Director. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France Département de Santé Publique. Hôpital Avicenne. Bobigny. France;

(6)PhD. Environmental scientist. Solagro. Toulouse. France;

(7)PhD. Epidemiologist. NORT (Nutrition Obésité et Risque Thrombotique). Aix Marseille Université. INRA. INSERM 13005. Marseille. France; (8)MSc. Environmental scientist. Solagro. Toulouse. France.

**Background and objectives:** Substantial climate change mitigation will not happen without a drastic reduction of greenhouse gas emissions (GHGEs). This involves important shifts in dietary patterns by a large proportion of the world's population.

The aim of this observational study was to compare and characterize diets with various levels of GHGEs from participants of the French NutriNet-Santé study.

**Methods:** Food consumption of 34,193 French adults included in the NutriNet-Santé cohort was assessed using an organic food frequency questionnaire. Dietary GHGEs (expressed in kg-CO2eq/year) of participants were computed, taking into account farming practices (organic or conventional production). Adjusted means of contribution of food groups to the diet (in percentage), percentage of organic food as well as compliance with the nutritional guidelines (reflected by the modified Programme National Nutrition Santé Guidelines Score, mPNNNSGS) were compared between weighted quintiles of GHGEs, using ANCOVA models.

**Results:** Dietary GHGEs ranged from 677 kgCO2eq/year (Q1) to 2954 kgCO2eq/year (Q5), after adjustment for sex, age and energy intake. Contribution of meat to the diet increased along GHGEs (ranging from 2.6% (Q1) to 11.5% (Q5)) while an inverse trend was observed for fruit and vegetables. Concerning dairy products, the lowest contribution was found in the most climate-friendly diet (Q1).

After adjustment for age and sex, daily energy intake significantly increased along GHGEs (Q1: 1580 kcal/d (95%CI=1569-1592) versus Q5: 2647 kcal/d (95%CI=2633-2662), (p-trend<0.0001)). Percentage of organic food in the diet decreased along with GHGEs

(from Q1: 43.4% (95%CI=42.8-44.0) to Q5: 15.4% (95%CI=14.6-16.2)), as well as the adherence to the nutritional recommendations (mPNNSGS ranged from 8.34/13.5 (95%CI=8.30-8.38) in Q1 versus 7.95/13.5 (95%CI=7.90-7.80) in Q5).

**Conclusions:** Based on observational data, our study provides new arguments concerning the potential of actual healthy and alternative diets, with low environmental impact. Participants with low GHGEs diets have the highest contribution of fruit and vegetables, and the lowest contribution of animal's origin products. Their diets are more organic, provide fewer calories, and their compliance with French guidelines are better.

Our results highlight the importance of promoting holistic changes in dietary patterns to meet future environmental challenges, including the mitigation of global warming.

**Keywords:** Climate change, Dietary pattern, greenhouse gas emissions

# COMBINED HEALTHY LIFESTYLES AND RISK OF DEPRESSIVE SYMPTOMS IN THE NUTRI-NET-SANTÉ COHORT

(1)Adjibade, Moufidath; (2)Assmann, Karen E.; (2)Andreeva, Valentina.;

(3)Galan, Pilar; (4)Hercberg, Serge; (2)Baudry, Julia; (2)Kesse-Guyot, Emmanuelle.

(1)MSc. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.; (2)PhD. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.; (3)Md Phd. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.; (4)Prof Md Phd. Lab director. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.

**Background and objectives:** It is known that several modifiable lifestyle indicators, including diet quality, smoking status, alcohol consumption, weight and physical activity are independently associated with depression; however, their combined effects on depression risk is less studied. This study aimed to develop a Healthy Lifestyle Index (HLI) score composed of all of the above indicators and to investigate their association with the risk of incident depressive symptoms in a large French cohort.

**Methods:** The study sample consisted of 25,837 middle aged participants from the NutriNet-Santé study, initially free of depressive symptoms. The HLI was computed by assigning 1 point for each healthy behavior related to diet quality (measured by the modified French Programme National Nutrition Santé-Guideline
Score), smoking status, alcohol consumption, body mass index and physical activity. Incident cases of depressive symptoms were defined by a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥17 for men and ≥23 for women at least once during the follow-up. Hazard Ratios (HR) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards models and population attributable risk (PAR) was calculated for each individual lifestyle indicator.

**Results:** A total of 2,112 first cases of incident depressive symptoms were identified over a mean follow-up of 6 years. In the adjusted models, compared with participants with a low score (0-2 healthy behaviors), participants with high and medium scores (4-5 and 3 healthy behaviors respectively) had a significantly lower risk of incident depressive symptoms (HR=0.75; 95% CI: 0.67-0.83) and (HR=0.84; 95% CI: 0.75-0.94) respectively, P-trend<0.0001. The estimated PAR representing the proportion of depressive symptoms cases in the population that are attributable to non-adherence to specific healthy lifestyle indicators were 8%, 5% and 5% for healthy diet, healthy weight and non-smoking respectively. The PAR was not estimated for physical activity and limited alcohol consumption because the estimated HR for these individual indicators was not statistically significant in multivariable models.

**Conclusions:** In this study, the combined healthy lifestyle behaviors were associated with a lower risk of incident depressive symptoms, indicating that modifying unhealthy lifestyles is of major interest in a context of prevention of depressive symptoms.

**Keywords:** Depressive symptoms; Lifestyle indicators; Population attributable risk

child nutrition through food production, and nutrition, health and hygiene behavior change communication (NHH-BCC). In Tanzania, HKI also used the EHFP platform to promote utilization of multiple micronutrient powders (MNP) for young children.

We assessed the effectiveness of HKI's EHFP platform for increasing MNP knowledge and utilization and reducing anemia compared to a non-EHFP beneficiary group that received MNP at home.

**Methods:** We used a cluster-randomized, longitudinal design. We randomly allocated 30 wards to EHFP or the comparison group (n=~1,150 children aged 6-12 months at baseline/group), and followed-up after 3, 12, and 18-months. At baseline and 12-months, both groups received a 2-month supply of MNP at home with MNP-relevant BCC. Village-level MNP sensitization was conducted before the 12-month delivery. In addition, the EHFP group received agricultural training and inputs, NHH-BCC and monthly MNP-specific interpersonal counselling (MNP-IPC) between 12- and 18-months. We assessed program exposure and impacts on maternal knowledge of MNP benefits, MNP utilization, and child anemia. We used intent-to-treat, cluster-adjusted OLS regression and linear mixed models to identify differences between time points (p-change<0.05) and study groups (p-group<0.05).

**Results:** MNP-IPC was higher (by design) in the EHFP compared to the comparison group (64% versus 5%, p-group<0.001); attendance at the MNP community sensitization was also higher (64% versus 29%, p-group<0.001). Between 3- and 18-months, knowledge of MNP benefits increased more in the EHFP group (+16pp versus +6pp, p-group=0.006); however, adequate MNP preparation increased in both groups (+20-21pp/group, p-change<0.001) and daily MNP consumption remained high in both groups (+8-11pp/group, p-change>0.05), with no group-wise differences. Similarly, anemia decreased between baseline and 3-months (-9-10pp/group, p-change<0.001) and between 12- and 18-months (-8pp/group, p-change<0.02) in both groups, with no differential decline between groups.

**Conclusions:** Promotion of MNP through EHFP increased exposure to MNP sensitization and MNP knowledge, but not utilization or effectiveness. However, given the effectiveness of EHFP in mobilizing communities for MNP sensitization events, community intervention platforms such as these may be a more viable delivery channel for distribution and promotion of MNP and other nutrition-specific interventions than possibly more costly and logistically challenging individual approaches.

**Keywords:** Community intervention platform; Anemia; Delivery; Micronutrient powder; Promotion

**Further collaborators:** This study was funded by Global Affairs Canada

<footnote>(1)Becquey, Elodie; (2)Olney, Deanna; (3)Golan, Jenna; (4)Praygod, George; (5)Veryser, Stephen; (6)Smith, Erin; (7)Kitilya, Brenda; (8)Kidola, Jeremiah; (2)Ruel, Marie; (1)Rawat, Rahul.</footnote>

<footnote>(1)PhD. Poverty, Health and Nutrition Division. International Food Policy Research Institute. Senegal.; (2)PhD. Poverty, Health and Nutrition Division. International Food Policy Research Institute. United States.; (3)MSc, MPH. Poverty, Health and Nutrition Division. International Food Policy Research Institute. United States.; (4)MD, PhD. Clinical Research Programme. National Institute for Medical Research-Mwanza. Tanzania.; (5)MSc. Helen Keller International. Tanzania.; (6)MPH. Helen Keller International. Tanzania.; (7)MPH. Clinical Research Programme. National Institute for Medical Research-Mwanza. Tanzania.</footnote>
COMPARISON OF TWO PREGNANCY NUTRITIONAL EVALUATION STANDARDS IN ADOLESCENT CHILEAN PREGNANT WOMEN

**Background and objectives:** There are no curves to assess nutritional status and weight gain during pregnancy for adolescent women. We aimed to compare the diagnostic ability of the so-called Rosso-Mardones (RM) and Atalah et al (AEA) curves to detect newborns at risk in pregnant adolescents.

**Methods:** A sample of 5554 adolescent pregnant women was selected. The mothers had their deliveries at the Sótero del Río Hospital in Santiago, Chile, between 2001 and 2004. They were nutritionally classified with both evaluation patterns at the beginning of gestation. The distribution of newborns at risk for each maternal nutritional status according to both curves was calculated for the following categories: birth weight < 3000 g, birth weight > 4250 g, and birth length < 50 cm. Sensitivity and specificity values of the RM and AEA charts were calculated to determine newborns at risk in both obese and underweight women.

**Results:** A higher proportion of obese and underweight women were diagnosed with the RM curve. Proportions of at risk newborns were similar for each maternal nutritional category according to both curves. However, absolute numbers for those live births were much higher in women classified by RM. This led to a greater sensitivity of the RM curve.

**Conclusions:** The higher RM sensitivity could support its use to improve preventive actions for pregnant women younger than 20 years of age.

**Keywords:** birth weight and length, body mass index, adolescent pregnancy.

**Further collaborators:** Health personnel from the public services

THE EFFECT OF GENDER ON NUTRITION FACTS LABEL USAGE OF CERTAIN FOOD PRODUCTS

**Background and objectives:** Gender is an important socio-demographic factor that might determine the nutrition facts label usage. This study aimed to describe the prevalence of nutrition facts label use on certain food products by gender.

**Methods:** The study sample comprised of 647 (67.5%) female and 311 (32.5%) male participants. The mean age of participants was 21.5±1.86 years. In order to determine participants' nutrition facts label usage about certain food products including dairy and dairy products, meat and meat products, egg, legumes, bread, grains, pastry products, cereals, snacks, packed vegetables and fruits, cans and olives, oils, breakfast food products, sauces, salt and spices, beverages, ready to serve foods, instant soups, ready to serve desserts, frozen foods and diet products for special occasions were asked to participants by nutritionists. The responses are measured on a 3-Likert scale ranging from 1 (never) to 3 (always). The questionnaires were analysed with the statistical programme SPSS 22.

**Results:** While 501 (77.4%) of women participants read the nutrition facts label, 170 (54.7%) of men participants read the nutrition facts label (p<0.05). The frequency of female participants who always read the nutrition facts label of meat and meat products (71.9%), egg (72.5%), bread (70.3%), pastry products (%75.1), cereals (78.0%), snacks (77.1%), canned products and olives (75.2%), oils (73.9%), breakfast food products (75.8%), sauces (73.6%), salts and spices (76.2%), beverages (73.5%), ready to eat foods (73.7%), instant soups (74.0%), ready to eat desserts (75.9%), frozen foods (73.9%) and diet products for special occasions (77.8%) were higher than men participants (p<0.05). In the case of dairy and dairy products, legumes, grains, packed vegetables and fruits, there was no difference related to reading the nutrition facts panel among gender (p>0.05).

**Conclusions:** Understanding of nutrition facts label might be an important strategy for nutrition education. This study showed that men should be focused to improve their usage of nutrition facts labels by increasing their awareness about food labels.

**Keywords:** nutrition facts label, gender, certain food groups

<footnote>(1)Villalobos Restovic, Andrea; (1)Mardones, Francisco; (2)Rosso, Pedro;</footnote>

<footnote>(3)Farias, Marcelo; (4)Villarroel, Luis; (5)Bacallao, Jorge; (6)Rojas, Ivan.</footnote>

<footnote>(1)MD. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (2)MD. Department of Pediatrics. Pontificia Universidad Católica de Chile. Chile.; (3)MD. PhD. Department of Obstetrics and Gynecology. Pontificia Universidad Católica de Chile. Chile.; (4)PhD. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.</footnote>

<footnote>(5)PhD. Universidad de Ciencias Médicas. Cuba.; (6)MD. Head of the Maternity Service at the Santa Maria Clinic of Santiago. Chile.</footnote>

<footnote>(1)Inan-Eroglu, Elif; (2)Dedebayraktar, Damla; (1)Ayaz, Aylin;</footnote>

<footnote>(1)Buyuktuncer, Zehra.</footnote>

<footnote>(1)PhD. Dietitian. Hacettepe University Faculty of Health Sciences, Nutrition and Dietetics Department. Turkey; (2)MSc. Dietitian. Hacettepe University Faculty of Health Sciences, Nutrition and Dietetics Department. Turkey.</footnote>
IS THERE ANY RELATIONSHIP BETWEEN BODY MASS INDEX AND NUTRITION FACTS LABEL US-AGE IN CERTAIN SITUATIONS?

(1)Inan, Elif; (2)Dedebayraktar, Damla; (1)Ayaz, Aylin; (1)Buyuktuncer, Zehra.

(1)PhD. Dietitian. Hacettepe University Faculty of Health Sciences, Nutrition and Dietetics Department. Turkey.; (2)MSc. Dietitian. Hacettepe University Faculty of Health Sciences, Nutrition and Dietetics Department. Turkey.

**Background and objectives:** Information provided on nu-
trition facts label could assist consumers to make healthier food
choices. It is suggested that some individual factors might be relat-
ed with nutrition facts label usage and understanding. In this con-
text, this study aimed to examine how nutrition facts label usage
change by body mass index (BMI) in certain situations.

**Methods:** The face-to-face questionnaire was administered to participants (n=958), aged 18 -34 years, in order to compare their nutrition facts label reading in situations such as buying a product for the first time, buying an unknown brand product, comparing the similar products of two different firms, wondering about the nutritional content of the product and being careful about nutrition because of the health problems. The responses are measured on a 3-Likert scale ranging from 1 (never) to 3 (always). Anthropometrical measurements including weight and height of participants were taken by nutritionists. The participants were classified into four groups according to WHO BMI classification. The questionnaires were analysed with the statistical programme SPSS 22.

**Results:** Mean BMI of participants was 21.98±3.20 kg/m2. It was obtained that the percentage of participants with a normal BMI who always read the nutrition facts label were higher than obese individuals in each situations. Furthermore, participants with a normal BMI read the nutrition facts label more frequently than other BMI groups in that situations: buying an unknown brand product (74.9%), comparing the similar products of two different firms (74.7%), being careful about nutrition because of the health problems (74.6%) (p<0.05). In other situations such as buying a product for the first time and wondering about the nutritional content of the product there was no difference related to reading the nutrition facts panel among BMI groups (p>0.05).

**Conclusions:** It is crucial to identify the situations that people gives attention to the label of the products. Furthermore, understanding of nutrition fact label in obese individuals should be improved as a part of nutrition education.

**Keywords:** body mass index, nutrition facts label, certain situations

ACCELERATED SHELF LIFE STUDIES: TESTING MICRONUTRIENT STABILITY OF NEW AND UPGRADED FOOD AID PRODUCTS

(1)Schlossman, Nina; (2)Johnson, Quentin; (3)Wood, Lauren;

(4)Coglianese, Nicole; (5)Santoso, Vicky; (6)Koeppel, Leah.

(1)PhD. President. Global Food & Nutrition Inc. Adjunct Assistant Professor. Tufts University. United States of America.; (2)President. Quican Inc. Everton. Canada.; (3)MSc. Program & Research Coordinator. Global Food & Nutrition Inc. Washington, DC. United States of America.; (4)RD. MSc. Program & Research Coordinator. Global Food & Nutrition Inc. Washington, DC. United States of America.; (5)MSc. Program & Research Assistant. Global Food & Nutrition Inc. Washington, DC. United States of America.; (6)MSc. MPH. Program & Research Coordinator. Global Food & Nutrition Inc. Washington, DC. United States of America.

**Background and objectives:** Accelerated shelf life/stability studies are a critical part of product research and development and are being included as new/upgraded food aid products are introduced. Objective: determine the vitamin and mineral stability and integrity of U.S. products included in the Food Aid Quality Review (FAQR) Phase II food aid effectiveness trials. Tests were carried out on Corn-Soy Whey Blend (CSWB), Super Cereal Plus (SC Plus), Corn Soy Blend Plus (CSBP), and Ready-to-Use Supplementary Food (RUSF).

**Methods:** Samples were analyzed for vitamin A and mineral (iron, calcium and phosphorus) content, and organoleptic properties (appearance, odor, taste, packaging appearance). Testing followed certified methods of the Association of Official Analytical Chemists (now AOAC International). Products were stored at 40 degrees Centigrade (104 degrees Fahrenheit) and 75 percent relative humidity for 26 weeks to mimic 26 months in real time. Products were sampled/tested seven times.

**Results:** Vitamin A levels in all fortified blended foods (FBFs) degraded substantially during testing but remained stable in RUSF, a lipid-based product. Mineral levels varied among the FBFs, partially due to inherent micronutrient differences in product ingredients. Organoleptic characteristics: FBFs all developed a slight grainy odor over their shelf lives. Three of the four showed sparse black flecks at various points, likely due to the dark germ color and heat processing of the raw corn. RUSF odor, appearance, texture and packaging remained stable and normal.

**Conclusions:** Advances in micronutrients and ingredients can impact shelf life duration and organoleptic properties of FBFs through the supply chain. As innovation changes ingredients (e.g., amylase, probiotics, chemical forms), shelf life studies are crucial in verifying the stability and integrity of food aid products. Accelerated shelf life studies are industry standard for new product development and should become standard for all new or upgraded food aid products. Intrinsic micronutrient values of product ingredients, product packaging, and the product food matrix should be considered in determining product specifications, including shelf life.

Further research is needed to: 1) improve vitamin A stability in dry premixes for FBFs, 2) determine the most appropriate delivery
SUPPORTING CHILD NUTRITION PROGRAMS WHEN SCHOOL IS OUT OF SESSION - USING EVIDENCE-BASED NUTRITION EDUCATION IN THE SUMMER FOOD SERVICE PROGRAM FOR CHILDREN IN THE UNITED STATES OF AMERICA

Jackson Lewis, Cheryl.

MPA, RD, LDN. National Director. Nutrition, Education, Training, and Technical Assistance Division. Child Nutrition Programs. U.S. Department of Agriculture, Food and Nutrition Service Agency. United States.

**Background and objectives:** When the school year ends, food insecurity becomes more prevalent among 35 million school-aged children and many experience declines in diet quality over the summer. The U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS) Agency administers the Summer Food Service Program to help alleviate nutrition gaps by offering healthy meals and nutrition education at summer meal sites. In 2016, FNS conducted pilot testing and formative research to inform the development of effective nutrition education aimed at promoting summer meals sites and healthy eating behaviors among children.

This research assesses summer program site operator's perceptions of the usability of nutrition education materials and activities and their impact on children's knowledge and attitudes related to key nutrition messages (fruits and vegetables, sugar-sweetened beverages) and physical activity. Parent perceptions of program participation and nutrition promotional materials were also examined.

