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

**Further collaborators**

On behalf of the MiniSALTEN Study Group.

144/2464

ENERGY, PROTEIN AND CARBOHYDRATE INTAKE IN RELATION TO ANTHROPOMETRIC PARAMETERS AT DIFFERENT MEALTIMES IN CHILDREN OF EVANES STUDY

(1)Mayorga Mazón, Clara de las Mercedes; (2)Monzón Rodríguez, Allyson Natalie; (2)Ligerini Vázquez, Lorena Johana; (2)Menendez Blanco, Cintya Yanella; (3)Guerendiain Margni, Marcela Esther.

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

**Background and objectives:** Indigenous communities, especially in rural regions, are more vulnerable to malnutrition. In rural schools of Ecuador, a fortified collation is provided to children, consisting of biscuit and colada, a typical drink, which is prepared using a flour mixture (quinoa, bean, peas and corn). Hence, our objective was to compare the association between anthropometric parameters and energy, protein and carbohydrate intake at different mealtimes in children from a rural school in Andean region.

**Methods:** It was included 100 schoolchildren (7.8±2.17 years) from San Juan (indigenous community), Chimborazo, Ecuador, belonging to EVANES study. Dietary intake was evaluated at each mealtime (breakfast, mid-morning collation, lunch, mid-afternoon collation and dinner) using a nutritional survey. Energy, protein and carbohydrate consumption was determined from the corresponding standard portion size, transforming the data into gr or ml, and using food-composition tables from Ecuador. Weight and height were measured in duplicate, and body mass index [BMI, weight (Kg)/height (m)2] was calculated. Standard deviation score of height and BMI were determined, applying the AnthroPlus software, which is based on Child Growth Standards of Word Health Organization (2007). Data analysis was performed using SPSS, version 20.0, considering statistical significant differences at p<0.05.

**Results:** No statistically significant relationship were found between anthropometric parameters and energy, protein and carbohydrate intake at breakfast, lunch and mid-afternoon collation. The most important results were observed at the mid-morning collation, which is provided at the school, where the colada is made with fortified flour. At this mealtime, the energy, protein, and carbohydrate intake was inversely related to weight, BMI and standard deviation score of BMI (p<0.05). On the contrary, a positive association was found between weight and caloric and protein consumption (p=0.033) at dinner.

**Conclusions:** The energy and nutrient intake is related to anthropometric parameters only at school collation and dinner. Our findings prove that, at school, the children who have lower weight and BMI receive more energy, protein and carbohydrates than those with better nutritional status. But, at home, specifically at dinner, the children who intake more energy and protein are the ones with the higher body weight.

**Keywords:** Energy intake; nutrient intake; anthropometric parameters; mealtimes; children.

144/2474

WOMEN'S DIETARY DIVERSITY IN BANGLADESH: COMMUNITY-LEVEL PATHWAYS THROUGH WOMEN'S EMPOWERMENT

(1)Sinharoy, Sheela; (2)Waid, Jillian; (3)Gabrysch, Sabine; (4)Yount, Kathryn M.; (5)Haardoerfer, Regine.

(1)MPH. PhD Candidate. Nutrition and Health Sciences Program. Emory University. USA.; (2)MSW. Director of Research, Learning, and Evaluation. Helen Keller International. Bangladesh.; (3)PhD. Unit Head, Epidemiology and Biostatistics. Institute of Public Health. Heidelberg University. Germany.; (4)PhD. Professor. Hubert Department of Global Health. Rollins School of Public Health. Emory University. USA.; (5)PhD. Assistant Professor. Department of Behavioral Sciences and Health Education. Rollins School of Public Health. Emory University. USA.

**Background and objectives:** A majority of women in Bangladesh consume inadequately diverse diets, but the influence of aggregate-level, contextual factors on women's diets is unknown. We examined whether community-level factors, including measures of women's empowerment, influenced women's dietary diversity through direct and indirect pathways.

**Methods:** We collected panel data in three rounds from urban and rural samples in Bangladesh between February 2015 and October 2016. We collected data on diet, women's empowerment, years of schooling, and household wealth and other demographics from 422 urban and 698 rural households. The urban sample was representative of the poorest three deciles of neighborhoods in Dhaka City Corporations, and the rural sample comprised the control arm of a cluster-randomized controlled trial in Habiganj District. We used exploratory factor analysis, confirmatory factor analysis, and multilevel structural equation modeling to examine relationships between socio-demographic characteristics, measures of women's empowerment, and dietary diversity at the community level.