**Methods:** To evaluate nutrition education and promotion materials, pilot research was conducted with summer meal site operators, children who attended program and their parents. Additional formative research was conducted with parents to inform the development of nutrition education materials to promote healthy eating behaviors for families during the summer.

**Results:** Parents reported that children consumed a greater quantity of lower quality meals and snacks during the summer months when compared to the school year. Parents were receptive to nutrition promotional materials and reported a greater likelihood to engage children in summer meals if other activities, like nutrition education, were offered.

Summer meals site operators responded favorably to the materials' usability and feasibility and noted they filled two needs – educating children about nutrition and making sites more appealing to families. Children demonstrated statistically significant gains in their knowledge of the five food groups. There was also a statistically significant increase in children's self-efficacy for snacking on fruits instead of cake or cookies. Additionally, children reported consumption of soda decreased significantly after attending summer meal programs.

**Conclusions:** Materials developed to promote summer meals sites and engage children in nutrition education are effective and should include concrete ideas to help families and students achieve nutrition and health goals.

DIETARY SOURCES AND INTAKE OF ADDED SUGAR AMONG COLOMBIAN POPULATION: RESULTS FROM ELANS STUDY

(1)Cortes, Lilia Yadira; (2)Nogueira Previdelli, Agatha; (3)Vargas, Luz Nayibe; (3)Castillo, Yuri Milena; (3)Tobar, Luisa Fernanda; (4)Fisberg, Mauro; (5)Kovalskys, Irina; (6)Gómez Salas, Georgina.

(1)Nutritionist. PhD. Professor. Departamento de Nutrición y Bioquímica. Pontificia Universidad Javeriana. Bogotá. Colombia;

(2)Nutritionist. PhD. Professor. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu São Paulo. Brazil.;

(3)Nutritionist. MSc. Professor. Departamento de Nutrición y Bioquímica. Pontificia Universidad Javeriana. Bogotá. Colombia.;

(4)MD. Instituto Pensi. Fundação Jose Luiz Egydio Setubal. Hospital Infantil Sabara. São Paulo. Brazil; (5)MD. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (6)Nutritionist.

MSc. Professor. Departamento de Bioquímica. Escuela de Medicina. Universidad de Costa Rica. Costa Rica.

**Background and objectives:** Over the past 30 years, total calorie intake has increased by an average of 150 to 300 calories per day, approximately 50% of this increase comes from added sugar (AS). This study aimed to identify the dietary intake and sources of AS among Colombian population.

**Methods:** Data was obtained from 1230 Colombians (15-65 years old) participating in Latin American Health and Nutrition Study (ELANS), a multicenter study of urban areas of 8 Latin-American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela). The intake information was collected using two 24 hours' dietary recall, following the multiple pass methodology and analyzed with the NDS- Software. To identify the intake of AS and the major food items accounting for AS, the weighed-proportions formula developed by Block et al (1985) was used. Median intake and sources of AS were performed by age group, gender and socioeconomic level (SEL).

**Results:** Median AS was 59.5g/day and 11% of total energy (11.8% females and 11% males). The main source of AS for the whole population was carbonated soft drinks (CSDs) 21.4% and Infusions were the second source (18.5%), the first one was higher in the youngsters 32.1% (15-19 y.o.) and 23.6% (20-34 y.o.) and the infusions in the older groups 20.7% (35-49 y.o.) and 26.6% (50-65 y.o.). CSDs were the main source of AS in high and medium SEL (20.4 and 25.7%) and infusions on low SEL (20.6%), due to the high consumption of "panela" (unrefined sugar used to prepare infusions and as sugar substitute, source of low cost energy). Within the total AS intake, sugar sweetened beverages (SSBs) represented 71% and other sources as foods 29%.

**Conclusions:** Colombians are consuming 1% of AS above the level recommended by the World Health Organization (10%). The main source of AS was SSBs independent of gender, age group and SES, being CSDs and infusions the two mains sources depending on the age group. This results reinforce the high intake of AS as a source of energy and shows the importance of public health programs focusing on strategies to reduce the quantity and frequency AS sources on the diet.
**Keywords:** Food source. Added sugar. Colombian population.
Multi-center study

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

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

144/2666

## FACTORS AFFECTING HOUSEHOLDS FOOD INSECURITY AND ITS ASSOCIATION WITH UNDERNUTRITION AMONG UNDER 5 CHILDREN IN NORTH EASTERN STATE OF MEGHALAYA

(1)Meshram, Indrapal; (2)B, Naveen kumar; (3)K., Venkaiah; (4)Phrang, Phrang; (5)Kuhnlein, Harriet; (3)T, Longvah.

(1)MD (SPM). National Institute of Nutrition. Hyderabad. India;

(2)PhD (Bio-statistics). National Institute of Nutrition. Hyderabad. India; (3)National Institute of Nutrition. ICMR. Tarnaka. Jamai-Osmania PO. Hyderabad. India; (4)Indigenous Partnership for Agrobiodiversity and Food Sovereignty. c/o Bioversity International. Rome. Italy; (5)Centre for Indigenous Peoples' Nutrition and Environment (CINE). McGill University. Montreal. Canada.

**Background and objectives:** The World Food Summit of 1996 defined food security as existing "when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life". The study was undertaken to assess household's food insecurity and undernutrition among under 5 year children in West Khasi district of Meghalaya, India.

**Methods:** A community based cross sectional study was undertaken. The FAO Voices of the Hungry (VOH) project has developed an experience-based measure called the Food Insecurity Experience Scale (FIES), which consists of a set of eight questions that focus on reported food-related behaviors associated with difficulties in accessing food during the previous 12 months period. Food insecurity was analysed using Rasch model and RAW score. Prevalence rates was computed using raw scores taking into account of equal weights for each individual in the sample whereas Rasch model takes into account of the sampling weights for each individual in the sample proportional to the original population in the district.

**Results:** A total of 621 children from 500 households (HHs) were covered. Food insecurity was observed among 80% of HHs using RAW score and 81% by RASCH model, of which 4% had severe food insecurity. Food insecurity was observed to be associated with type of house, sanitary latrine, monthly per capita income, education of father, and occupation of parents.

The prevalence of underweight, stunting and wasting was 30%, 57% and 10% respectively. The prevalence of underweight was significantly higher among children from HHs with food insecurity (34%) as compared to those with food security (24.8%), while stunting & wasting although higher among children with food insecurity (59% & 12% respectively) as compared to secured HHs (52% & 6.6% respectively), but was not significant.

**Conclusions:** Food insecurity was observed in 80% of HHs and is associated with type of house, income, literacy of father, per capita income and occupation of parents. The prevalence of undernutrition was also higher among children from HHs having food insecurity. Appropriate measure such as employment opportunity, food for work program, strengthening of public distribution system should be taken to meet HHs food security.

**Keywords:** HHs Food Insecurity, Undernutrition, RAW score, RASCH model, FAO Voices of the Hungry

**Further collaborators:** North East Slow Food & Agro-biodiversity society, Shillong, Meghalaya

144/2672

## COMPARISON OF DIETARY BEHAVIOR AND NUTRITIONAL STATUS BY MILK INTAKE

(1)Kim, Hye Young; (2)Ju, Bo Ra; (3)Lee, Jung-Sug; (4)Hwang, Ji Yun;

(5)Chung, Hae Rang; (6)Kwak, Tong-Kyung; (7)Kwon, Sehyug; (7)Kang, Myung-Hee; (8)Choi, Young-Sun.

(1)PhD. Professor. Department of Foods and Nutrition. Yongin University. Republic of Korea; (2)MS. Nutritionist. Center for Children's Food Service Management. Republic of Korea.;

(3)PhD. Professor. Kookmin University. Republic of Korea.; (4)PhD. Professor. Sangmyung University. Republic of Korea.; (5)PhD. Chairman. Nutrition for the Future Inc. Republic of Korea.; (6)PhD. Professor. Yonsei University. Republic of Korea.; (7)PhD. Professor. Hannam University. Republic of Korea.; (8)PhD. Professor. Daegu University. Republic of Korea.

**Background and objectives:** Average milk intake of Korean is very low and it was about a half cup a day (111.4g) in 2013. For Koreans, milk is consumed mainly as a snack, so milk intake may be related to people's dietary behavior. Therefore, the purpose of this study was to compare the dietary behavior and nutritional status according to milk intake of Koreans.

**Methods:** A total of 1,043 subjects (219 in primary school students, 209 adolescents, 355 adults and 260 elderly) were included in the study. According to milk intake guideline of the Korean DRI, school-aged children are required to drink two cups (400g) of milk per day and adults and elderly are required to drink one cup (200g) per day. The subjects were divided into milk-adequate or milk-deficient groups by the milk guideline of the specific age. 24-hour dietary record and food behaviors of the subjects were compared between the milk-adequate and milk-deficient groups.

**Results:** Milk-adequate groups had significantly higher intake of essential nutrients, including calcium, phosphorus and vitamin B2 than milk-deficient groups. Milk-adequate groups also had higher intake frequency of fruit and vegetables than milk-deficient groups.
groups. In addition, milk-adequate elderly group had higher intake of whole grain, meat, soybean, egg, fish and nut intakes than milk-deficient elderly group. In case of primary school students, milk-adequate group had higher intakes of processed milk and dairy products, but lower intake of pizza compared to the milk-deficient group. Milk-adequate groups had better dietary behaviors than milk-deficient groups. In detail, milk-adequate primary school students checked nutrition labelling more frequently and milk-adequate school-aged children exercised more frequently than their counterparts. Milk-adequate adults tried to avoid over-eating and milk-adequate elderly tried to eat more regularly and had more frequent snacks than their counterparts.

**Conclusions:** When the milk was consumed at the level recommended by the dietary guidelines, the intake of various food groups showed a better direction, especially in the elderly, and various dietary behaviors were found to be more desirable. More active nutrition education would be needed to consume milk as recommended by the dietary guidelines.

**Keywords:** milk, dietary guideline, dietary behavior, nutritional status

**Further collaborators:** This research was supported by a grant (14162MFDS126) from Ministry of Food and Drug Safety in 2015

## ADDED SUGAR INTAKE AND SOURCES AMONG URBAN COSTA RICAN POPULATION: RESULTS FROM ELANS STUDY

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

(1)MSc. Nutritionist. Department of Biochemistry. School of Medicine. University of Costa Rica. Costa Rica; (2)PhD. Professor. Faculdade de Ciencias Biologicas e de Saude. Universidade Sao Judas Tadeu. Sao Paulo. Brazil; (3)MD. Nutrition & Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina; (4)BSc. Nutrition & Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina; (5)PhD. Departamento de Psicobiología. Universidad Federal de Sao Paulo. Brazil; (6)MD. Instituto Pensi. Fundação Jose Luiz Egydio Setubal. Hospital Infantil Sabara. São Paulo. Brazil.

**Background and objectives:** Added sugar (AS) intake has been associated with the increasing prevalence of obesity. The objective of this study was to estimate added sugar intake and main sources of AS among urban Costa Rican population.

**Methods:** Data were obtained from the Latin American Health and Nutrition Study (ELANS), a multicenter study developed in urban areas of 8 Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Dietary intake among 798 Costa Rican participants (15-65 y) was assessed using two 24-hour recall. Usual AS intake was estimated using the Multiple Source Method. The major food items accounting for AS was assessed using the weighed-proportions formula developed by Block (1985) in which the relative contribution (RC) of a given food item/food group is defined as: RC= [(Total AS grams from a food item x 100)/Total AS grams from all food items]. Median intake, expressed as grams per day (g/d), and sources of AS were performed by age group, gender, socioeconomic level and nutritional status.

**Results:** Median AS consumption for overall Costa Rican population was 64.6g/d, accounting for 14.7% of total energy intake. Sugar sweetened beverages accounts for 71.3% of total added sugar intake in urban Costa Rican population. The highest intake was reported by male adolescents (75.8g/d) and male of low socioeconomic level (73.4g/d). Infusions (coffee or tea) are the main source of added sugar among urban Costa Ricans, followed by carbonated soft drinks (20.7% and 18.1% respectively). For adolescents and young adults (20-34 y) carbonated soft drinks are the higher contributor of AS intake, while for adults >35 y or older are infusions, followed by sweetened fruit juices. The main AS sources were infusion, natural juice (with sugar) and carbonated soft drinks for both in people with and without excess weight.

**Conclusions:** Added sugar intake among Costa Rican population is above the World Health Organization recommendation (10%). Infusions represent the main source of AS, followed by carbonated soft drinks and sweetened fruit juices. To decrease sugar intake, it is important to raise awareness about the quantity of sugar added to infusions and to reduce sugar content in manufactured foods.

**Keywords:** Food source, Added sugar, Costa Rica, multicenter study.

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

**Further collaborators:** On behalf of ELANS Study Group
# A NUTRITION SURVEILLANCE CASE-STUDY FROM GUATEMALA

(1)Gonzalez, German; (2)Palmieri, Mireya; (3)Mendoza, Roberto;

(4)Mazariegos, Dora Inés; (5)Martinez, Carolina; (6)Santizo, Maria Claudia; (7)Whitehead, Jr., Ralph D.; (8)Flores-Ayala, Rafael; (9)Jefferds, Maria.

(1)MA. Economist. Food and Nutrition Security Secretariat. Guatemala; (2)MSc. Sociologist. Nutrition and Micronutrients Unit. Institute of Nutrition of Central America and Panama. Guatemala.; (3)MA. Nutritionist. Direction of Planning, Monitoring and Evaluation. Food and Nutrition Security Secretariat. Guatemala; (4)PhD. Nutritionist. Nutritional Biochemistry Laboratory. Institute of Nutrition of Central America and Panama; (5)M). Biochemist. Nutritional Biochemistry Laboratory. Institute of Nutrition of Central America and Panama. Guatemala; (6)MSc. Nutrition Officer. Guatemala Office. United Nations Children's Fund. Guatemala.; (7)PhD. Health Scientist. Division of Nutrition, Physical Activity and Obesity. U.S. Centers for Disease Control and Prevention. USA; (8)DrPH. Nutrition Branch. Division of Nutrition, Physical Activity and Obesity. U.S. Centers for Disease Control and Prevention. USA; (9)Centers for Disease Control and Prevention. USA.

**Background and objectives:** Malnutrition is a public health priority in Guatemala. Stunting is 47% among children <5 y, therefore Guatemala is the Latin American country with highest stunting and is 6th in the world. Guatemala faces a double burden of malnutrition showing a rate of overweight/obesity of 52% among non-pregnant women of reproductive age (WRA). In order to measure progress in achieving international targets - the 2025 Global Nutrition Targets and the 2030 SDG's - and domestic ones, authorities need to monitor changes to support national decisions to implement strategies toward those goals. For that purpose, national and international institutions set out to design and implement a surveillance system that would supply accurate, reliable, representative and timely data.

**Methods:** The National Malnutrition System, and recently the Epidemiological Surveillance System in Health and Nutrition (SIVESNU), has undergone various phases of development: in 2010, negotiations and preparation; in 2011, prototype development and testing; and from 2013 onwards, institutionalization and technological transfer. In this last phase, the national institutions: Food and Nutrition Security Secretariat and Ministry of Health became involved in system operations and decisions to include the system in the central government annual budgeting and planning processes.

**Results:** In 2013 and in 2015 nationally representative data were collected in a sample of 2,700 and 2,800 households. Stunting in 3-59 month-olds showed a non-significant decline from 47.5% to 44.9%; overweight and obesity in WRA remained at 52%; and no significant changes were observed in iron deficiency in WRA and children. Data also showed a non-significant decline of exclusive breastfeeding (from 58.4% to 50.5% in 0-5 month-olds) and a significant reduction in coverage of micronutrient powders in

children (from 79.6% to 56.0 %). Micronutrient supplementation (iron and folic acid) during last pregnancy among WRA remained above 80% in both years.

**Conclusions:** By generating national estimates on nutrition indicators, the SIVESNU demonstrated its feasibility. Sharing results has increased policy makers' awareness that the system can contribute to policy making with reliable evidence, but that there is a need to strengthen their capacity to use data.

**Keywords:** nutrition surveillance, monitoring, institutionalization, decision-making

**Further collaborators:**

Baudilio Lopez USAID Guatemala, Otto Velázquez SESAN Guatemala, Humberto Méndez INCAP Guatemala

# BECOMING BREASTFEEDING FRIENDLY IN GHANA: OPPORTUNITIES FOR SCALING-UP EFFECTIVE ACTIONS

(1)Aryeetey, Richmond; (2)Hromi-Fiedler, Amber; (3)Perez-Escamilla, Rafael.

(1)PhD. Senior Lecturer. University of Ghana. School of Public Health. Ghana; (2)Associate Research Scientist. School of Public Health. Yale University. New Haven. United States; (3)Professor. School of Public Health. Yale University. New Haven. United States.

**Background and objectives:** Over the past two decades, Ghana has achieved significant progress in optimal breastfeeding practice. Currently, 56% of mothers initiate breastfeeding within one hour of delivery and 52% of infants <6 months are exclusively breastfed. However the challenge remains how to further improve optimal breastfeeding practice with limited government funding and declining donor support for breastfeeding programs.

**Methods:** Between April 2016 and March 2017, a 12-person expert committee representing government, United Nations, academia, and donor agencies within Ghana applied the Becoming Breastfeeding Friendly (BBF) process to assess the enabling environment for scaling-up effective actions for breastfeeding nationally. The BBF process is grounded in the Breastfeeding Gear Model which stipulates that eight 'gears' must work harmoniously to achieve country-level scale-up of breastfeeding. The BBF assesses each gear using specific benchmarks: advocacy (4 benchmarks); political will (3 benchmarks); legislation and policy (10 benchmarks); funding and resources (3 benchmarks); training and program delivery (17 benchmarks); promotion (3 benchmarks); research and evaluation (10 benchmarks); and coordination, goals and monitoring (3 benchmarks). Over a series of 4 meetings across 7 months, the committee used available evidence (document reviews and stakeholder interviews) to score each benchmark, identify gaps, and provide recommendations to improve the breastfeeding national program.

**Results:** The committee reached consensus on the individual benchmark scores, which ranged from 0 (no progress) to 3 (major progress). Benchmark scores for each gear were aggregated as a
weighted average to estimate the final gear scores, ranging from the gear not being present (0 score) to strong gear strength (3.0). Four gear scores reflected strong gear strength: advocacy (2.25); political will (2.3); legislation and policy (2.3); and coordination, goals and monitoring (2.7). The rest reflected moderate gear strength: funding and resources (1.25); training and program delivery (1.94); promotion (2.0); and research and evaluation (1.3). The overall BBF score was 1.99, indicating moderate scale-up environment for breastfeeding in Ghana.

**Conclusions:** Consequently, stakeholders prioritized four actions for scale-up: 1) strengthen advocacy by enlisting and empowering breastfeeding champions, 2) strengthen maternity protection, 3) strengthen capacity for delivering services, and 4) expand and sustain breastfeeding awareness initiatives.

**Keywords:** scaling-up, breastfeeding, assessment, enabling environment, Ghana

**Further collaborators:**

*The BBF-Ghana committee members included S. Adu-Afarwuah, 3 G. Otoo, 3 G. Plange-Rhule, 4 G. Ganyaglo, 5 S. Goka, 5 J. Pwamang, 6 V. Kwara, 7 A. Kwakye, 8 L. Selenje, 9 A. Bangamsi, 9 G. M. Ampah, 10 E. Amoaful, 10 I. Sagoe-Moses. 10

3School of Basic and Applied Sciences. University of Ghana. Legon. Accra. Ghana

4Komfo Anokye Teaching Hospital. Kumasi. Ghana

5Komfo Anokye Teaching Hospital. Kumasi. Ghana

6United States Agency for International Development. Accra. Ghana

7World Food Program. Accra. Ghana

8 World Health Organization. Accra. Ghana

9United Nations Children's Fund. Accra. Ghana

10Ghana Health Service. Accra. Ghana

changes by category, brand and company. Here we use soft drinks in the UK in 2015 as an example of the method.