**Results:** In our sample, 79% of urban women and 85% of rural women consumed inadequately diverse diets. Factor analysis resulted in three latent variables for women's decision-making, voice with
husband, and freedom of movement. We observed a strong positive association between schooling and dietary diversity at the individual level (β=0.224, p<0.001) but no association at the community level. Schooling was not associated with the community-level latent variables for decision-making, voice with husband, and freedom of movement. However, the disparity in years between a husband's and wife's completed grades of schooling was significantly associated with women's decision-making (β=0.18, p=.002), voice with husband (β=0.12, p=.008), and freedom of movement (β=0.41, p=.033) at the community level. None of these latent variables were associated with dietary diversity at the community level.

**Conclusions:** This is the first use of multilevel structural equation modeling to examine community-level pathways related to nutrition. The disparity between women's schooling and that of their husbands was associated with all three measures of women's empowerment, suggesting that important relationships may exist at the community level. Further research is needed to better understand the contextual factors influencing women's diets in urban and rural Bangladesh.

**Keywords:** community-level, contextual, multilevel, women's nutrition, diet

**Background and objectives:** The malnutrition is one of the most prevalent problems in underdeveloped countries, which is associated with poverty. Chimborazo is the poorest province in Ecuador, mainly, in rural communities, which are often indigenous. Those populations, are highly vulnerable from a socioeconomic and nutritional point of view. Thus, our objective was to evaluate the nutritional status of children from a rural school, and to explore the association with serum proteins.

**Methods:** A cross-sectional descriptive study was conducted in ninety-five children (EVANES project), from a rural school in Yaruquíes, Chimborazo. The anthropometric evaluation was performed using standard deviation score of height and BMI, according to Child Growth Standards of Word Health Organization

(WHO, 2006 and 2007). It was applied the WHO Anthro and AnthropPlus software. Weight and height were measured in duplicate, and body mass index [BMI, weight (Kg)/height (m)2] was calculated. Blood samples were collected by venipuncture. Concentration of total proteins, globulins and albumin was determined. The serum proteins were divided into tertiles. Data analysis was carried out using SPSS software, version 22.0. Statistical significant differences were considered at p<0.05. To establish the relationship between ordinal variables, the Spearman test was applied, and, to determine differences in quantitative parameters, the one-way ANOVA, corrected by Bonferroni, was used.

**Results:** The mean of age was 8.36±2.45 years. Only 1.1% of children were undernutrition, 9.5% overweight and 2.1 obesity. On the other hand, the 47.4% of them were stunting. The tertiles of globulins were inversely related to nutritional status determined from the BMI for age, but not to height for age. When the anthropometric parameters were compared according to tertiles of serum proteins, it was observed that the weight and height were lower in tertil 3 of globulins than tertil 2. Also, the standard deviation score of height was higher in tertil 2 compared to tertil 1 of the same protein. No statistically significant differences were found with the other parameters.

**Conclusions:** The main problem detected in Yaruquíes, a rural community in Chimborazo, was stunting. Only globulins were related to anthropometric parameters. Further studies are required to identify causes and consequences of nutritional status.

**Keywords:** Serum proteins; nutritional status; children

**Background and objectives:** Myanmar has a low exclusive breastfeeding (EBF) rate at 24% and 15% for children under six and at six months. Objective is to implement and evaluate the impact of a SMS intervention on the breastfeeding practices as a first time in Myanmar.

**Methods:** A two-arm parallel randomized controlled trial with monthly follow-up phone calls between 1-6 months post-delivery was conducted in January-December 2015 at Central Women's Hospital, Yangon, Myanmar. A total of 353 pregnant women, who were 24-38 weeks of gestation with singleton uncomplicated pregnancy, literate and owned a mobile phone, were recruited and randomly as-

<footnote>(1)Miño Orbe, Patricia Azucena; (2)Robalino Flores, Ximena del Rocío;</footnote>

<footnote>(2)Balladares Saltos, Aida Mercedes; (3)Guerendiain Margni, Marcela Esther.</footnote>

<footnote>(1)MSc. Pharmaceutical Chemistry. School of Clinical Laboratory. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (2)MSc. Laboratory Technician. School of Clinical Laboratory. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>