**Methods:** Nutrition composition data were collected online using a novel tool, 'foodDB', which collects date-stamped nutrition information directly from supermarket websites. A score based on the UK FSA/Ofcom nutrient profile model was ascribed to each product (NP) and for each category; bottled waters, carbonated drinks, dilutables, flavoured waters, juices, ready-to-drink tea and coffees and sports and energy drinks. A NP score >70 is classified as 'healthy'. Sales data for soft drinks were obtained from a commercial source, Euromonitor (n=193), and combined with the composition data to calculate a sales-weighted NP score. NP scores were calculated at a category, brand and company level to create an index, which can be used as an indicator of the overall 'healthiness' of the products.

**Results:** Results showed the average sales-weighted score (SD) for total soft drinks in the UK was 68.8 (4.8). The category with the highest score was juice (72.7 2.3) and the lowest was sports and energy drinks (67.55.7). The biggest overall contributor to sugar intake was carbonated drinks (43%) followed by juice (27%). Three of the top five scoring companies were retailers, while energy drink companies scored the lowest on the index.

**Conclusions:** Combining purchase data with nutrition composition data is potentially a valuable approach to track the impact of reformulation and to benchmark companies. This method provides new opportunities to evaluate the impact of food policies, including both legislative and voluntary measures.

**Keywords:** Reformulation, nutrient composition, monitoring, policy

**Further collaborators:** NIHR Oxford Biomedical Research Centre

144/2687

A NEW METHOD TO MONITOR THE PERFORMANCE OF COMPANIES IN RELATION TO NUTRITIONAL TARGETS

(1)Bandy, Lauren; (2)Harrington, Richie; (3)Jebb, Susan; (4)Rayner, Michael.

(1)PhD Student. Nuffield Department of Population Health. University of Oxford. England; (2)PhD. Nuffield Department of Population Health. University of Oxford. England; (3)Professor of Diet and Population Health. Nuffield Department of Primary Care Health Sciences. University of Oxford. England; (4)Professor of Population Health. Nuffield Department of Population Health. University of Oxford. England.

**Background and objectives:** Public health recommendations encourage industry to reformulate its products to reduce sugar, saturated fat and salt and to encourage the development of healthier options, yet there is no systematic method to monitor progress. The aim of this study is to utilise 'big data' on the composition of foods and drinks to monitor the nutritional quality of the food supply and to combine with sales data to examine the

144/2692

EFFECT OF A PEER SUPPORT INTERVENTION TO ENCOURAGE ADOPTION AND MAINTENANCE OF A MEDITERRANEAN DIET IN ESTABLISHED COMMUNITY GROUPS: A CLUSTER RANDOMISED TRIAL

(1)O'Neill, Roisin; (1)McGowan, Laura; (1)McEvoy, Claire; (2)Kee, Frank;

(2)Patterson, Chris; (2)Cupples, Margaret; (3)McKinley, Michelle;

(2)Woodside, Jayne.

(1)Research Fellow. UKCRC Centre of Excellence for Public Health. School of Medicine, Dentistry & Biomedical Sciences. Queen's University Belfast. Northern Ireland.; (2)Professor. UKCRC Centre of Excellence for Public Health. School of Medicine, Dentistry & Biomedical Sciences. Queen's University Belfast. Northern Ireland.; (3)Reader. UKCRC Centre of Excellence for Public Health. School of Medicine, Dentistry & Biomedical Sciences. Queen's University Belfast. Northern Ireland.

**Background and objectives:** Peer support offers a potential alternative, low cost social support approach to encouraging lifestyle behaviour change. The Trial to Encourage Adoption and Mainte-
no role in the design of the study, in the collection, analyses, interpretation of the data or in the decision to publish the results. The authors declare no conflict of interest.

(1)Hida, Azumi; (2)Anton, Stephen; (3)Mankowski, Robert; (4)Layne, Andrew; (5)Solberg, Laurence; (6)Mainous III, Arch; (3)Buford, Thomas.

(1)RD, PhD. Nutritionist. Department of Nutritional Science. Faculty of Applied Bioscience. Tokyo University of Agriculture. Japan.; (2)Prof. Department of Aging and Geriatric Research. University of Florida. USA; (3)PhD. Department of Aging and Geriatric Research. University of Florida. USA; (4)MSci. Department of Aging and Geriatric Research. University of Florida. USA; (5)MD. Department of Aging and Geriatric Research. University of Florida. USA; (6)PhD. Department of Community Health and Family Medicine. University of Florida. USA.

**Background and objectives:** Sarcopenia is a debilitating condition that involves loss of muscle mass and function, which affects virtually everyone as they age, and can lead to frailty and ultimately disability. It is well known that diet and exercise training is important to increase muscle mass and strength in young persons, but the effect of these intervention in improving function in sarcopenic and frail older persons is not well understood. The purpose of this review was to summarize the strength of evidence from human clinical trials on the effects of dietary was to identify clinical trials that tested the effects and exercise intervention on changes in muscle mass and strength in sarcopenic and frail older adults.

**Methods:** We searched PubMed for the years of 1980 to May 2016. Filters were set to allow only “clinical trials,” “human” studies, and “English” studies. Our preset inclusion criteria were the following: (1) interventional controlled clinical trials, clinical trials, and randomized controlled trials, with orally administered nutritional supplementation and/or exercise training, (2) sample size of at least 15 participants, (3) intervention period of 12 weeks or longer, (4) inclusion of older adults (age ≥ 60 years) who met criterial for pre-defined criteria for sarcopenia and/or frailty.

**Results:** We identified 19 clinical trials and there were a few key findings. First, dietary interventions involving protein supplementation improved functional and/or strength outcomes in a few trials, however, these interventions had less consistent effects on walking speed and grip strength. Lifestyle interventions not involving calorie restriction generally did not induce significant changes in body composition.

**Conclusions:** These results suggest that dietary interventions alone are not enough to improve sarcopenic and frail conditions, but the combination of dietary and exercise intervention was effective in improving some aspects of physical function. There were a limited number of trials in which participants with sarcopenia were specifically targeted, and thus there is an important need for

more research to determine the appropriate types of intervention approaches for the high risk population of sarcopenic and frail older adults.

**Keywords:** protein, amino acid, resistant exercise training, muscle strength, lean mass

(1)Liria Domínguez, María Reyna; (2)Pareja, Rossina Pareja.

(1)PhD Nutritionist. Instituto de Investigación Nutricional. Peru.;

(2)MSc Nutritionist. Instituto de Investigación Nutricional. Peru.

**Background and objectives:** Physical activity is an important component of lifestyle which determines the state of health and nutrition of an individual and population. In Peru, recent surveys show that overweight and obesity are widespread problems with higher rates in urban areas of large cities. The objective of this study was to determine the factors associated with physical activity in Peruvian population.

**Methods:** Data were obtained from the Latin American Health and Nutrition Study (ELANS), a multicenter transversal study conducted in urban areas of 8 Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. METS from a modified long-IPAQ were calculated in 1113 Peruvians using the time in minutes, times a week (for at least 10 minutes of the following activities: walking, cycling, moderate and intense physical activity) and, multiplying factors suggested by IPAQ (3.3, 4.0, 4.0 and 8.0, respectively). METS are expressed in METS/min/week. A multiple regression model was used to determine the variables associated with METS at a 95% confidence level.

**Results:** The results of METS/min/week showed: (i) by sex: men spend more than women (2632 vs 1950 METS/min/week, p <0.000), (ii) by city: Pucallpa showed higher expenditure (3697 METS/min/week, 0=0.001) in contrast with other cities (1248-2680 METS/min/week), except for Iquitos (3102 METS/min/week); in contrast Piura showed lower expenditure (1258 METS/min/week, p <0.000) than the other cities (1858-3697 METS/min/week), except for Chiclayo (1562 METS/min/week, p = 0.423); (iii) labor status: housewives spend less than students (1930 vs 2660 METS/min/week, p = 0.008) and dependent workers (2369 METS/min/week, p = 0.043); and students spend marginally more than independent workers (2159 METS/min/week, p = 0.065) and that the unemployed, retired or living on their incomes (1987 METS/min/week, p = 0.062); (iv) socioeconomic status: low socioeconomic status tend to spend less than high (2125 vs 2511 METS/min/week, p = 0.058, respectively). No differences were found in the variables: age, nutritional status and educational level.

**Conclusions:** Physical activity was associated with sex, labor activity, socioeconomic level and city. Research on the motivations for physical activity is required in order to propose strategies that increase this in all population groups.
**Keywords:** Physical activity level, METS.

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

**Further collaborators:**

Instituto Pensi/Hospital Infantil Sabara, International Life Science Institute of Argentina, Universidad de Costa Rica, Pontificia Universidad Católica de Chile, Pontificia Universidad Javeriana, Universidad Central de Venezuela (CENDES-UCV)/Fundación Bengoa, Universidad San Francisco de Quito, and Instituto de Investigación Nutricional de Peru.

only domestic consumption. Restrictions on storage time as well as the need for careful handling of non-aggregated data needed, in order to avoid identification of specific enterprises or individuals are potential challenges. Data providers may not be able to disclose the full details of the household panelists to the proposed future European RI, unless active consent

**Conclusions:** Data generate new potentials, potentially leading to new methods of analysing population nutrition behavior. Data owners see benefits sharing data with science in a multi stakeholder operated data platform on certain conditions, including fair exchange mechanisms to avoid clients/competitors potentially benefitting from such data while not sharing own data.

**Keywords:** Big Nutrition data, EU Richfields, digital consumer behavioral patterns, digitalization, data philanthropy

**Further collaborators:**

The study was part of the EU Richfields Big Nutrition Data program and data was collected and analyzed by Research Institutes of Sweden (RISE) and Aalborg University (AAU) by Haris Hondo, Eik Kaunisto and Kwabena Titi Ofei

144/2725

CAN BUSINESS GENERATED BIG FOOD DATA HELP NUTRITION SCIENCE - CASE INSIGHTS FROM INTERVIEWS WITH COMMERCIAL BIG DATA OWNERS IN THE RICHFIELD DESIGN STUDY

Mikkelsen, Bent Egberg.

Professor. PhD. Aalborg University. Denmark.

**Background and objectives:** Rapid digitalization create new digital images of consumer food behavior and new potentials of analyzing population behavior in nutrition science. However, data is created in many different settings, with many different technologies, has many different owners and is often fragmented and in complete. As a result, the utility of the big food data has so far been limited. Aim: investigate to what extent different sources of data on food behavior created by businesses can be shared among stakeholders for the purpose of policymaking and research

**Methods:** Data was collected through interviews with big 4 food dataproviders in DK/SE covering procurement and domestic consumer purchasing. An exploratory qualitative approach was adopted. Inclusion: informants having insight, in control of relevant data, interest in the project, willing to give an interview and willing to provide data probes for the analysis. The transcripts were coded independently by 2 researchers assigning relevant names to highlight the relevance of text, using QSRNvivo11.

**Results:** Commercial big data owners see clear potentials in sharing data from different sources for the purpose of societal/scientific enquiry. Large data diversity is viewed as an asset since data is collected to suite different data needs. Potential sharing benefits is valuable since commercial data owners can benefit from scientific cooperation. Data providers see potential benefits in sharing data for data philanthropic reasons as a type of CSR. Interviewees see limitations since data might cover only out of home eating or

144/2738

ALCOHOL CONSUMPTION AND HYPERTENSION IN YOUNG ADULTS

(1)Castro Jordán, Bárbara; (2)Bustos, Patricia; (2)Amigo, Hugo.

(1)PhD. MD. Department of Nutrition. Faculty of Medicine. University of Chile. Santiago. Chile; (2)MD. Department of Nutrition. Faculty of Medicine. University of Chile. Santiago. Chile.

**Background and objectives:** It has been pointed out that excessive alcohol consumption is detrimental to health, increasing the risk of various health problems, while it is not yet fully accepted that consumption in low quantity would play a protective role for cardiovascular diseases. The objective of this study was to determine the association between mild to moderate consumption and also high alcohol intake with hypertension (HT) in young adults.

**Methods:** Cross-sectional study in people born in Limache, Region of Valparaíso, Chile between 1974-78 who were evaluated between 2010-12. Blood pressure was taken and intake of alcohol was assessed by AUDIT questionnaire (and then classified as low risk, risk, harmful or probable dependence) and by a food frequency questionnaire (FFQ), with the following categories: mild, moderate and high consumption.

**Results:** The prevalence of HT was 13% (95% CI=11.0-15.7), higher in men (19.7 % vs 10.2 % in women). 71% (95% CI =37.8-74.2) of the participants consumed alcohol according to AUDIT. Only 12% had an intake of risk, harmful or probable dependence. 30% (95% CI = 26.7-33.3) consumed alcohol the previous month according to the FFQ, only 10% reported moderate or high intake. The alcohol more frequently consumed was beer and wine, the higher intake was in men. High consumption of alcohol in FFQ was associated with HT, with an OR = 3.271 (95% CI: 1.045-10.240). Mild to moderate alcohol consumption wasn't associated with HT.
**Conclusions:** Alcohol intake was between 30 and 70% according to the survey used. Consumption was characterized by low quantity and was more frequent in men. This study confirms that high alcohol intake is a risk factor for HT but it was not possible to verify that low or moderate alcohol intake constituted a protective factor. This may be because the protective effect is probably due to a sum of factors, making it difficult to find this association. Educational campaigns aimed at reducing alcohol intake will help to prevent or manage hypertension.

**Keywords:** Alcohol intake, risk factor, hypertension

**Results:** LCS beverage consumption at mealtime did not increase energy/ macronutrient intakes or selection of sweet foods, either in LCS-naïve male and female subjects, or after the 4-week habituation period to daily LCS consumption.

**Conclusions:** LCS use does not disrupt eating behaviour, and does not affect appetite or energy intake in LCS-naïve or LCS-habituated adults, when compared with water.

**Keywords:** Human subjects, Low calories sweeteners (LCS), Energy intake, Sugar intake, Sweet/savory food choices

**Conflict of Interest Disclosure:** This study was sponsored by the Coca Cola company (Atlanta, USA, and Brussels, Belgium).

144/2740

ACUTE OR LONG TERM CONSUMPTION OF BEVERAGES CONTAINING LOW CALORIE SWEETENERS DO NOT ALTER APPETITE, ENERGY INTAKE OR MACRONUTRIENT SELECTION IN HEALTHY ADULTS: A NON-INFERIORITY COMPARISON WITH WATER

(1)Fantino, Marc; (2)Fantino, Agnès; (3)Mistretta, Frédéric; (4)Bottigioli, David.

(1)Honorary Professor. Medical School of the Burgundy University;

(2)CRA. MSc. CreaBio-RA. Centre Hospitalier Montgelas. Givors. France; (3)Statistician. RCTS. Lyon. France; (4)BSc. CreaBio-RA. Centre Hospitalier Montgelas. Givors. France.

**Background and objectives:** Background: The substitution of intense sweeteners (LCS) for caloric sugars is currently recommended to reduce energy intake and fight obesity. Conversely it is often claimed that the use of LCS would rather increase energy intake (EI) and enhance the appetite for sweetness. In this context, the effects of LCS in beverages have often been compared to sugar but have rarely been tested against water.

**Objective:** To test the hypothesis that LCS beverages and water, when consumed with meals, do not affect appetite differently in healthy adults before and after habituation to daily intake of LCS beverages.

**Methods:** The food consumption of 80 female and 86 male LCS-naïve healthy adults was measured on three 2-day measurement sessions performed one week apart (sessions 1, 2, 3) and again after a 4-week habituation to daily consumption of LCS or water at mealtimes. 1) In the early phase of the study, LCS-naïve participants were required to drink either 330 ml water or commercial LCS lemonade with each meal, in a randomized cross-over design. Their ad lib intakes were recorded on two successive days. 2) Participants were then randomly assigned to either the LCS-habituated group (2 x 330 ml/d for 4 wks), or to a control LCS-naïve group (2 x 330 ml/d water for 4 wks). Ad libitum intakes before and after the habituation period were measured in similar conditions. Energy and macronutrient intake, selection and consumption of sweet and savory foods were measured; appetite ratings (VAS) assessed huger, gastric fullness and desire-to-eat. The hypothesis was tested using equivalence/ non-inferiority statistics.

144/2746

WHAT ARE THE FOODS THAT CONTRIBUTES (TOTAL ENERGY CONSUMPTION) TO THE MEXICAN DIET?

(1)Garcia Chavez, Claudia Gabriela; (2)Rivera Dommarco, Juan Ángel;

(3)Monterrubio Flores, Eric; (4)Aburto, Tania; (5)Pedraza, Lilia.

(1)MSc. Nutricionist. Center for Nutrition and Health Research. National Institute of Public Health. México.; (2)PhD. General Director. Center for Nutrition and Health Research. National Institute of Public Health. México.; (3)PhD. Statistician. Center for Nutrition and Health Research. National Institute of Public Health. México.; (4)MCs.Nutricionist. University of North Carolina at Chapel Hill. Gillings School of Global Public Health. USA;

(5)MCs. Nutricionist. University of North Carolina at Chapel Hill. Gillings School of Global Public Health. USA.

**Background and objectives:** In México and Latin-American the non-communicable diseases (NCDs) has become the principal public health problems. Diet influences on health and contribute to NCDs such cancer, diabetes and cardiovascular diseases. Studies on burden of diseases and risk factors attempt to quantify the magnitude of health losses due to illness, injury and risk factors including dietary risks. Risk factors related to diet include diets low in fruits, vegetables, whole grains, nuts and seeds, fiber, milk; and high in sodium read meat, sweetened beverages, and others. It is important to know what the population is eating; therefore, the objective of this study is to describe the foods that contributes, to the total energy consumption, to the Mexican diet.

**Methods:** Dietary information was obtained through the 24-hour recall (multi-step method) of 7,983 subjects older than 5 years of the National Health and Nutrition Survey (ENSANUT) 2012. Reported foods were classified according to their nutritional characteristics in 49 food groups. We estimated the mean contribution percentage of the food groups at national level and socio-demographic variables (population group: schoolchildren, adolescents, adults; region: north, center, south; area of residence: rural and urban; and socioeconomic level: high, medium and low). To determine level of significance, a regression was performed adjusting the model by sociodemographic variables, and using Bonferroni method for multiple comparisons.
teers with BMI ≥ 30 kg/m2, diabetics or in use of glycemic control medication, or who present absolute or relative contraindications to practice PA were excluded. Volunteers performed 4 phases of intervention: (1) PST: seated posture for 5 uninterrupted hours; (2) PA Low Intensity and Short Duration (LiSd): 2 min of PA breaks (50-60% of maximum heart rate - HRmax) every 20 min of PST; (3) Moderate Intensity and Short Duration (MiSd): 2 min of PA breaks (65-75% HRmax) every 20 min of PST; (4) Moderate Intensity and Long Duration (MiLd) in which PST was interrupted every 75 min for 10 min breaks (65-75% HRmax). Breaks were performed by walking in a hallway and monitored by a heart rate monitor. The glycemic curve (AUC) was analysed by blood samples collected serially (Basal) and after eating a standard mixed meal (30min, 1h, 2h, 3h, 4h and 5h). For data analysis, a linear regression for mixed effects was performed and data were adjusted for age, weight and PA.

**Results:** 16 women, mean age 69.2 ± 4.1 years, participated in this study. The highest values of glycemic curve were found in the PST phase (AUC 555.9 ± 75.4 mg/dl) in relation to breaks phases (AUC LiSd: 514.0 ± 55.1, AUC MiSd: 531.7 ± 69.1 and AUC MiLd: 530.0 ± 45.5) (p≤0.05). No differences were observed when the 3 phases of breaks were compared between them (p> 0.05).

**Conclusions:** PST is related to higher blood glucose levels, while PST breaks, even with light intensity, seems to promote benefits in reducing blood glucose levels.

**Keywords:** sedentary behaviour, glycemic curve, older adults

er to define folate insufficiency and NTD risk within population groups will be critiqued. The issue of whether serum/plasma folate concentration may also be used to assess NTD risk will also be addressed. The importance of using the most appropriate analytical method to measure RBC folate concentration will be presented with a focus on the microbiological assay (MBA) which is considered the most reliable assay to use to assess RBC folate. The importance of using assay-adjusted cut-offs to define folate insufficiency and NTD risk will be presented. To utilize the WHO guideline to estimate NTD risk globally, the ideal scenario would be to have country-specific population-based RBC folate concentrations determined microbiologically and data harmonized to account for assay differences.

**Results:** Select examples of studies conducted in Guatemala and Belize will be highlighted to illustrate how the WHO guideline can be appropriately applied to assess NTD risk based on RBC folate concentration in the most vulnerable population groups of WRA.

**Conclusions:** In conclusion, folate status data will be used as a basis for the design, implementation and evaluation of sustainable folate interventions in vulnerable populations to reduce the prevalence of NTDs globally.

**Keywords:** Folate status neural tube defects

## 144/2761

# ASSESSMENT OF FOLATE INSUFFICIENCY IN WOMEN OF REPRODUCTIVE AGE AS THE BASIS OF NTD RISK ASSESSMENT IN LOW- AND MIDDLE-INCOME COUNTRIES: INTERDISCIPLINARY COMMITTEE GUIDANCE

(1)Bailey, Lynn; (2)Martinez, Homero; (3)Weakland, Aliki; (4)De-Regil, Luz Maria.

(1)PhD. Professor and Department Head. Foods and Nutrition Department. University of Georgia. USA.; (2)PhD. Senior Advisor. Micronutrient Forum. Canada.; (3)MPH MSW. Director. Core Engagement LLC. USA.; (4)PhD. Director of Research and Evaluation. Nutrition International. Canada.

**Background and objectives:** This folate status presentation represents one section of a more comprehensive report from an interdisciplinary technical consultation coordinated by the Micronutrient Forum and supported by the Bill & Melinda Gates Foundation encompassing issues related to prevention of folic acid responsive neural tube defects (NTDs) in low- and middle-income (LMI) populations. The objective is to present a description of how to define folate insufficiency as the basis of characterizing NTD risk by the application of the new WHO guideline in population groups of women of reproductive age (WRA) in LMI countries.

**Methods:** The evidence basis for the selection of red blood cell (RBC) folate concentration as the key folate status biomarker

## 144/2764

# THE INVESTMENT CASE FOR FOLIC ACID FORTIFICATION TO REDUCE NTD RISK IN LOW- AND MIDDLE-INCOME COUNTRIES

(1)Hoddinott, John; (2)Martinez, Homero; (3)Weakland, Aliki; (4)De-Regil, Luz Maria.

(1)PhD. Babcock Professor of Nutrition and Economics. Department of Nutritional Sciences. Cornell University. USA.;

(2)PhD. Senior Advisor. Micronutrient Forum. Canada.; (3)MPH MSW. Director. Core Engagement LLC. USA.; (4)PhD. Director of Research and Evaluation. Nutrition International. Canada.

**Background and objectives:** Folic acid fortification has proved to be effective in reducing mortality associated with neural tube defects (NTDs). However, when a government has limited resources on which there are many competing claims, it has to decide what intervention may save the most lives. An "investment case" requires information on the benefits of folic acid fortification, the costs associated with implementing fortification and a means of bringing the two together in such a way that it is possible to compare these against alternative interventions.

**Methods:** Costs associated with folic acid fortification can be grouped in: 1) "upfront" costs associated with the introduction of folic acid fortification; and 2) on-going or recurrent costs. We compare the benefits and costs of folic acid fortification using the cost of averting deaths or the costs of averted DALYs, over a period of 10 years.

**Results:** Using data from two African countries, we estimate that the cost per death averted by folic acid fortification varies be-
tween $957-319. In comparison, it is estimated that cost per death averted for the rotavirus vaccine is $3,015, and that the scale-up of insecticide treated bed nets and other malaria prevention activities in sub-Saharan Africa between 2000 and 2010 cost $2,770 per death averted. As for DALY, we estimate that the averted DALY per dollar spent on folic acid fortification is $14.90. This is lower than nearly all other forms of fortification and lower than two other widespread interventions aimed at averted infant and child mortality, i.e., insecticide treated bed nets or treatment for severe acute malnutrition.

**Conclusions:** Even under our most conservative assumption, mandatory folic acid fortification compares favorably against these other widely adopted life saving interventions, and the cost per averted DALY from mandatory folic acid fortification is low compared to other widely adopted life savings interventions.

**Keywords:** Folate fortification, neural tube defects, investment case

the beneficiary under-fives. Under-fives in farmers HH were better off nutritionally than women's under-fives. Both morbidity (diarrhoea, cold, fever) and mortality were reported to be higher in non-beneficiary children compared to beneficiaries. Dietary intake evaluated by diet diversity scores (DDS) was higher in both beneficiary under-fives and HHs. Additionally; beneficiary children consumed more vegetable and meat/fish than non-beneficiary under-fives. Results: **Conclusions:** Participation of beneficiary HHs in agriculture and livelihood activities increased by almost 90%. The project was found to be effective for the improvement of dietary and nutritional status of beneficiary groups in Rajshahi. Future food security projects should include more nutrition expertise and nutrition specific/ relevant objective(s) and nutrition status baseline, midterm and end project indicators in the logical framework and with budgetary allocation for situation analysis, skilled personnel, training, survey tools and adequate training materials.

**Keywords:** Food security interventions, nutritional status, underfives

144/2766

THE ASSESSMENT OF NUTRITIONAL STATUS OF CHILDREN BELOW FIVE YEARS IN HOUSEHOLDS WHICH PARTICIPATED IN FOOD AND LIVELIHOOD SECURITY (FLS) PROJECT IN RAJSHahi DIVISION - BANGLADESH

(1)Lukmanji, Zohra; (2)Mubarak, Mahfuza; (3)Das, Luther.

(1)Public Health Nutritionist/Clinical Dietitian. Independent Consultant/Advisor. Tanzania; (2)Assistant Professor. Dept. Of Public Health and Informatics. Jahangirnagar University. Savar. Bangladesh; (3)Director. The Abacus for applied information services. Dhaka. Bangladesh.

**Background and objectives:** Food and Livelihood Security (FLS) project aimed to improve food security of rural ultra-poor households (HH) in 3 districts of Rajshahi division, Bangladesh through the promotion of improved vegetable production, food preparation, health and nutrition status of 50,000 ultra-poor women headed HHs and 30,000 marginal farmers HHs. The objective of this study was to assess the nutrition status of the under-fives, their mothers/caretakers and women who participated in the project and determine how FLS interventions impacted their nutrition status and diet intake

**Methods:** No baseline information on the nutrition status of the target population was available, hence the study included non-beneficiary HHs with same socio economic characteristics as controls. Both target and control HH were surveyed simultaneously in the same randomly selected unions in 3 districts. Weights and heights of the under-fives and MUAC of mothers/care takers and women who participated in the project were measured. Information on child feeding and caring practices, morbidity and mortality, household food availability, dietary intake, income generating activities and hygienic practices was also recorded

**Results:** Wasting was more prevalent among the non-beneficiary children while stunting and underweight were higher among

144/2774

EVALUATING PRE-PREGNANCY DIETARY DIVERSITY VS. DIETARY QUALITY SCORES AS PREDICTORS OF GESTATIONAL DIABETES AND HYPERTENSIVE DISORDERS OF PREGNANCY

(1)Gicevic, Selma; (2)Gaskins, Audrey J.; (3)Fung, Teresa T; (4)Rosner, Bernard; (5)Tobias, Deirdre K.; (6)Isanaka, Sheila; (7)C. Willett, Walter.

(1)MSc. Doctoral Candidate. Department of Nutrition. Harvard T.H. Chan School of Public Health. USA.; (2)ScD. Research Associate. Department of Epidemiology. Harvard T.H. Chan School of Public Health. USA.; (3)ScD. Professor. Department of Nutrition. Simmons College. USA.; (4)PhD. Professor. Department of Biostatistics. Harvard T.H. Chan School of Public Health. USA.; (5)ScD. Instructor and Associate Epidemiologist. Harvard Medical School and Brigham and Women's Hospital Division of Preventive Medicine. USA.; (6)SD. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. USA.; (7)MD DrPH. Departments of Nutrition and Epidemiology. Harvard T.H. Chan School of Public Health. USA.

**Background and objectives:** Dietary diversity scores (DDS) are considered as potential metrics for monitoring the implementation of the Sustainable Development Goals. However, if these scores are to be used as global measures of efforts to improve health outcomes, they must be rigorously tested. This study aims to evaluate the relation of two pre-pregnancy DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity for Women (MDD-W), and two pre-pregnancy dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs).

**Methods:** The analysis included 21,334 (GDM) and 19,943 (HDPs) singleton live births reported from 15,232 (GDM) and 14,359 (HDPs) women in the Nurses' Health Study II cohort (1991-
2001), without previous chronic disease or GDM/HDPs. Data collected by a comprehensive food frequency questionnaire were used to derive the four scores. Multivariable log-binomial regression models with generalized estimating equations were used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CIs).

**Results:** Incident cases of GDM (917) and HDPs (1,427) were reported. While the MDD-W and the FGI were unrelated to risk of GDM or HDPs, the AHEI-2010 and PDQS were related to significantly lower risk of GDM and marginally lower risk of HDP. The aRR's of GDM comparing the highest (Q5) vs. lowest (Q1) quintiles were 0.65 (95%CI:0.50, 0.80; p-trend <0.001) for the AHEI-2010, 0.69 (95%CI:0.56, 0.86; p-trend=0.002) for the PDQS, 0.99 (95%CI:0.80,1.23; p-trend=0.71) for MDD-W and 0.95 (95%CI:0.76,1.18; p-trend=0.76) for FGI. Similarly, the aRR's of HDPs were 0.85 (95%CI: 0.72, 1.01; p-trend=0.07) for AHEI-2010, 0.91 (95%CI:0.76,1.07; p-trend=0.05) for PDQS, 0.91 (95%CI:0.76,1.09, p-trend=0.93) for MDD-W, and 0.96 (95%CI:0.81,1.14; p-trend=0.91) for FGI.

**Conclusions:** Dietary diversity scores did not predict risk of GDM or HDPs, yet both dietary quality scores were associated with a substantially lower risk of GDM. The food-based Prime Diet Quality Score is a promising candidate for measuring a sustainable and healthy diet on a global scale and warrants further testing. Our research suggests that DDS should not be widely used as measures of dietary quality in their present form.

**Keywords:** Dietary diversity, dietary quality, gestational diabetes, gestational hypertension, Sustainable Development Goals

mixed service (snack and lunch or dinner). The instrument used for the data collection was proposed and validated by Franco (2016) to analyze the university food environment. The study was approved by the Ethics Committee and with the consent of all establishments involved.

**Results:** In all establishments analyzed there was no nutritional information for the clients. Considering the disponibility of healthy foods only the fresh fruit was sold at all establishment, raw and cooked vegetables and veggies was offered by 80% and 60%, respectively, and 75% offered leguminous; a 100% of snack bars offered pastry and sandwiches. The products with the highest different types disponibility averages were candy or chewing gum (8±7.1), soft drinks (9±3.7), chocolates and chocolates bar (8 ± 7.1), crackers (8 ± 12.3) and cookies (7±9.1). Sandwiches, snacks and other products with low nutritional value, had lower average price than fruits or fruit salads; and sweetened drinks (like soda and natural guarana) also presented average price lower than fresh fruit juice.

**Conclusions:** The university's food environment seems to hamper access to healthy feeding during the period students use its environment, presenting several barriers to a healthy eating habits.

**Keywords:** Food environment. University. Beverages. Foods. Price.

## 144/2780

### FOOD ENVIRONMENT CHARACTERIZATION OF A PUBLIC UNIVERSITY IN RIO DE JANEIRO

(1)Dias, Juliana Furtado; (2)Batista, Carolina de Araujo; (3)Pereira, Alessandra Pereira; (4)Leão, Leila Sicupira Carneiro de Souza; (4)de Aquino, Luana Azevedo; (4)Santos, Claudia Roberta Bocca; (5)Franco, Amanda da Silva.

(1)PhD. Professor. Departamento of Aplicated Nutrition. Nutrition School. Rio de Janeiro Federal State University. Brazil;

(2)Graduation Student. Departamento of Fundamental Nutrition. Nutrition School. Rio de Janeiro Federal State University. Brazil;

(3)Professor. UNIRIO. Rio de Janeiro. Brazil.; (4)PhD. Professor. Departamento of Nutrition and Public health. Nutrition School. Rio de Janeiro Federal State University. Brazil; (5)PhD. Professor. Nutrition Graduation. Veiga de Almeida University. Rio de Janeiro. Brazil.

**Background and objectives:** Food environment analysis helps to identify factors that can influence food behavior and is considered a promising strategy to promote healthy eating habits. Thus, the objective of this study was to describe the food environment of a public university in Rio de Janeiro, Brazil.

**Methods:** The data collection was performed during the second semester of 2016 in establishments located inside the university campuses, totalizing 1 snack bar and 4 establishments with

## 144/2783

### EVALUATION OF THE QUALITY OF LIFE OF HYPERTENSES IN AMBULATORIAL TREATMENT

(1)Dias, Marcia Regina Messaggi Gomes; (2)Damin, Samara; (2)Sousa, Viviane de; (3)Kopruszinski, Cíbele Pereira.

(1)PhD Nutricionist. Nutrition Department. Federal University of Paraná. Brazil; (2)Doctor. Evangelical College of Paraná. Brazil;

(3)PhD Nutricionist. Nutrition Department. Federal University of Paraná. Brazil.

**Background and objectives:** Hypertension is a clinical condition and is considered one of the most important modifiable risk factors for cardiovascular disease. The perception of the disease and its risks, the development of target organ damage, adverse effects of drug therapy and the difficulty faced in changing the lifestyle of this condition are significant determinants of life quality. **Objective:** To evaluate the life quality and how it is associated with socioeconomic profile.

**Methods:** Descriptive cross-sectional study of individuals in ambulatory treatment with systemic hypertension. The Minichal questionnaire was used to evaluate the life quality and the questionnaire of the Brazilian Institute of Geography and Statistics (BIGS) to assess the socioeconomic level.

**Results:** The sample consisted of 51 individuals (59% female). The mean age was 61.10±10.60 years, no statistical difference between the sexes; p=0.25. The mean time of diagnosis of systemic arterial hypertension was 11±8.84 years. The mean systolic blood pressure was 143±21.66 mmHg and the mean diastolic blood pressure was 88±12.44 mmHg. The mean arterial pressure was
106±14.69 mmHg. Of the total sample, 25 (49%) never smoked, 20 (39.2%) were smokers and 6 (11.8%) were still smokers. The mean time of smoking was 4.33 ± 12.84 years and the mean time that ex-smokers quit smoking was 6.95±11.56 years. Only 23 (45%) reported physical activity practicing on a regular basis, and the average frequency in the week were 1±1.91 times. Regarding the Minichal questionnaire on life quality, the mean scores of the responses on the mental state was 6.8±4.99 (0-27), the average scores on the somatic manifestations were 7.2±4.3 (1-17), and the mean total score, summing up the state of mind with somatic manifestations, were 14±8.48 (3-42). Regarding the socioeconomic profile of the sample, according to the BIGS census questionnaire, 38 (74.5%) were classified as low-income senior, 5 (9.8%) low-income and lower 8 (15.7%) lower middle-income.

**Conclusions:** Women showed a worse life quality in relation to the somatic manifestations, compared to men. The lower the individual was classified by the BIGS survey, the worse was the life quality. Those who engage in physical activity had a better quality of life.

**Keywords:** Hypertension, ambulatory treatment, socioeconomic level, quality of life.

144/2804

A NOVEL PROCESSED FOOD CLASSIFICATION
SYSTEM APPLIED TO DISAGGREGATED FOOD
CODES IN THE AUSTRALIAN FOOD NUTRIENT
DATABASE 2011-13

(1)Machado, Priscila Pereira; (1)Steele, Euridice Martínez; (2)Monteiro, Carlos.

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

**Background and objectives:** Evidence that the degree of food processing effectively addresses the quality of diets and their impact on all forms of malnutrition has been documented in several countries. Categorizing foods by the level of processing and by disaggregating both composite and single-ingredient food codes provide more accurate consumption data. The objectives of the study are to disaggregate composite food codes used in the Australian food composition database in order to provide a more precise estimate of intake at the individual level and categorize food components according to the level of food processing.

**Methods:** We identified composite food codes from the Australian Food Nutrient Database (AUSNUT) 2011-13 that were subject to disaggregation. For all those food items judged to be a handmade recipe, food recipes provided by AUSNUT were applied to disaggregate. We classified food items and/or the underlying ingredients into four groups according to NOVA, a new food classification system based on the extent and purpose of industrial food processing. Food item classification was accomplished by taking into account food descriptions in document provided

by AUSNUT, the source of food (e.g. homemade, fast food, takeaway) and the ingredient list of food items sold in Australia. The proportion of NOVA food groups by AUSNUT food group and underlying ingredients were calculated.

**Results:** A total of 3701 food codes (67% of the total) from the AUSNUT 2011-13 were subject to disaggregation. Less than 1% of the food codes that were supposed to be disaggregated was classified in the food code level. Across the food composition database, the overall proportion of unprocessed and minimally processed foods was 34%, culinary ingredients was 3%, processed foods was 12%, and ultra-processed products was 51%.

**Conclusions:** By incorporating disaggregated data combined with the application of the classification system based on the degree of food processing into AUSNUT food composition database, variations can be seen in the proportion of some food groups whose consumption used to be underestimated. This strategy will allow researchers to quantify properly the contribution of the food groups in order to assist in assessing the nutritional quality of the dietary intake of population.

**Keywords:** Food Processing; Classification; Disaggregation; Food composition database

**Further collaborators:**

Professor Timothy Gill and PhD Zhixian Sui from University of Sydney have been collaborated in the application and revision of the NOVA usage in the AUSNUT database.

144/2809

RELATIONSHIP BETWEEN KNOWLEDGE, BELIEFS AND PRACTICES IN BREASTFEEDING OF NURSING MOTHERS AND THE HEALTH TEAM OF THE BARRIO ALTOS DE LA REJA, MORENO, PROVINCE OF BUENOS AIRES. ARGENTINA. 2014

Naumann, Sonia Ana.

MPH. Nutritionist. Research Centre on Food and Nutritional Problems. University of Buenos Aires. Argentina.

**Background and objectives:** This research consisted in identifying knowledges, beliefs and practices (KBP) in breastfeeding (BF) of mothers and local health team members of the Health Unit Nº 39, Barrio Altos de la Reja, Moreno, Province of Buenos Aires, Argentina and the relations between this KBP during 2014.

**Methods:** Qualitative approach favored by semi-structured interviews, participant observation, in situ photographs and notes. Convenience sample of 15 nursing mothers borned in the Province of Buenos Aires, BF or not, and 9 members of the local health team. Categories of analysis: knowledge, beliefs and practices.