<footnote>(1)Hmone, Myat Pan; (2)Li, Mu; (3)Agho, Kingsley; (4)Dibley, Michael.</footnote>

<footnote>(1)School of Public Health. Sydney Medical School. University of Sydney. Australia; (2)Professor, Sydney School of Public Health. University of Sydney. NSW 2006. Australia.; (3)Senior Lecturer, School of Science and Health. Western Sydney University. NSW 2571. Australia.; (4)Professor in Global Public Health Nutrition. Sydney School of Public Health. Sydney Medical School. The University of Sydney. Australia.</footnote>
signed to intervention or control groups. The intervention group re-
ceived breastfeeding promotion SMS and the control group received
other maternal and child health care SMS from recruitment to six
months postpartum. We hypothesized that the EBF rate in the in-
tervention infants would be double that of the control infants at six
months. We defined EBF as giving only breastmilk, not even water
except medicines. Data was analyzed by intention to treat principle.
Poisson regression analysis with generalized estimation equations
(GEE) was used to adjust for within person correlation and the ef-
fect of time, group and group by time interaction as covariates.

**Results:** The intervention significantly improved the EBF rate (43% vs 15%; Relative Risk (RR), 2.83; 95% confidence interval (CI), 1.85,4.33), current breastfeeding rate (RR 1.17; CI, 1.08-1.26) and reduced bottle feeding (RR 0.30; CI, 0.17,0.54) and complementary feeding (RR 0.72; CI, 0.52-0.99) among infants at six months and predominant breastfeeding (RR 0.90; CI, 0.60,1.36) at four months. For the overall follow-up period, the SMS intervention significantly reduced acute lower respiratory illness (RR 0.95; 95% CI, 0.91,0.98; P<0.005) and diarrhea (RR 0.95; 95% CI, 0.91,0.99; P<0.008) compared to the control group. Subgroup analysis showed the intervention had a higher effect on women with low breastfeeding knowledge, low self-efficacy to breastfeed and no intention to EBF at recruitment.

**Conclusions:** Use of SMS text messages was effective in promoting EBF and reducing other adverse infant feeding practices in Myanmar. Further research is recommended to assess this intervention model in other settings including rural areas.

**Keywords:** m-Health, Intervention studies, Exclusive breastfeeding, Child nutrition, Myanmar.

144/2493

VITAMIN A STATUS IN THE THIRD TRIMESTER OF PREGNANCY IN BRAZILIAN AMAZON

(1)Ribeiro Neves, Paulo Augusto; (2)Alzineth Campos, Chiara;

(3)Barreto Malta, Maira; (4)Hatzlhoffer Lourenço, Bárbara; (5)de Castro, Marcia; (6)Augusto Cardoso, Marly; (7)MINA-Brazil Working Group.

(1)PhD candidate. Nutritionist. Department of Nutrition. School of Public Health. University of Sao Paulo. Brazil.; (2)Master in Science candidate. Nutritionist. Department of Nutrition. School of Public Health. University of Sao Paulo. Brazil.; (3)Postdoc fellow. Nutritionist. Department of Nutrition. School of Public Health. University of Sao Paulo. Brazil. (4)Adjunct Professor. Nutritionist. Department of Preventive Medicine. Federal University of Sao Paulo. Brazil; (5)Associate Professor. Demographer. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. USA.; (6)Full Professor. Nutritionist. Department of Nutrition. School of Public Health. University of Sao Paulo. Brazil.;(7)Department of Nutrition. School of Public Health. University of Sao Paulo. Brazil.

**Background and objectives:** Vitamin A status during pregnancy has been associated with maternal and child outcomes worldwide, including birth weight, lung function and bone mineralization. The present study describes the predictors of vitamin A status in the third trimester of pregnancy in Brazilian Amazon.

**Methods:** Prospective study in the urban area of Cruzeiro do Sul, Western Brazilian Amazon. A total of 445 pregnant women, with up to 20 weeks of pregnancy, and who were attending pre-natal care at primary health centers were enrolled in the study. Demographic, socioeconomic, environmental, and clinical characteristics, as well as obstetric history, anthropometric, dietary, and biochemical data were gathered at second trimester of pregnancy (gestational age week: 20.03 ± 2.91). Serum retinol measured by HPLC at third trimester of pregnancy (gestational age week: 27.76 ± 1.61) was the outcome of interest. Multiple linear regression models with hierarchical selection of independent variables were used to evaluate associations with serum retinol. The analysis were adjusted for gestational age at the outcome assessment. Data analysis was performed in Stata 14.0 with *p* < 0.05.