**Results:** The majority of the nursing mothers was deprived of BF in the first hour of life. Mothers and health workers known official guidance on exclusive breastfeeding (EBF), but dominated the early introduction of foods/drinks. Both groups doubt about duration of BF and extend it for one year. The main reason for discontinuation of EBF is mothers perception of "my milk is not enough / not fed". The local health team believes is due to lack
of containment of mothers in their environment. The main difficulty linked to the BF according mothers are complications with their breast care and their main preparations for enhanced BF is to modify their diet to produce more and better quality of milk. Knowledge of both groups about benefits of BF focus on nutritional and immunological properties, others are almost unknown to the mothers. Among the disadvantages of BF, some mothers raise their body image, cause leading to interrupt BF, while the health team imaginary supposed to belong this to upper-class levels. Some mothers expressed "shyness" about BF in public spaces. Some males breastfeed longer than women, while health personal ignored BF in terms of gender. BF training aimed at health team is negligible, circumscribing BF promotion activities to nursing mothers in the consulting room.

**Conclusions:** Tensions between KBP regarding BF between the two study groups, mainly in relation to the official recommendations of BF, maternal nutrition during lactation, female and BF aesthetics, gender and BF and the need to strength training BF and promotion in community and primary care health.

**Keywords:** Breastfeeding, health promotion, nutrition, childhood, weaning.

**Further collaborators:** Luisa Pinotti, Gloria Sammartino

144/2811

SODIUM CONSUMPTION PATTERNS ACCORDING TO SOCIODEMOGRAPHIC CHARACTERISTICS IN AN ECUADORIAN POPULATION: RESULTS FROM THE LATIN AMERICAN STUDY OF NUTRITION AND HEALTH (ELANS)

(1)Villar, Monica; (2)Cruz, María Cecilia; (3)Eguiguren, Lucia; (4)Yepez Garcia, Martha Cecilia.

(1)MSc. Nutritionist. Colegio Ciencias de la Salud. Salud Publica. Universidad San Francisco de Quito. Ecuador; (2)BSc. Nutritionist. Colegio Ciencias de la Salud. Salud Publica. Universidad San Francisco de Quito. Ecuador; (3)BSc. Colegio Ciencias de la Salud. Salud Publica. Universidad San Francisco de Quito. Ecuador; (4)MSc. Medical Technology. Ciencias de la Salud. Escuela de Medicina. Universidad San Francisco de Quito. Ecuador.

**Background and objectives:** The World Health Organization (WHO), states that one of the most important risk factors in the emergence of chronic non communicable diseases (NCDs), is the high consumption of sodium and salt in the diet. Due to this, the average of sodium intake in an Ecuadorian population was assessed according to sociodemographic characteristics.

**Methods:** Sample study compriss 800 Ecuadorian participants between 15 and 65 years old, living in the urban area of different cities of the Coast and Sierra. This data was from LANS study (Latin American Study of Nutrition and Health). Two 24-hour recall surveys were performed according to the multi-step methodology on non-consecutive days, so it may be determined the relationship of usual sodium intake and total caloric intake per day. Sodium intake was analyzed according to the different sociodemographic

characteristics (sex, age, region of residence and socioeconomic level) by applying statistical tests T-student, one-way ANOVA and Post Hoc Bonferroni.

**Results:** The average sodium intake was 4901.9 mg per day in the entire sample. Men consume more sodium than women (5387.4 mg and 4423.7 mg, respectively, p= 0.00). There is no significant difference in average sodium intake between the Coast and Sierra of Ecuador, as well as the socioeconomic level. A positive correlation coefficient of 0.73 was found between the consumption of calories and sodium. The foods that contribute most to the diet are popcorn, bacon, pork rind, olives, cheeses, ham and different types of sausages, although not necessarily the most consumed.

**Conclusions:** The average sodium intake found exceeds the amount of sodium recommended by the World Health Organization (up to 2300 mg) by 113%. There is a positive correlation coefficient between the caloric and sodium intake. Foods that contribute the most sodium consumption in Ecuadorians' diet (popcorn, bacon, pork rind) are not necessarily the most frequently consumed.

**Keywords:** Sodium, chronic non communicable diseases, consumption pattern, sociodemographic.

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

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

144/2819

EXECUTING A TECHNICAL CONSULTATION ON FOLATE STATUS IN WOMEN AND NEURAL TUBE DEFECTS RISK-REDUCTION TO PRIORIZE INVESTMENTS AND ACCELERATE FEASIBLE AND EFFECTIVE INTERVENTIONS

(1)Martinez, Homero; (2)Weakland, Aliki; (3)Brown, Ken; (4)Bailey, Lynn;

(5)Botto, Lorenzo; (6)De-Regil, Luz Maria.

(1) MD PhD. Senior Advisor. Micronutrient Forum. Canada.; (2) MPH MSW. Director. Core Engagement LLC. USA.; (3) MD. Senior Program Officer and Initiative Lead. Nutrition Global Development. Bill & Melinda Gates Foundation. USA.; (4) PhD. Professor and Department Head. Foods and Nutrition Department. University of Georgia. USA.; (5) MD. Professor of Pediatrics. University of Utah School of Medicine. USA.; (6) PhD. Director of Research and Evaluation. Nutrition International. Canada.

**Background and objectives:** Reducing the risk of neural tube defects (NTDs) represents a significant and feasible opportunity to decrease the toll of birth defects globally. A large fraction of NTDs are preventable through relatively simple nutritional interventions, based on improving folate status in the population. Yet, many challenges remain including lack of global data on folate sta-
tus and NTDs, implementing sustainable folic acid interventions at scale, and identifying better low-cost, field friendly methods and innovations to assess folate status, deliver interventions for NTD risk-reduction, and monitor outcomes. The objective is to present the development and execution of a technical consultation utilizing an accelerated and directed integrated process, to define the burden of folate inadequacy in women of reproductive age as a basis of assessing NTD risk, to characterize NTD prevalence, and to recommend feasible intervention approaches in low- and middle-income countries.

**Methods:** A multi- and inter-disciplinary committee was established to develop a roadmap that considered the magnitude of the problem, identified knowledge gaps in research and practice, identified feasible opportunities to implement and accelerate interventions, and reflected on the challenges of methodological approaches to risk-reduction. The committee was composed of global experts in nutrition, epidemiology, policy translation, public health program implementation, foalte biomarker assessment, economics, and private industry.

**Results:** An independent, knowledgeable and unbiased committee was formed and a roadmap for action in low- and middle-income countries was developed that includes key scientific and technical contributions to the fields of nutrition and birth defects risk-reduction.

**Conclusions:** A structured, integrated, multi-disciplinary approach to address long-standing gaps in folate assessment and NTD burden yielded long-considered advances in the fields of nutrition and birth defects risk-reduction. Further, the roadmap developed through the consultation is just one part of the necessary equation to amplify prevention globally, as it is imperative to engage collectively and directly with those working at national and sub national levels. This approach harmonized efforts to realize an untapped and significant opportunity to reduce the risk of NTDs through nutritional interventions.

**Keywords:** Folate, neural tube defects, development

144/2820

EFFECTS OF ASTRAGALUS EXTRACT MIXTURE ON BONE GROWTH RATE IN STUNTING-INDUCED ANIMAL MODEL

(1)Kim, Hocheol; (2)Lee, Donghun; (3)Lee, Sung Hyun; (4)Kang, Yunhee.

(1)KMD PhD. Herbal Pharmacologist. Department of Herbal Pharmacology. Kyung Hee University College of Korean Medicine. Seoul. Korea; (2)KMD PhD. Herbal Pharmacologist. Department of Herbal Pharmacology. Kyung Hee University College of Korean Medicine. Seoul. Korea; (3)MSc. Korea Institute of Science and Technology for Eastern Medicine. NeuMed Inc.. Seoul. Korea; (4)PhD. Nutrition consultant. Center for Human Nutrition. Department of International Health. Johns Hopkins Bloomberg School of Public Health. Baltimore. Maryland. USA.

**Background and objectives:** Globally, more than one fourth of children under 5 years of age were stunted. Three quarters of total stunted children are from sub-Saharan Africa and South Asia,

where aflatoxin exposure is common through contaminated maize and groundnuts. Previous studies have demonstrated a correlation between aflatoxin-exposure and stunting. HT042 is a standardized functional food ingredient approved by Korean FDA with a claim "height growth of children". We evaluated efficacy of HT042 on bone growth rate in dietary aflatoxin-induced stunting animal model.

**Methods:** Newly weaned animals were given aflatoxin contained diets with or without HT042 supplementation from 21-42 day old. Tibial length, bone mineral content and bone microstructure were measured at baseline and endpoint by micro CT. Serum or hepatic gene and protein expressions of growth hormone signaling were determined using established methodologies.

**Results:** Aflatoxin-exposed animals exhibited stunted growth, liver pathology and suppression of gene expressions of growth hormone signaling. HT042 supplementation significantly reduced stunted bone growth, bone mineral content compared with a control group. HT042 also attenuated aflatoxin-induced suppression of growth hormone signaling.

**Conclusions:** HT042 protects normal bone growth and bone formation against the experimental stunting induced by dietary aflatoxin. The effects of HT042 may be attributable to its growth hormone stimulating properties. Based on these findings, it is tempting to speculate that HT042 may be a therapeutic candidate for stunted children with aflatoxin exposure.

**Keywords:** stunting, children, HT042, Astragalus extract mixture

144/2821

OPTIMIZATION OF NUTRITIONAL MONITORING OF SCHOOLCHILDREN, JOIN ACTIONS FROM THE MINISTRIES OF EDUCATION AND HEALTH. JUJUY, ARGENTINA

(1)Barsimanto, Graciela Raquel; (2)Aramayo, Hugo; (3)Humacata, Vanesa; (4)Tabera, Celia; (5)Najar, Cristobal; (6)Burgos, Andrea;

(7)Cabello, Manuela; (8)Carabajal, Ana Maria; (9)Velasquez, Rita.

(1)MSc. Nutritionist. APS Nutrition. Public Health Ministry. Jujuy. Argentina; (2)Certify Public Account. General Administration Department. Education Ministry. Jujuy. Argentina; (3)BSc. Informatic Sistems. Education Ministry. Jujuy. Argentina;

(4)Nutririonist. School food.Education Ministry. Jujuy. Argentina;

(5)Physical Education Teacher. Education Ministry. Jujuy. Argentina;

(6)Nurse. School Food. Education Ministry. Jujuy. Argentina; (7)BSc. Medicine. APS Director. Public Health Ministry. Jujuy. Argentina;

(8)BSc. Medicine. Public Health Ministry. Jujuy. Argentina.

**Background and objectives:** Background: In the Province of Jujuy, north of Argentina, the ministries of education and health have taken on the responsibility of developing procedures for nutritional monitoring and follow-up with schoolchildren since 2011 using the WHO Reference 2007, and through conducting a census on paper with manual entry of data. In 2016, they added the anthropometric fields of the software WHO AnthroPlus to the Student Unique File (Legajo Único del Alumno, LUA) of the Student Management Computer System, to use twice yearly in student assessment.
**Objective:** Use WHO AnthroPlus to describe the nutritional status of schoolchildren. Promote, monitor, and evaluate interventions from an inter sectional approach

**Methods:** We used the WHO BMI/Age indicators, which provides differentiated standard deviations (SD): risk of being underweight (-1.9 SD, -1 SD), underweight (<-2 SD), Normal (-0,9 SD, 1 SD), overweight (>1 SD, 1,9 SD), obese (>2 SD). Measurements of weight and height are taken by physical education teachers, and these measurements are then loaded into the LUA system in normalized form. These results are shared with the primary health care system (Atención Primaria de la Salud; APS) to facilitate any necessary interventions.

530 schools and a total of 120,000 children were projected to participate in this monitoring.

**Results:** In the first census in the year 2016, the monitoring system reached a total of 85473 students. Find that 48.6% of the students had a normal nutritional status, 5,2% presented a risk of being underweight, 1.4% were underweight, 24,3% were overweight and 20,5% were obese.

This allows knowing the prevalence of malnutrition in each region of the province

**Conclusions:** The incorporation of the WHO AnthroPlus software in the LUA system has allowed for the collection of timely indicators for an integral approach to the school-age population through the primary health care system (APS). It has also proved to be an adequate system for epidemiology nutritional monitoring in schools and in primary health care centers at the different geographic areas of Jujuy.

**Keywords:** Nutrition- Schools -Monitoring, WHO AnthroPlus - PRIMARY HEALTH, CARE

**Further collaborators:** Ariel Villalba. Emiliana Garzón. Veronica Serra. Jorge Yurquina. Federico Liquin. Viviana Levin. Susana Galo

more when it occurs in adolescents. The objective was to determine the food consumption and physical activity of a group of obese adolescents with insulin resistance.

**Methods:** After an anthropometric census to 1,206 high school adolescents, it was detected that 25.1% (n = 303) were obese. With the obese adolescents who agreed to participate (n = 246), insulin resistance (IR) was determined using HOMA-I, with a cutoff value >=3.16, to define IR. We interviewed 59 adolescents with two questionnaires. One was a Food Frequency which included ten food groups: Whole dairy products, Integral cereals, Legumes, Fruits, Vegetables, Added Sugar, Fatty foods, Confectionery, Salt added and Fried foods. For every food group consumed suitably a point was assigned. Two groups were formed "Adequate Consumption" with >= 7 points, and "Inconsistent Consumption" <7 points. Regarding the instrument on physical activity, a validated instrument was used (Godard et al., 2008). According to this questionnaire, "active" participants should have >=5 and "Inactive" less than 5 points.

**Results:** Seventy nine percent (n=47) presented an "Inadequate Consumption" of food groups. The most prevalent was the Sugar Candy and Soft Drinks with 94.9% (n = 57). Among the foods most consumed in this group were candies / chewing gum, sweet cookies and potato chips with a frequency greater than 3-4 times/week in more than 20% of the respondents. The next group of foods with a high percentage of "Inadequate Consumption" was whole dairy products, 57.6% (n=34). Fifty five percent (n=33) of the adolescents was in the 'Active' category. Finally, it was found that in the 'Active' group as well as in the 'Inactive' one, more than 70% of the participants had "Inadequate Consumption".

**Conclusions:** There is a high prevalence of inadequate food consumption, especially from the Sugar Candy and Soft Drinks group. Although more than half of the adolescents were considered as physically "Active" however 70% of them had inadequate food consumption.

**Keywords:** obesity, adolescents, physical activity, diet

144/2827

## FOOD CONSUMPTION AND PHYSICAL ACTIVITY IN ADOLESCENT OBESE WOMEN WITH INSULIN RESISTANCE

**Background and objectives:** The prevalence of obesity concerns for its close relationship with metabolic disorders and even

144/2828

## SEDENTARY BEHAVIOR AND ITS ASSOCIATION WITH UNIVERSITY STUDENTS' NUTRITIONAL STATUS

**Background and objectives:** Sedentary behavior is an important factor influencing students' weight. Therefore, the purpose

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

<footnote>(5)Cochachin Henostroza, Omaira; (5)Aquino Ramírez, Anthony;</footnote>

<footnote>(5)Baca Quiñonez, Jean.</footnote>

<footnote>(1)MSc. Biologist. Instituto de Investigación Bioquímica y Nutrición. Universidad Nacional Mayor de San Marcos. Perú; (2)MSc. Medical Doctor. Instituto de Investigaciones Clínicas. Universidad Nacional Mayor de San Marcos. Lima. Perú; (3)MSc. Centro Nacional de Alimentación y Nutrición. Instituto Nacional de Salud. Lima. Perú; (4)Medical Doctor. Servicio de Endocrinología. Hospital Nacional Dos de Mayo. Lima. Perú; (5)Student. School of Nutrition. Universidad Nacional Mayor de San Marcos. Lima. Peru.</footnote>

<footnote>(1)Vieira Liberato, Juliana; (2)De Alcântara, Solange Pires Leite;</footnote>

<footnote>(2)Gobetti, Clara Affonso; (3)De Alcântara, Bruno Dos Santos; (4)de Aquino, Luana Azevedo.</footnote>

<footnote>(1)IC à BSc. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (2)BSc. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (3)MSc. Graduate Program in Collective Health. Fluminense Federal University. Brazil.; (4)PhD. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.</footnote>
of this study was to evaluate the sedentary behavior and its associ-
ation with the nutritional status of university students.

**Methods:** The present study consisted of a cross-sectional cut-out of the baseline of the "Longitudinal Study of Nutrition and Health in University Students (NUTSAU)", with students enrolled in the second period of UFRJ-Campus Macaé. The instrument used for data collection was a structured self-completion questionnaire. The anthropometric evaluation consisted in the measurement of body mass and height, and later the body mass index was estimated. Sedentary behavior was estimated based on responses to sitting time, time spent watching television and time spent using consumer electronics daily. It was considered sedentary behavior more than 6 hours per day sitting (Craig et al, 2003), more than two hours watching television or using electronics (Strasburger et., 2013). Statistical analysis was performed using the SPSS application version 19.0. The project was approved by the Research Ethics committee of UFRJ-Campus Macaé.

**Results:** The sample consisted of 147 university students, of whom 22.6% of the women and 26.2% of the men were overweight. Regarding the sitting time, in the use of electronics and watching TV, it was observed that 75%, 92.1% and 38.6% of the students, respectively, performed such activities above the recommended time. There was a higher time of excessive use of electronic devices among women (66.4%, p = 0.02), totaling 396.3 ± 322.2 min / week among non-overweight university students compared to 413.3 ± 318.5 min / week in college students with excess weight (p = 0.79).

**Conclusions:** There was a high prevalence of excessive time in sedentary behavioral activities, with a greater association of the use of electronic devices among the female sex.

**Keywords:** Sedentary behaviors, Nutritional status, University

**Methods:** A descriptive cross-sectional study was carried out in six rural communities of Guatemala. The study included 538 children of both genders three to nine years and 1,060 parents. The instrument included sociodemographic, anthropometric (BMI/age), dietary and environmental aspects. The analysis used regression and multivariate models.

**Results:** 49% of children in the study had some type of malnutrition due to excess or deficiency. In children under five, 8% presented mild undernutrition, 2% moderate undernutrition, 76% normal nutritional status, 9% overweight and 5% obesity. In children 5 to 9 years old, 1% showed underweight, 84% normal nutritional status, 13% overweight and 2% obesity. An increased risk for chronic malnutrition was found in children under 5 (OR 2.35), male (OR 1.40), children of illiterate mothers (OR 1.41), children with extended family (OR 1.93), and children with hemoglobin levels lower than 11 g/dl (OR 2.93). The risk for acute malnutrition and anemia increases with the number of children in the family (OR 1.50 and 20.56 for each additional child respectively). Western children under five, male, of families with two children had a 19.29 times higher risk of acute malnutrition than children from the East. Two percent of the children showed coexistence of malnutrition, stunting along with overweight or obesity. The dietary pattern identified was low in protein and fiber and high in sugars, salt and fat.

**Conclusions:** The study identified a higher prevalence of malnutrition due to excess than to deficiency in the group of children from rural communities in Guatemala. The study identified risk factors for malnutrition due to deficiency such as being a child under five, male, child of an illiterate mother, be part of an extended family, have two or more siblings, well water use and ground floor.

**Keywords:** malnutrition, children, sociodemographic risk factors, nutritional risk factors

**Further collaborators:**

Eugenia Colom, MD. Faculty of Medicine and Health Sciences.
Mariano Galvez University. Guatemala.

Fernando Ortiz, MD. Faculty of Medicine and Health Sciences.
Mariano Galvez University. Guatemala.

144/2835

## SOCIODEMOGRAPHIC AND NUTRITIONAL RISK FACTORS ASSOCIATED WITH MALNUTRITION DUE TO EXCESS AND DEFICIENCY IN CHILDREN AGED 3 TO 9 YEARS IN RURAL COMMUNITIES OF GUATEMALA

(1)López-Donado, Lorena; (2)de Leon, Mercedes; (2)Quiñonez, Esthefany; (2)Ruiz, Carolina; (2)Sabido, Juan Carlos; (2)Suazo, Pavelka; (2)Galicia, Cristian.

(1)MSc Nutritionist. School of Nutrition. Faculty of Medicine and Health Sciences. Mariano Galvez University. Guatemala;
(2)BSc physician. Faculty of Medicine. Mariano Galvez University. Guatemala.

**Background and objectives:** In Guatemala, 49% of children have chronic malnutrition. A state of malnutrition, both in excess and deficiency, is associated with several health problems. Low weight can affect proper growth and development and obesity during childhood is related to chronic diseases in the adult stage. The objective was to identify children with malnutrition as well as their associated risk factors.

144/2837

## EATING HABITS OF BREAKFAST AND LUNCH IN MEXICAN CHILDREN

(1)Chávez Palencia, Clío; (2)Arellano Gómez, Laura.

(1)PhD. Nutritionist. Department of Population Health Sciences.
University of Guadalajara. Mexico.; (2)PhD. Nutritionist.
Department of Health, Psychology and Community. Jesuit
University of Guadalajara. Mexico.

**Background and objectives:** Children's obesity is a global nutritional issue with an increasing prevalence. In 2012, the prevalence of overweight and obesity in Mexico was 34.4% in school-aged children. There is evidence that processed food and sweetened beverages are main contributors to obesity epidemic in children. The objective to this study was to describe eating habits of breakfast and lunch in Mexican children.
**Methods:** Descriptive observational study. The data were obtained from a current participatory intervention study in 330 school-aged children at six public schools from Acatlán de Juárez, Jalisco, Mexico. These are descriptive baseline results were obtained by an interview about breakfast eating habits and observation of food consumption in lunch. We analyzed food and beverages available at schools and surroundings. Food intake at lunch was observed and analyzed with National Health and Nutrition Survey 2012 database.

**Results:** More than half of the children did not eat breakfast before school (54.4%). 55% of the children brought lunch from home, the rest bought in school. The main reason because they didn't brought it was because the parents did not have time to prepare lunch. The person who decides what to take with snacks in all the subjects who do it is the mother or the father (62.6%), followed by the same child (30.7%), grandparents (5%) and others %). Of the schoolchildren who carry home snacks in total, only 21.1% carry between 0-3 times a week fruit and 7.8% vegetables. The percentage of children who had an adequate energy intake at lunch was only 5.2%. On average, lunch provided 314.4 kcal (±246.6 SD), 9.7 g (±9.7 SD) of protein, 43.8 g (±35 SD) of carbohydrates ad 11.7 g (±12.7 SD) of lipids. Sugar provided more than recommended daily (20.9 g). The percentages of daily recommendation were 10.3 for calcium, 21.9 for iron, 15 for zinc, 14.6 for vitamin A, 76.7 for vitamin C. Percentage of school children who were higher than the sodium recommendation for lunch was 57.6.

**Conclusions:** Eating habits of breakfast and lunch in Mexican children found to be inadequate. Advice is required on the sale and preparations of snacks according to the recommendations.

**Keywords:** eating habits, breakfast, lunch, obesity

144/2838

DETERMINANTS OF FOOD CHOICES AND ITS
ASSOCIATION WITH UNIVERSITY STUDENTS'
NUTRITIONAL STATUS

(1)De Alcántara, Solange Pires Leite; (1) Gobetti, Clara Affonso; (1)Vieira Liberato, Juliana; (2)De Assis, Bruno Dos Santos; (3)de Aquino, Luana Azevedo.

(1)BSc. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (2)MSc. Graduate Program in Collective Health. Fluminense Federal University. Brazil.; (3)PhD. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.

**Background and objectives:** Food choices are one of the most important factor influencing students' weight. Therefore, the purpose of this study was to evaluate the context of determinants of food choices and its association with the nutritional status of university students.

**Methods:** Cross-sectional analysis of data derived from the baseline of the "Longitudinal Study of Nutrition and Health in University Students (NUTSAU)", conducted in second-semester students of Rio de Janeiro Federal University-Macaé Campus. The instrument used for data collection was a structured self-completion questionnaire.

The anthropometric evaluation consisted of body mass and height measurements, and thus body mass index was calculated. The determinant choice pattern was estimated based on nine questions with three response options. Statistical analysis was performed using the SPSS program, version 19.0. The project was approved by the Research Ethics Committee of UFRJ-Macaé Campus.

**Results:** The sample consisted of 62 university students. In relation to BMI, 21% overweight. It was observed that the motivation for food choices in relation to the natural content (n = 50), 60% of the students indicated natural ingredients, of which 73.3% were classified as adequate, 26% indicated that they did not contain artificial ingredients, of these 92.3% classified as adequate and 14% without additives, 57.1% with excess (p = 0.055). Regarding ethics (n = 48), 72.9% of students preferred foods with packaging that did not harm the environment, of which 80% were classified as adequate (p = 0.047). W eight control (n = 50), 50% indicated foods that are low in fat, 84% rated as adequate, 40% assist in weight control, 70% as appropriate, 10% foods with low calories, 60% in excess P = 0.107). Considering the price (n = 53), it was observed that 60.4% indicated a fair price, 22.6% cheap and 17% not expensive (p = 0.294).

**Conclusions:** The present study showed that the determinants of "natural content" and "ethics" may be a protective factor for overweight in university students.

**Keywords:** Food choice. Nutritional status. University.

144/2841

FACTORS ASSOCIATED WITH ENERGY ADEQUACY IN PERUVIAN ADOLESCENTS AND ADULTS: RESULTS FROM THE ELANS STUDY

(1)Pareja, Rossina Pareja; (2)Liria Domínguez, María Reyna.

(1)MSc. Nutritionist. Instituto de Investigación Nutricional. Peru;

(2)PhD Nutritionist. Instituto de Investigación nutricional. Peru.

**Background and objectives:** The adequacy of energy intake is associated with nutritional requirements and therefore nutritional status. The aim of this study is to determine the factors associated to energy adequacy in Peruvian adolescents and adults.

**Methods:** Data were obtained from the Latin American Health and Nutrition Study of Peru (ELANS-Peru), a multicenter study conducted in urban areas of 8 Latin American countries. Two 24 hour dietary recall were conducted in 1113 Peruvians (15 to 65 years old) and processed using the Nutritional Data System for Research (NDS-R) software. Multiple Source Method was applied to estimate the usual intake (kcal). For energy adequacy (EA), basal energy expenditure-BEE was calculated according to age, sex and physical activity level-PAL proposed by Gerrior et al (2006), using the long IPAQ. A multiple regression analysis was conducted to estimate the associated factors at 95% confidence level.

**Results:** Associated factors with EA were: (i) by age: adolescents had higher percentage of energy adequacy than the 20 to 49 years old population (106% vs 99% p=0.006), (ii) by sex: women showed greater EA than men (104% vs 94%, p<0.000), (iii) by PAL:
as the level of physical activity (PA) decreases, EA increases (active-very active 82%, low active 94%, sedentary: 106%, p<0.000 between each PA category, (iv) by region, the adequacy found was as follow: Lima city and Callao 101%, Coast 97%, Mountain 100% and Forrest 108%, where the Forrest had significantly higher adequacy than the others (p=0.015), (v) by socioeconomic level: an inverse association was found between socioeconomic level and EA (low 103%, middle 100% and high 95%), significant differences were found between low vs high level (p<0.000) and middle vs high (p=0.021), (vi) by BMI: people with higher BMI had lower EA (normal 127%, overweight 107%, obese: 95%, p<0.000).

**Conclusions:** The inverse association found between BMI and EA could be due to an overestimation of energy requirements and/or underreporting of overweight and obese people.

EA is higher in young boys and girls, in woman, in poor and in sedentary people. Developing strategies to adjust intake to recommendations should take into account the associated variables.

**Keywords:** Energy, adequacy, ELANS,

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

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

144/2844

COOKING SKILLS INDEX - BRAZIL: DEVELOPMENT AND RELIABILITY ASSESSMENT

**Background and objectives:** Despite the importance of the cooking skills for healthy eating, this subject has hardly been explored scientifically in Brazil. The lack of an instrument for measure those skills and adapted to the Brazilian reality may be one of the reasons for the scarcity of these studies. This work describes

the development and the reliability assessment of an index to evaluate cooking skills in Brazil.

**Methods:** The Cooking Skills Index - Brazil (CSI-Brazil) is a 0-100 index specially designed for this research, which was based on the Brazilian's Dietary Guidelines (2014), and results from the application of ten questions about the confidence regarding cooking skills considered relevant in Brazil. The reliability assessment was conducted with the repeated application (test-retest) of the questions to 51 parents of school-age children residing in São Paulo, SP, Brazil. Internal consistency was assessed by the Cronbach's alpha. Reproducibility was assessed by the quadratic weight kappa (95% CI) and the prevalence and bias adjusted kappa (PABAK).

**Results:** The participants (n=51) were mostly mothers (92.2%), aged between 30 and 39 years (64.7%), white (67.4%), married (84.3%), employed (80.4%) and with complete secondary education (44%). According to the Cooking Skills Index - Brazil, these participants reached similar average points on test-retest interviews (71.3 points -range 46.7-93.3; 71.8 points - range 50-96.7, respectively). The Cronbach's alpha of the instrument (0.75) indicated good internal consistency. The weighted quadratic kappa for the total of the items indicated moderate instrument reproducibility (0.55), while the PABAK showed almost perfect reproducibility (0.89).

**Conclusions:** As advantages, the developed instrument is short and simple, has easy, fast and standardized application, and synthesizes skills in a scale from zero to 100, which facilitates their interpretation. In this first evaluation, the CSI-Brazil showed good internal consistency (Cronbach's alpha> 0.70) and acceptable reproducibility (weighted kappa 0.55; adjusted kappa 0.89), recommending its use in studies to evaluate cooking skills in Brazil.

**Keywords:** Cooking. Surveys and Questionnaires. Reproducibility of Results:

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

144/2859

BODY MASS INDEX AND INTRAMUSCULAR FAT INFILTRATION IN FRAIL AND NON-FRAIL ELDERLY

**Background and objectives:** Aging determines several changes in body composition, and is associated with increased fat

<footnote>(1)Adriano Martins, Carla; (2)Baraldi, Larissa; (3)Scagliusi, Fernanda;</footnote>

<footnote>(4)Slater Villar, Betzabeth; (5)Monteiro, Carlos.</footnote>

<footnote>(1)PhD candidate. Nutritionist. School of Public Health. Center for Epidemiological Studies in Health and Nutrition. University of Sao Paulo. Brazil; (2)PhD. Nutritionist. Center for Epidemiological Studies in Health and Nutrition (NUPENS). Department of Nutrition, School of Public Health, University of Sao Paulo. Brazil;</footnote>

<footnote>(3)Professor. Nutritionist. Center for Epidemiological Studies in Health and Nutrition (NUPENS). Department of Nutrition, School of Public Health, University of Sao Paulo. Brazil; (4)Professor. Department of Nutrition. School of Public Health. Center for Epidemiological Studies in Health and Nutrition. University of Sao Paulo. Brazil; (5)Professor. Center for Epidemiological Studies in Health and Nutrition (NUPENS). Department of Nutrition, School of Public Health, University of Sao Paulo. Brazil.</footnote>

<footnote>(1)Maira da Cruz Alves, Natália; (2)Ailton Oliveira Carneiro, José;</footnote>

<footnote>(3)Pfrimer, Karina; (4)Pinheiro Amador dos Santos Pessanha, Fernanda; (5)Lopes de Pontes, Tatiane; (6)Ferriolli, Eduardo.</footnote>

<footnote>(1)MsC. Physiotherapist. Internal Medicine by the Ribeirão Preto Medical School - University of São Paulo. Brazil.; (2)PhD in Internal Medicine by the Ribeirão Preto Medical School - University of São Paulo. Brazil.; (3)PhD. Nutritionist. Internal Medicine by the Ribeirão Preto Medical School - University of São Paulo. Brazil.; (4)MsC. Physiotherapist. Internal Medicine by the Ribeirão Preto Medical School - University of São Paulo. Brazil.; (5)BSc in Nutrition by the Federal University of Amazonas. Brazil.; (6)MD. PhD in Internal Medicine by the Ribeirão Preto Medical School - University of São Paulo. Brazil.</footnote>
mass and changes in its distribution pattern. All changes in body
composition have importance in the functionality of the elderly, as
they culminate in a reduction of muscle with the increase of total
body fat, making the elderly more susceptible to a limitation of
mobility. The purposes of this study were: To compare the intra-
muscular fat infiltration in frail and non-frail elderly and to verify
its association with muscle mass and body mass index.

**Methods:** Cross-sectional exploratory study. A total of 40 el-
derly people (10 non-frail men and 10 non-frail women, 10 frail
men and 10 frail women) selected at the Geriatrics Outpatient
Clinic of the Hospital das Clínicas de Ribeirão Preto. Body weight
and height were measured and body mass index (BMI) calculat-
ed. Thigh muscle volume (MV) and intramuscular fat infiltration
(IMAT) were assessed by nuclear magnetic resonance.

**Results:** The mean BMI, IMAT and MV of the groups were: non-frail women: 28.8±5.5kg.m⁻²; 6.84±2.4 % and 150,0±19,2cm3; Frail women: 31.75 ± 5.8 kg.m⁻²; 11.16±3.5% and 130.8±28.6cm3; Non-frail men: 26.8±5.1 kg.m⁻²; 5.75±1.77% and 223.7±15.8 cm3; Frail men: 24.3±5.3kg.m⁻², 7.55±2.3% and 237.2±26.8 cm3. In the frail elderly group IMAT had a moderate positive association with BMI (r=0.57, p<0.05). In the non-frail elderly group, IMAT presented a strong negative association with muscle volume (r= -0.62, p<0.05).

**Conclusions:** Increase in total body fat, as assessed by the BMI, was associated with increased fat infiltration in muscle, which seems to influence negatively muscle volume.

**Keywords:** intramuscular fat infiltration, body composition, aging

months of age. The proportions of children meeting the minimum
dietary diversity (MDD), minimum meal frequency (MMF) and
minimum acceptable diet (MAD) were calculated.

**Results:** At 12 months, the proportion of children who were breastfed (97.5% in the SQ-LNS vs. 95.0% in the MNP group, p=0.238), received food from a 4 or more food groups (93.6% in the SQ-LNS vs. 94.9% in the MNP group, p=0.590), received solid, semi-solid, or soft foods the minimum number of times or more (86.8% in the SQ-LNS vs. 91.9% in the MNP group, p=0.118), received a MAD (87.0% in the SQ-LNS vs. 91.2% in the MNP group, p=0.149) did not differed by group. When season was taken into account (which differed between groups at baseline), provision of SQ-LNS was associated with higher odds of meeting the MMF (Odds Ratio [OR] =2.7, 95% CI: 1.3-5.9) and MAD (OR=2.7, 95% CI: 1.2-5.8) indicators. Further adjustment for food insecurity, maternal education and child's age did not further change these results.

**Conclusions:** Provision of SQ-LNS to infants receiving regular preventive care services did not reduce breastfeeding rates, or the proportion of them meting the MDD, MMF or MAD indicators, while it may positively affect meal frequency and acceptable diet in this population.

**Keywords:** lipid-based nutrient supplements, breastfeeding, dietary diversity, minimum meal frequency, minimum acceptable diet

**Further collaborators:**

Funding provided by the UBS Optimus Foundation and the Action Against Hunger Foundation. The lipid-based nutrient supplements (Nutributter®) were donated by Nutriset (Malaunay, France).

144/2882

PROVISION OF LIPID-BASED NUTRIENT SUPPLIES AND INFANT AND YOUNG CHILD FEEDING PRACTICES IN HUÁNUCO, PERU

(1)Matias, Susana; (2)Vargas-Vasquez, Alejandro.

(1)PhD. Epidemiologist. University of California. Davis. USA; (2)MS.
Nutritionist. Fundación Acción Contra el Hambre. Perú.

**Background and objectives:** The use of small-quantity li-
pid-based nutrient supplement (SQ-LNS), a food-based home
fortification product, may be an effective strategy to prevent un-
dernutrition, however there are concerns about the possibility of
affecting infant and young children feeding (IYCF) practices.

We aimed to examine the effects of providing SQ-LNS to chil-
dren from 6 to 12 months on their IYCF practices.

**Methods:** In a two-arm randomized effectiveness trial conducted in Huánuco (Peru), children were enrolled at 6 months of age (n=422) and received either SQ-LNS or multiple micronutrient powders (MNP) from 6-12 months. Supplements were distributed during their monthly child well-being appointments at Ministry of Health (MOH)-run health centers. Baseline information included infant, maternal and sociodemographic data. In addition of the primary (growth and anemia) and secondary (child development) study outcomes, information on breastfeeding, dietary diversity and meal frequency during the previous 24-h were collected at 12 months of age.

144/2903

SERUM/PLASMA LEVELS OF ZINC IN TYPE 2 DIABETIC SUBJECTS VERSUS HEALTHY SUBJECTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

(1)Fernández Cao, José Cándido; (2)Warthon-Medina, Marisol; (3)Hall
Moran, Victoria; (4)Arija, Victoria; (5)Serra-Majem, Lluis; (6)Lowe,
Nicola M.

(1)PhD. Nutritionist. Departamento de Nutrición y Dietética. Facultad de Ciencias de la Salud. Universidad de Atacama. Copiapó. Chile.; (2)PhD. Nutritionist. Section of Nutrition and Public Health. School of Food Science and Nutrition. University of Leeds. Leeds. UK.; (3)PhD. Nutritionist. Maternal and Infant Nutrition and Nurture Unit. University of Central Lancashire. Preston. UK.; (4)PhD. Medical. Unidad de Nutrición y Salud Pública. Facultad de Medicina y Ciencias de la Salud. Universitat Rovira i Virgili. Reus. Spain.; (5)PhD. Medical. Research Institute of Biomedical and Health Sciences (IUIBS). University of Las Palmas de Gran Canaria. Las Palmas. Spain; (6)PhD. Biochemistry. International Institute of Nutritional Sciences and Applied Food Safety Studies. School of Sport and Wellbeing. University of Central Lancashire. Preston. UK.

**Background and objectives:** Type 2 diabetes mellitus (T2DM) is one of the leading chronic diseases worldwide. Zinc
plays an important role in glucose metabolism, joining in the syn-
thesis, storage, secretion and action of insulin. A large number of
studies have compared serum/plasma levels of zinc in subjects
with T2DM vs. nondiabetic subjects, but their results are incon-
clusive. This systematic review and meta-analysis aimed to com-
pare serum/plasma levels of zinc in type 2 diabetic subjects with-
out complications vs. healthy subjects.

**Methods:** This study has been registered in Prospero (2015: CRD42015020178). A robust search developed in the EURRECA Network was performed at Embase, Pubmed/Medline, and The Cochrane Library until March 16, 2016. Studies were selected if a) they had an observational design, b) were performed on subjects >18 years, c) had data on the mean and standard deviation of serum/plasma levels of zinc in both type 2 diabetic subjects without complications and nondiabetic subjects. Animal/lab studies, studies with diabetic participants other than T2DM, and study designs other than cross-sectional, case-control and prospective cohort studies were excluded. Potentially relevant articles for the systematic review and meta-analysis were selected for full exploration. Data are expressed as mean differences (MD) with 95% CIs, using the generic inverse-variance random-effects model. Heterogeneity was assessed by the Cochran Q-statistic and quantified by the I2 statistic (significance P<0.100). Publication bias was investigated by visual inspection of funnel plots and quantitatively assessed using Egger's and Begg's tests. All analyzes were performed using STATA 12.

**Results:** The search strategy initially yielded 12,044 publications, of which 29 were initially selected. Finally, 19 studies were included in the final meta-analysis after excluding poor quality studies according the STROBE checklist. Pooled analysis showed that MD for serum/plasma levels of zinc was -11.82mg/dL (95% CI: -18.86, -4.78). There was no evidence of publication bias (P = 0.723), but heterogeneity was high (I2 = 97.7%, P <0.001).

**Conclusions:** In this systematic review and meta-analysis we observed lower serum/plasma levels of zinc in subjects with T2DM than in healthy subjects. However, given the high heterogeneity, further studies would be necessary to confirm this result.

**Keywords:** Zinc, type 2 diabetes mellitus, systematic review and meta-analysis,

especially those one regarding the nutrition facts label (NFL). How-
ever, the comprehension of the food labels remains inadequate for
most of consumers. In this context, the aim of this study was to
report the reading habits of food labels and NFL by professors of a
private university in São Paulo-Brazil.

**Methods:** A descriptive study was performed through a cross-sectional approach. A structured questionnaire with 29 questions was applied addressing socio-demographic features and food labels-related variables, such as, reading habits and reading motivations. The nutritional characteristics most observed in the NFL were identified as well as its possible influence in the purchase intention. A group of 38 professors from a private University in São Paulo-Brazil, from both gender, was randomly interviewed. The exclusion criterion was professors graduated in Nutrition.

**Results:** The mean age of the interviewed was 43.0 years (±10.9) and the average household income was greater than 10 minimum wages (68.4%). Regarding the food label, the expiration date was the item most observed (27.2%). Most of interviewed (70.6%) reported reading the NFL frequently. The main reason for using NFL was the consumer's concern for a healthy diet (21.2%). The other reasons were the fat, cholesterol and sodium content. The information most and less read were quilocalories content and daily value percentage, respectively. About 92% of the interviewed reported NFL content influence in their purchase intention.

**Conclusions:** It was observed that most of the interviewed was concerned about NFL content to keep a healthy diet, which influence their purchase intention.

**Keywords:** food label; nutrition facts label; purchase intention.

144/2905

READING HABITS OF FOOD LABELS BY PROFES-
SORS OF A PRIVATE UNIVERSITY IN SÃO PAU-
LO-BRAZIL

(1)Kato Takano, Deise; (2)Baldan Pineda, Paula Henrique; (3)Lucca, Alessandra.

(1)BSc. Nutritionist. Health Sciences Institute. Universidade Paulista. Brazil.; (2)MSc. Biologist. Health Sciences Institute. Universidade Paulista. Brazil.; (3)PhD. Nutritionist. Health Sciences Institute. Universidade Paulista. Brazil.

**Background and objectives:** Food labels allow for consum-
ers choosing food products according to their characteristics, es-

144/2906

READING HABITS OF FOOD LABELS BY STU-
DENTS OF A PRIVATE UNIVERSITY IN SÃO PAU-
LO-BRAZIL

(1)Oliveira Sampaio Novaes, Karina; (2)Baldan Pineda, Paula Henrique; (3)Lucca, Alessandra.

(1)BSc. Nutritionist. Health Sciences Institute. Universidade Paulista. Brazil.; (2)MSc. Biologist. Health Sciences Institute. Universidade Paulista. Brazil.; (3)PhD. Nutritionist. Health Sciences Institute. Universidade Paulista. Brazil.

**Background and objectives:** Food labels allow for consum-
ers choosing food products according to their characteristics, es-
pecially those one regarding the nutrition facts label (NFL). How-
ever, the comprehension of the food labels remains inadequate for
most of consumers. In this context, the aim of this study was to
report the reading habits of food labels and NFL by students of a
private university in São Paulo-Brazil.

**Methods:** A descriptive study was performed through a cross-sectional approach. A structured questionnaire with 29 questions was applied addressing socio-demographic features and food labels-related variables, such as, reading habits and reading motivations. The nutritional characteristics most observed in the NFL were identified as well as its possible influence in the pur-
chase intention. A group of 53 students from a private University in São Paulo-Brazil, from both gender, was randomly interviewed. The exclusion criterion was students attending in Nutrition graduation course.

**Results:** The mean age of the interviewed was 21.93 years (±5.72) and the average household income was between 2 and 5 minimum wages (52.8%). Regarding the food label, the expiration date was the item most observed (42.5%). Minority of interviewed (28.3%) reported reading the NFL frequently. The main reason for using NFL was the consumer's concern for a healthy diet (33.8%). The other reason was the non-understanding of the food label (23.6%). The most and less familiar terms were quilocalories (19.2%) and daily value percentage (80%), respectively.

**Conclusions:** The minority of the interviewed was concerned about NFL content, mainly due to the non-understanding of the specific terms.

**Keywords:** food label; nutrition facts label; healthy diet.

144/2910

INTERNET BASED PRECISE INDIVIDUAL DIETARY INTERVENTION STRATEGY, A PILOT SCHEME FOR IODINE

Zhang, Wanqi; Cui, Tingkai.

Department of Nutrition and Food Hygiene. School of Public Health. Tianjin Medical University. Tianjin. China.

**Background and objectives:** Though the Universal Salt Iodization (USI) eliminated Iodine Deficiency Disorders in China, a number of people still remain iodine deficient or excessive. Single level of table salt iodization does not fit everyone as iodine content in diets and the environment varies dramatically, and dietary habits differ greatly among populations. Precise individual dietary intervention is essential to change this situation. Individual iodine status assessment is the prerequisite for iodine intervention but so far there is no acceptable biomarkers to reflect it. Meanwhile, individual dietary guidance requires food consumption assessment. Food Frequency Questionnaire (FFQ) is a good tool for individual nutrients intake calculation, but respondents need to be guided by professions when filling the paper-based questionnaire, and calculation and interpretation of the results is also nutritional specialists dependent, which precludes large-scale utilization.

**Methods:** To build up an internet-based iodine status evaluation and intervention system, the following work must be completed. Local optimized iodine-specific food frequency questionnaire (I-FFQ) is revised. Iodine content data of local food and drinking water is determined. An internet-based software is developed. By transforming the paper based I-FFQ into an Internet-based App that calculates precise iodine intake with a food composition database, an accurate, fast, free and convenient self-evaluation tool is made available to the public as a simple individual guidance to choose from multiple levels of iodization salt.

**Results:** To achieve an optimal iodine intake, a tailored diet guidance is constructed from user's physiological data and diet

trend as the feedback result, along with a table salt option suggestion. By prioritizing food with popularity and iodine concentration using data analyzed from thousands of I-FFQ surveys, we improved App usability.

**Conclusions:** Revising USI with the combined strategy of our App and multi-level salt iodization, optimal iodine intake can be easily achieved. On the basis of the above plan, other nutrients can be added so that the system will be applicable to all diet nutrients.

**Keywords:** iodine; internet; USI; individual; intervention

144/2916

ASSESSMENT OF SODIUM INTAKE IN SAMPLE OF MOROCCAN CHILDREN USING 24 H URINARY EXCRETIONS

(1)Saeid, Naima; (2)Elmzibri, Mohamed; (1)Qandoussi, Latifa; (3)Elberri, Hicham; (1)Raji, Fatiha; (1)Baddou, Issad; (2)Elkari, Khalid; (4)Aguenaou, Hassan.

(1)PhD. Joint Research Unit in Nutrition and Food. URAC 39 (CNESTEN-Ibn Tofail University). Regional Designated Center of Nutrition (AFRA/IAEA). Morocco; (2)Dr. Joint Research Unit in Nutrition and Food. URAC 39 (CNESTEN-Ibn Tofail University). Regional Designated Center of Nutrition (AFRA/IAEA). Morocco;

(3)Dr. Epidemiology & Control Diseases Directorate Ministère de la Santé / Ministry Of Health. Morocco; (4)Pr. Joint Research Unit in Nutrition and Food. URAC 39 (CNESTEN-Ibn Tofail University). Regional Designated Center of Nutrition (AFRA/IAEA). Morocco.

**Background and objectives:** Background: Worldwide, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity accounting globally for 60% of all deaths and 43% of disease burden globally. Nowadays, it is widely accepted that an excessive intake of salt is associated with a broad range of NCDs, such as hypertension and cardiovascular diseases. The World Health Organization (WHO) recommendation outlines the importance of prioritizing sodium intake reduction, as a main approach to reduce blood pressure and to decrease the risk of CVDs and strokes. WHO recommends for adults, the consumption of less than 2 g of sodium / day (5g of salt / day). For children, the reduction of sodium intake prevents and decrease risk of hypertension during childhood. In fact, 33% of Moroccans suffer from hypertension, and 13% are obese. Aims: The present study was planned to assess the status of sodium in a Moroccan children living in Rabat region. This study takes place as part of the national action plan for the fight against non-communicable diseases (NCD) of 2014-2016.

**Methods:** The study was conducted on 131 children aged 6-18 years. Sodium excretion was measured by 24-h urinary collection by Inductively Coupled Plasma Mass Spectrometry and the creatinine excretion was used to validate completeness of urine collections.

**Results:** The average of urinary sodium was 2234 ± 824.15 mg/day (equivalent to 5.7g/d of salt). In 94% cases, the sodium intake is higher than the recommended adequate intake, 40% of children have a sodium status exceeds the upper limit, as recommended.
**Conclusions:** The dietary sodium intake of children was Higher compared to the WHO recommended value. Thus, there's need to elaborate strategies at national levels to reduce salt intake and limit the associated diseases.

**Keywords:** Salt intake, 24h urine sodium excretion, ICP-AES, children, Rabat.

**Further collaborators:** Ministry of health, Morocco

suffered ID at high risk. Male were at low risk for ID. It supports the program planning for iron nutrition promotion on females.

**Keywords:** China Nutrition and Health Survey, iron deficiency, serum ferritin, serum soluble transferrin receptor, body iron

**Further collaborators:**

National Nutrition and Health Survey 2010-2012 was supported by the Ministry of Health, China. We thank the team members and all participants from 31 provinces.

144/2920

EVALUATION OF IRON STATUS IN CHINESE POPULATION IN POVERTY RURAL AREAS

(1)Wang, Lijuan; (2)Huang, Jian; (3)Li, Hong; (4)Shao, Bing; (2)Piao, Jianhua; (5)Yang, Xiaoguang; (5)Huo, Junsheng.

(1)PhD. Nutritionist. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China;

(2)BD. Nutritionist. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China.; (3)BD. Nutritionist. Beijing Center for Disease Control and Prevention. China.; (4)PhD. Nutritionist. Beijing Center for Disease Control and Prevention. China.; (5)PhD. Nutritionist. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China.

**Background and objectives:** To assess the iron status among populations by age and gender in poverty rural areas in China.

**Methods:** Sampling of participants was based on a large population sampling frame for 2010-2012 China National Nutrition and Health Survey by stratified multistage cluster sampling method. Serum ferritin (SF), serum soluble transferrin receptor (sTfR) and high sensitive C-reactive protein (hsCRP) were measured by the immunoturbidimetric assay. Body iron (BI) was calculated from sTfR and SF concentrations. Subjects with indication of inflammation (hsCRP>5 mg/L) were excluded from the analyses. A total of 4059 participants including 1983 males and 2076 nonpregnant females (≥6 years old) were involved.

**Results:** The average concentrations of SF, sTfR and BI for the whole population in poverty rural area were 103.1 ng/mL, 3.33 mg/L and 9.18±4.19 mg/kg, respectively. For males, the corresponding values were 140.0 ng/mL, 3.19 mg/L and 10.42±3.70 mg/kg, and for females, they were 77.0 ng/mL, 3.46 mg/L and 7.99±4.28 mg/kg. The difference of SF, sTfR and BI among different age and gender groups were statistically significant. Except 6-11-y subgroup, the lg(SF) was positively correlated with BI and Hb, and the lg(sTfR) was negatively correlated with lg(SF), BI and Hb (p<0.01). Depending on the iron status indicator applied, the prevalence of ID ranged from 1.2% to 7.5% among males and 5.0% to 19.0% among nonpregnant females. Comparison of the prevalence of ID by different iron indicators and cutoffs, the prevalence of defined ID by sTfR was the highest and the lowest by BI. In addition, the prevalence of ID for male is higher than for female, and for 18-44-y female is the highest.

**Conclusions:** The observed iron status of Chinese populations in poverty rural areas suggested females aged 12-17-y and 18-44-y

144/2925

GOVERNANCE OF WATER, SANITATION AND HYGIENE (WASH) IN SUB-SAHARAN AFRICA AND ASSOCIATIONS WITH NUTRITIONAL STATUS IN CHILDREN UNDER FIVE YEARS OF AGE: A SYSTEMATIC REVIEW

(1)Momberg, Douglas; (2)Ngandu, Christian; (3)May, Julian; (4)Norris, Shane; (5)Said-Mohamed, Rihlat.

(1)PhD Fellow. MRC/Wits Developmental Pathways for Health Research Unit. Department of Paediatrics and Child Health. School of Clinical Medicine. Faculty of Health Sciences. University of the Witwatersrand. South Africa; (2)Phd Fellow. MRC/Wits Developmental Pathways for Health Research Unit. Department of Paediatrics and Child Health. School of Clinical Medicine. Faculty of Health Sciences. University of the Witwatersrand. Johannesburg. South Africa.; (3)Economist. DST-NRF Centre of Excellence in Food Security. University of the Western Cape. Cape Town. South Africa; (4)Epidemiologist. MRC/Wits Developmental Pathways for Health Research Unit. Department of Paediatrics and Child Health. School of the Witwatersrand. Johannesburg. South Africa.; (5)Biological Anthropologist. MRC/Wits Developmental Pathways for Health Research Unit. Department of Paediatrics and Child Health. School of Clinical Medicine. Faculty of Health Sciences. University of the Witwatersrand. Johannesburg. South Africa.

**Background and objectives:** In 2011 global estimates put the number of children in the developing world that were stunted at 165 million. African prevalences have stagnated since 1990 at about 40%, with little improvement expected. Stunting is a major public health concern because of associations with adult health and disease risk later in life. The realisation that physical growth cannot completely be improved by optimized diet and reduced diarrhoea has led to the hypothesis that another underlying cause of stunting is early exposure to poor WASH and recurrent infectious episodes leading to immune impairment across the lifecourse.

**Methods:** A systematic review is underway to examine the governance of WASH in sub-Saharan settings and associations with nutritional status in children under five years of age. Articles are selected from PubMed Central, Science Direct, and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement, evidence-based guidelines that provide a set of items to report in systematic reviews and meta-analyses, is
school children, as a pilot study for the preparation of the future National Survey.

**Methods:** This transversal study is conducted on 280 children and adolescent aged 6 to 18 years. Anthropometrics data and clinical survey were collected. Urinary sodium and iodine excretion was measured on 24-h urinary collection assessed respectively, by Inductively Coupled Plasma Mass Spectrometry and spectrophotometrically using the Sandell-Kolthoff reaction, the creatinine excretion was used to validate completeness of urine collections

**Results:** The means were 2.2 ±0.08 g/day (equivalent 5.7±0.2g/ day of salt) for daily urinary sodium, and 96 µg/l for iodine excretion. 70% of children presented iodine deficiency, and 50% consume more than recommended sodium intake, among which 62% presents IDD

**Conclusions:** Most of children consume more than recommended intake of supposed fortified salt by iodine, and children still suffer from iodine deficiency, so the Ministry of Health must consider other's alternatives than salt iodization in his future strategy of IDD reduction.

**Keywords:** Iodine, sodium, 24-h urinary excretion, children, adolescent, Morocco

**Further collaborators:** Ministry of health

marinated egg on each school day for two years. No intervention was provided for 292 students in the control group. Height, weight and dietary intake were measured to assess their nutrition status, and body composition was measured by bioelectrical impedance method. The mixed linear model of repeated measurements was adopted for the comparison of each index.

**Results:** The lean body mass of boys in the intervention group increased by 0.5 kg, statistically higher than those in the control group after one year intervention (P=0.0007), which became no significant after two years. Boys in the intervention group showed more increase of body fat by 0.2 kg after one year (P=0.0343) and by 0.5 kg after two years (P=0.0013), compared with those in the control group. Moreover, the difference between groups was significant in boys only in lowest and middle tertiles of body weight for lean body mass, and in highest tertile for body fat. However, no significant effect was observed in girls on body composition indices.

**Conclusions:** The two-year milk and egg supplementation could promote the increase of lean body mass and body fat in Chinese pre-pubertal boys in poor rural area, but not in girls.

**Keywords:** Body composition. Egg. Milk. Children. Poor Rural Area

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THE EFFECT OF TWO YEARS MILK AND EGG SUPPLEMENTATION ON BODY COMPOSITION OF PRE-PUBERTAL CHILDREN IN CHINESE POOR RURAL AREA

(1)Zhang, Qian; (2)Zhao, Ran; (2)Gan, Qian; (1)Xu, Peipei; (2)Li, Li; (3)Pan, Hui; (2)Li, Shuang; (2)Wang, Tingting; (4)Hu, Xiaoqi.

(1)PhD. Department of Student Nutrition. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China; (2)Master. Department of Student Nutrition. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China; (3)Bc. Department of Student Nutrition. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China; (4)Prof. Department of Student Nutrition. National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China.

**Background and objectives:** Under-nutrition of children remains popular in Chinese poor rural area. It was due in part to their low protein intake and would affect growth and development. So a two-year milk and egg supplementation trial was conducted to evaluate the effect on the growth, especially on body composition of pre-pubertal children in Chinese poor rural area.

**Methods:** Four primary schools were recruited randomly in a poor rural county of Chinese southwest as the intervention group, and four compared schools with similar background as the control group. A total of 672 students were recruited aged 7 to 11yrs from the Grade 2nd to Grade 4th. About 380 students in the intervention group were supplied with 200 g of School Milk and 50 g of

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DIETARY CHANGE AND LIFESTYLE DISEASES AMONG TIBETAN NOMADS : FIELD NUTRITION RESEARCH AT TIBETAN REFUGEE CAMPS IN LADAKH, INDIA

(1)Kimura, Yumi; (2)Norboo, Tsering; (3)Sakamoto, Ryota; (3)Okumiya, Kiyohito.

(1)Graduate School of Human Sciences. Osaka University. Japan;
(2)MD. Ladakh Institute of Prevention. India; (3)Ph.D. MD. Center for Southeast Asian Studies. Kyoto University. Japan.

**Background and objectives:** Highland is one of the most severe places to get enough foods in the world. However, our current study found relatively high prevalence of lifestyle diseases such as obesity, hypertension and diabetes even in such remote highland. Assessing dietary status is important to know one of the backgrounds of these lifestyle-related diseases. This study aims to reveal the nutritional intake of the Tibetan nomads living in Himalayan highland in Ladakh, India, and analyze the relation between nutritional intake and diabetes. It also introduces the lifestyle of Tibetan nomads who settled in town, with a special focus on dietary changes from their nomadic lifestyles to ones in the city.

**Methods:** Field nutrition research, the field work methodology with a combination of epidemiology, nutrition and anthropology, had carried out in 3 different settings; 1) Leh town (elevation approximately 3200-3600 m ASL), the central city of Ladakh, 2) Domkhar village, located in the mountains valley (3000-3800 m ASL), 3) Changtang plateau, nomadic highland (4200-4900m ASL). Health checkups in Leh have mainly covered ethnic Tibetans living in Tibetan refugee camps around Choglamsar. We carried
ried out health checkups of local residents aged 40 or over who voluntary joined the check-up (Leh, n = 304; Domkhar, n = 208, Changtang, n=300). Diabetic status was diagnosed by 75g oral glucoses tolerance test and total energy intake was estimated using 24h recall method.

**Results:** The incidence of diabetes and IGT among the study subjects were 33% in Leh, 30% in Domkhar village, and 17% in Changtang plateau. Total energy intake was lower in Changtang plateau and the food variety was poor compared to the Leh town. Through the interview, dietary changes were found especially among the former nomads who currently moved in the town from nomadic lifestyle.

**Conclusions:** Lifestyle diseases are higher among the subjects living in Leh town than those who living in nomadic area, Changtang plateau. For the former nomads, the lifestyle had changed a lot after they settled in town. It is important for healthcare workers to pay attention to those population as a high risk group of developing lifestyle diseases in the future.

**Keywords:** Dietary change, Lifestyle diseases, Tibetan, Nomad, Himalayan highland

**Further collaborators:** Research Institute for Humanity and Nature, Kyoto, Japan

**Conclusions:** The daily consumption observed is far away from the recommended. 74,66% didn't consume nutrient-dense foods on a daily basis, with a risk of poor nutrient intake. This was analyzed in context of overweight increase.

The consumption of food with high nutrient content was low. There must be taken public population measurements, especially education.

**Keywords:** Milk. Meats. Vegetables. Fruits. Oils

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## CONSUMPTION OF NUTRIENT DENSE FOODS IN NORTHEAST CITIES OF ARGENTINA, RESISTENCIA AND CORRIENTES

(1)Szymula, Claudio; (2)Rubio, Carlos; (3)Imfeld, Mabel.

(1)Phd. Nutricionist. Argentina; (2)Phd. Faculty of Medicine. National University of the Northeast. Corrientes. Argentina;

(3)Phd. Faculty of Medicine. National University of the Northeast. Corrientes. Argentina.

### Background and objectives: Background

From year 2000 we have been monitoring the consumption of food in our region, noting that the intake of foods rich in fats, sugar and starch are the most used. The various dietary guidelines suggest eating nutrient-dense foods and reducing those rich in sugars and fats which does not really happen.

### Objectives

To study the weekly frequency the consumption of various nutrient-dense foods in the cities of Resistencia and Corrientes in the northeast of Argentina.

**Methods:** With the Nutrition students of the Medicine School we surveyed in the year 2016, 5167 persons of the cities of Corrientes and Resistencia. The study population selected by convenience was 18 years or older. A weekly food consumption trend survey was conducted (daily, almost daily, infrequent and never). The total was divided into two groups: daily intake and non daily consumption

**Results:** We observed that the daily food consumptions in percents were: milk 71.47, various types of meats 81.81, green vegetables 60.47, non green vegetables, 45.62, fruits 61.29, oil 49.89, and the totality of the six groups of foods were 25.43

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## KNOWLEDGE OF UNDERGRADUATE NUTRITION STUDENTS ABOUT THE NOVA FOOD CLASSIFICATION

(1)Maiara Lopes Cardozo, Carla; (2)Ramos Langa, Fernanda;

(3)Menegassi, Bruna.

(1)Bachelor student. Faculty of Health Sciences. Federal University of Grande Dourados (UFGD). Brazil.; (2)Statistician. Faculty of Health Sciences. Federal University of Grande Dourados (UFGD). Brazil.; (3)MSc. Nutritionist. Faculty of Health Sciences. Federal University of Grande Dourados (UFGD). Brazil.

**Background and objectives:** The second edition of the Directorate Guidelines for the Brazilian Population, published in 2014, gained prominence in the national and international media because this document deploys a new food classification NOVA, that is based on the processing levels of foods. It is important, however, that NOVA food classification reaches its target audience, starting with undergraduate nutrition students. The aim of this study was to assess the knowledge of students entering and graduating nutrition school concerning the NOVA food classification.

**Methods:** It was performed a study of quantitative approach, transversal and descriptive carried out in a higher education in a public institution in the state of Mato Grosso do Sul, Brazil. A questionnaire was used with a list of 30 foods divided into four groups: natural or minimally processed foods (I), processed culinary ingredients (C), processed foods (P) and ultra-processed foods (U). The study was composed of 69 participants selected for convenience, and 64% of students entering and 36% graduating nutrition school, of these 96% female and 4% male.

**Results:** According to the U Mann-Whitney test, the score of correct classification in the overall analysis (C, I, P, U) was significantly higher (p = 0.000) between the group of graduating nutrition school (median = 17) that the group of students entering (median = 14).

**Conclusions:** Thus, there was the necessity to approach the content of the Guide from the first semester of graduation allowing students greater knowledge and performance on this subject.

**Keywords:** Students, Food processing, Dietary guidelines.
# FREQUENCY OF OBESITY IN CITIES OF THE ARGENTINE NORTH-EAST, RESISTENCIA AND CORRIENTES

(1)Szymula, Claudio; (2)Rubio, Carlos; (3)Imfeld, Mabel.

(1)Phd. Nutritionist. Argentina; (2)Phd. Faculty of Medicine. National University of the Northeast. Corrientes. Argentina;

(3)Phd. Faculty of Medicine. National University of the Northeast. Corrientes. Argentina.

## Background and objectives: Introduction

Since 2000 we study the frequency of overweight (OW) and obesity (O) in the region, with values between 48 and 55 %. In 2011, we find 70 % of OW and O, in persons of 40 years or older. Objectives

To study the frequency of overweight and obesity in cities of Resistencia and Corrientes.

**Methods:** With the Nutrition students of the Medicine School we studied in the year 2017, 5167 persons of Resistencia and Corrientes. The studied population selected by convenience, was 18 years or order. The frequency of OW and O, according to BMI, was established in the whole population, and also by sex,and age

**Results:** OW O frequency in the total population was 34.71 % and in the group of 40 years or older was 60,95 %. The frecuency of OW O in males was 40. 28 % and in fameles 46.37.

**Conclusions:** The frecuency of OW O is biggest in the 40 years or older population, than the youngest group

The frequency of OW O is biggest in females than males

**Keywords:** Overweight. Obesity. Index Corporal Mass. Sex. Age.

was analyzed in households of Montevideo the evolution of INSAN during 2014-2016.

**Methods:** Descriptive study, non-probabilistic annual sample of 1,500 households. The households were grouped in three zones: east, center and west according the Ministry of Social Development proposal. The ELCSA, which measures INSAN based on household experience, was applied.

**Results:** The INSAN situation in households was maintained during this period, 9% -10% INSAN moderate, 4% -3% INSAN severe. In households with children under 18 years old, the prevalence of INSAN moderate increased from 9% to 15% and INSAN severe from 3% to 5%, while the opposite occurred in households without children under 18 years old: INSAN moderate remained in 8% and the INSAN severe decreased (4% to 2%), which reafirms poverty in childhood in Uruguay. The analysis by zone identified that the prevalence of households with INSAN moderate in the central area decreased (7% to 5%) and with INSAN severe remained at 2%. In households of the east and west of Montevideo, poverty levels range between 3.1 and 11.5%. When the ELCSA was applied it was detected in the eastern zone that INSAN moderate households increased (12% to 15%), the INSAN severe remained (6%). In the west, INSAN moderate and severe households increased by 4% and 1%, respectively; prevalences 3 and 2 times more than those observed in the central zone. The three most commonly cited reasons for INSAN moderate households were "to stop having a healthy diet" or "unvaried diet" "concern that they would run out of food". In INSAN severe households was added "having eaten less than they should".

**Conclusions:** The quantity and quality of food are presented as underlying dimensions in the INSAN households studied.

**Keywords:** Food Insecurity, households, ELCSA

# EVOLUTION OF FOOD INSECURITY (INSAN) IN HOUSEHOLDS OF MONTEVIDEO DURING 2014-2016

(1)Fajardo, Gabriela; (2)Cauci, Adriana; (3)Muniz, Florencia; (3)Piñeyro, Cecilia; (4)Britz, Monica.

(1)Nutritionist School of Nutrition. University of the Republic. Uruguay; (2)Nutritionist. School of Nutrition. University of the Republic. Uruguay; (3)Nutritionist. School of Nutrition. University of the Republic. Uruguay; (4)MSc. Epidemiology. Nutritionist. School of Nutrition. University of the Republic. Uruguay.

**Background and objectives:** Information regarding the distribution of food insecurity in the population and the location of those most affected can contribute to building political to counteract this phenomenon. Applying the Latin American and Caribbean Food Security Scale (ELCSA) complements the data from other indicators by including dimensions that underlie different issues that are affected against INSAN situations. The aim of the study

# PATTERNS OF RISK AND PROTECTIVE BEHAVIORS RELATED TO NON-COMMUNICABLE DISEASES AMONG BRAZILIAN ADOLESCENTS

(1)Ricardo, Camila; (2)Azeredo, Catarina; (3)Levy, Renata.

(1)Master Student. Faculdade de Medicina. Universidade de São Paulo. Brazil; (2)PhD. Faculdade de Medicina. Universidade Federal de Uberlândia. Brazil; (3)Phd. Faculdade de Medicina. Universidade de São Paulo. Brazil.

**Background and objectives:** A small group of modifiable risk factors accounts for most of the disease burden and mortality due to non-communicable diseases (NCD). These risk behaviors frequently originate in adolescence and remain in adulthood with short-, medium- and long-term consequences. Currently, in addition to determining the prevalence of each of the risk factors, it is important to evaluate how they cluster among the population, since some of these behaviors might interact with each other, producing an even greater risk than the sheer sum of individual risks. We aim to identify patterns of risk and protection behaviors related to chronic diseases among Brazilian adolescents and
to verify their association with socioeconomic and demographic
characteristics

**Methods:** Our data source was the Brazilian National Survey of School Health (Pesquisa Nacional de Saúde do Escolar – PeNSE) 2012, which collected data on adolescent health through a self-administered questionnaire in a representative sample of students enrolled in the 9th grade of elementary education in public and private Brazilian schools. We used data about diet, physical activity, smoking, alcohol consumption, socioeconomic and demographic characteristics. Factor analysis was used to identify patterns of behavior from a list of risk and protective factors for NCD. The association between the identified patterns and students' characteristics was evaluated using linear regression models.

**Results:** Four patterns of behavior were found: “unhealthy diet”, “healthy diet”, “physical activity” and “alcohol and cigarette use”. In general, the groups that presented the worst profile of adherence to the behavioral patterns found were: girls, older adolescents, and those who did not live with their mother and their father.

**Conclusions:** Four behavioral patterns were found among Brazilian adolescents. The identification of more vulnerable groups can support strategies for health promotion and prevention of diseases related to the control of NCD even during adolescence.

**Keywords:** behavioral patterns; c; risk factors; adolescent; non-communicable diseases; epidemiological surveillance.

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REACH, EFFECTIVENESS, ADOPTION AND IMPLEMENTATION OF A NATIONAL HEALTHY EATING CAMPAIGN: A PROCESS AND IMPACT EVALUATION USING A MIXED-METHODS APPROACH

**Background and objectives:** Evaluation ensures government accountability for spending, provides evidence of the impacts of an intervention and gives decision makers opportunities to improve subsequent initiatives. The Eat Well Campaign (EWC): Food Skills was a year-long national healthy eating initiative that Health Canada (HC) developed and disseminated with cross-sector partners to promote food skills to Canadian parents. The purpose of this study was to evaluate the reach, effectiveness, adoption and implementation of the EWC among Canadian parents and HC's cross-sector partners.

**Methods:** The reach and effectiveness of the EWC was evaluated among a representative sample of Canadian parents by using a series of web-based questionnaires that captured sociodemographic data, information of EWC exposure and the impacts of the campaign. A qualitative process evaluation was conducted

to describe the adoption and implementation of the EWC among HC's multi-sector partners using thematic analysis of telephone interviews.

**Results:** Reach was significantly greater among French-speaking parents, those with lower income and less education. The perceived effectiveness appeared to be greater for beliefs and knowledge components than for behaviors. The majority of parents were only exposed to one campaign element and exposed one or fewer times per month. Nevertheless, the perceived effectiveness of the campaign was significantly greater for each additional campaign element and for every additional time the campaign was viewed. The process evaluation revealed that compatibility between organizations and the campaign was a significant facilitator for EWC adoption, and there were relatively few barriers. Barriers were more prominent during implementation than adoption and included time, concerns over campaign strategy and financial resources. Compatibility during adoption was associated with partners' commitment, flexibility and understanding during implementation.

**Conclusions:** Early collaborative planning is recommended to anticipate and minimize potential barriers such as time and financial resources. Behavior change should be the primary focus of future initiatives. These initiatives should seek to include partners that have high compatibility with the initiative, as this is likely to result in improved implementation and greater engagement of partners.

**Keywords:** Cross-sector partners, food skills, impact evaluation, parents, process evaluation.

144/3012

COMPARISON OF NUTRITIONAL QUALITY OF SNACKS FOR CHILDREN AND NOT FOR CHILDREN

**Background and objectives:** The aim of this study is to compare the nutritional quality of a snack individually packed with marketing techniques packaging for children, with those snacks whose packaging are not intended for children, at a supermarket chain in the city of Montevideo during 2014.

**Methods:** The universe was composed of the snacks available in the supermarket, that meet the Health Ministry of Uruguay (MSP) directives. The criteria for assessing advertising and promotion on the snacks packaging followed the ones of the INFORMAS project. Snacks were classified according to whether or not the snack packaging was intended to children (PITC) or not (PNITC). The criteria to assess nutritional content of snacks was the MSP one.

<footnote>(1)Fernandez, Melissa Anne Fernandez; (2)Desroches, Sophie;</footnote>

<footnote>(3)Marquis, Marie; (1)Turcotte, Mylene; (2)Provencher, Veronique.</footnote>

<footnote>(1)MSc. Nutritionist. Institute of Nutrition and Functional Foods. Laval University. Canada.; (2)PhD. Nutritionist. Institute of Nutrition and Functional Foods. Laval University. Canada.; (3)PhD. Nutritionist. Department of Nutrition. University of Montreal. Canada.</footnote>

<footnote>(1)Natero Felipe, María Virginia; (2)Fernandez, Estela; (3)Saravia, Luisa.</footnote>

<footnote>(1)MSc. Lic. Nutritionist. Departamento de Alimentos. Escuela de Nutrición. Universidad de la República. Uruguay; (2)MSc. Lic. Nutricion. Depto. Alimentos. Escuela de Nutrición. Universidad de la República. Uruguay; (3)MSc. Lic. Nutricion. Posgrado. Escuela de Nutrición. Universidad de la República. Uruguay.</footnote>
**Results:** The nutritional quality was classified as: do not meet the criteria of MSP, partially met (only for one serving size) or fully met; 13.3% of the snacks partially satisfied and 12.3% fully meet these criteria. Statistical analysis showed that PITC selected by packaging marketing techniques, have no nutritional quality difference with those not intended for children and both groups have the same nutritional quality (p = 0.201). Significant differences were found assessing food groups (cookies, alfajores, milk desserts and yogurt, cereal bars) by nutrient composition.

The PITC alfajores have lower caloric intake, lower fat content, and lower sodium intake.

In the case of cookies, PNITC have a higher caloric intake, total fat, saturated fat, and trans fat, than PITC.

In the group of dairy yogurts and milk desserts, PNITC have lower intake of sodium, total fats, saturated fats compared to PITC.

Cereal bars intended for children have a greater contribution of calories and total fats than those that are not.

**Conclusions:** The nutritional quality of snacks aimed to children and those who are not, is the same. In the analysis by food groups there are differences that may be showing a tendency to improve the nutritional quality of food PITC in relation to the PNITC.

**Keywords:** nutritional quality, children, food packaging, childhood obesity

## EXPOSURE TO ADVERTISING AND FOOD INTAKE OF SCHOOL-AGE CHILDREN IN ARGENTINE PROVINCES

**Background and objectives:** In a context of a worldwide growing concern about the advertising of food for kids it was proposed to study in school kids in Argentina the relationship between exposure to television, the remembrance of advertisements, the meaning, purchase intentions and consumption of ultra-processed products (UP) and non-processed or slightly processed products (NP).

**Methods:** Observational study in a non-probabilistic sample of 8 to 12 year old school kids and their parents from primary education

schools from 6 Argentine districts. Structured questionnaires were applied to kids and parents. Additionally the school environment was observed and the faculty and personnel interviewed.

**Results:** 1261 school kids and 778 parents from 20 schools were evaluated. 48,4% of the school kids (n=610) watch television at least 30 hours per week. 69,9% remembered UP food advertising spots and 19,8% NP food advertising spots, similar ratios were identified for billboards, internet and promotions. Regarding credibility, 20% of the school kids and 35% of the parents expressed that advertisements either don't lie or lie just a little.

The number of UP purchase requests from the kids to their parents showed a significant correlation with the amount of hours exposed to television, standing out a rho= 0.19 (p < 000).

An association between higher consumption of some processed foods and UP (solids and beverages) with higher exposure to TV (p=-0,03; p=-0,002), internet (p=-0,004; p=-0,004), billboards (p=-0,019; p=-0,01), and promotions (p=-0,006; p=-0,003) was found.

**Conclusions:** The frequency of exposure of school kids to advertisement is significantly related with their remembrance and purchase requests to their parents of all kinds of food, especially processed and UP. An association of higher consumption of some processed and ultra-processed foods with TV exposure has been detected. The evidenced influence of UP food advertising on children shows the need to adopt legislation to regulate it.

**Keywords:** Feeding Behavior, Food Publicity, Child Nutrition

**Further collaborators:** Mariela Mastroianni, Maria Laura De Anseris, Sofia Waimann, Leticia Barcellini, Hebiatra Guillermo Mengarelli, Analia Merli, Emiliano Centeno Recanati, Ciminari Nair, Matias Mola, Ines Polito, Juan Franchini, Bianca Argento, Antonela Lombert, Valenti Gorostegui, Gabriela Saldia, Mariela Solaso.

## THERE IS LOW-HANGING FRUIT UP THERE: URBAN ACCESSIBILITY OF STREET MARKETS IN SANTIAGO, CHILE

**Background and objectives:** To analyse how much of the urban grid is covered by street markets in each of the municipalities of Santiago, Chile, considering a 600 m threshold (roughly equivalent to a 10-minute walk).

**Methods:** All street markets of Santiago were mapped and geo-referenced. Then, an accessibility analysis of street markets within the urban grid was performed, including a socio-economic analysis of households living in the city.

**Results:** Street markets cover 52% of the city's urban grid. It is also indicates that this percentage varies depending on people's in-

<footnote>(1)Virgolini, Mario; (2)Leonardelli, Eduardo; (3)Carrazana, Carla;</footnote>

<footnote>(4)Fallocca, Veronica; (5)Alfaro, Agustina; (6)Exner, Natalia; (7)Lavayen, Fabiola; (8)Sordini, Natalia; (9)Scarinci, Guillermo.</footnote>

<footnote>(1)Anthropologist. Facultad de Ciencias Médicas de la Universidad Nacional de La Plata. Argentina; (2)Psychologist. Universidad Favaloro. Ciudad de Buenos Aires. Argentina; (3)Nutritionist. Universidad Isalud. Ciudad de Buenos Aires. Argentina;</footnote>

<footnote>(4)Psychologist. Facultad de Ciencias Medicas. Universidad Nacional de La Plata. Argentina.; (5)Social Communicator. Instituto Populorum Progressio. Jujuy. Argentina; (6)Nutritionist. Universidad Católica de La Plata. Argentina; (7)Nutritionist. Universidad Nacional de Córdoba. Argentina; (8)Nutritionist. Universidad FASTA. Mar del Plata. Argentina; (9)Nutritionist. Universidad Nacional de Rosario. Argentina.</footnote>

<footnote>(1)Weisstaub, Sergio Gerardo; (2)Mora, Rodrigo; (3)Greene, Margarita;</footnote>

<footnote>(4)Herrmann Lunecke, Geraldine; (4)Bosch, Francisco.</footnote>

<footnote>(1)MD, Msc. INTA. University of Chile. Chile; (2)PhD. School of Architecture. University Diego Portales. Chile; (3)School of Architecture. Catholic University of Chile. Chile; (4)School of Architecture. University Diego Portales. Chile.</footnote>