**Results:** Overall, the following variables explained serum retinol levels at third trimester of pregnancy in the adjusted model (R2-adj=11.22%): menarche age (β: 0.000; 95% CI: 0.000, 0.002), weekly gestational weight gain (β: 0.055; 95% CI: 0.003, 0.141), seasonality (rainy season from November to April: β: 0.018; 95% CI: 0.004, 0.043), weekly consumption of Amazonian carotenoid-source fruits (such as buriti and pupunha) (β: 0.010; 95%CI: 0.000, 0.004), and retinol levels at 16-20 weeks of pregnancy (β: 0.013; 95%CI: 0.001, 0.004) were positively associated; having a smoker at home was negatively associated with the outcome (β: -0.007; 95%CI: -0.027, -0.0001).

**Conclusions:** In this study, the menarche age, weekly gestational weight gain, the Amazon rainy season and vitamin A status in the mid-pregnancy were predictors of serum retinol levels in the third trimester. Consumption of locally available Amazonian fruits should be encouraged in this population for improving vitamin A status. The passive smoking may play a role on decreasing vitamin A levels as a proxy of smoking exposure in pregnant women.

**Keywords:** vitamin A; pregnancy; epidemiologic factors; cohort studies; nutritional status.

**Further collaborators**

National Counsel of Technological and Scientific Development
– CNPq, and Maria Cecília Souto Vidigal Foundation.

144/2496

ASSESSMENTS OF SARCOPENIA AND ITS ASSOCIATED FACTORS IN COMMUNITY-DWELLING MALAYSIAN CHINESE MIDDLE-AGED ADULTS AND ELDERLY

(1)Foo, Leng Huat; (2)Wen, Yin Siew; (3)Abdul Kadir, Azidah.

(1)Universiti Sains Malaysia. Malaysia.; (2)School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan. Malaysia.; (3)School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan. Malaysia.

**Background and objectives:** Sarcopenia is considered as an emerging public health problems and challenges worldwide, including in Malaysia, but very limited information concerning the influence of lifestyle factors and blood inflammation levels on
sarcopenia among community-dwelling older populations in Asia. The aim of the present study was to assess the prevalence of sarcopenia and its associated risk factors of body composition, dietary and lifestyle practices and blood inflammation markers in older adults.

**Methods:** A total of 232 apparently healthy Chinese older adults aged 50 years and above were included in the study. Validated questionnaires were used to assess dietary and lifestyle practices, whereas pro-inflammatory cytokine status was assessed by blood interleukin-6 concentrations (IL-6). Sarcopenia was assessed by diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS).

**Results:** The prevalence of sarcopenia was 12.5% among these apparently healthy community-dwelling Chinese older adults. A similar pattern of sarcopenia was found between males and females. Multivariate logistic regression analysis showed that older age and higher concentrations of pro-inflammatory cytokine levels of IL-6 were significantly associated with greater risk of sarcopenia, after adjustments of age, gender and body composition levels.

**Conclusions:** The present findings indicate that older adults aged 70 years and above and higher inflammation levels had significantly greater sarcopenia risk. Hence, effective dietary and lifestyle intervention strategies should emphasize to reduce the inflammation associated with aging in order to prevent the rapid loss of muscle mass and strength that can lead to sarcopenia. Moreover, prospective studies with large sample size are required to further elucidate the natural progression and predisposing modifiable dietary and lifestyle factors associated with rapid loss of muscle mass and strength that consequently leading to sarcopenia.

**Keywords:** Sarcopenia, inflammatory, interleukin-6, dietary, elderly

frequency of consumption of dairy products and a preliminary self-report on lactose intolerance. Moreover, participants were asked whether they have been diagnosed as lactose intolerant.

**Results:** 81.5% of the participants reported a frequent consumption of milk, at least 1 glass per day (200 ml). The main reasons given by the participants who do not consume any milk was dislike for the taste of milk (38.5%) or suffering of intestinal discomfort (28%). 9.3% of the population considers that they are lactose intolerant; however most of them (81.0%) have not been diagnosed. Of this group, 24.0% has permanently ceased to consume milk. 5% of the people in this study choose to consume lactose-free milk. Of this percentage, 79% of people who consume it are those who perceive themselves as lactose intolerant without being diagnosed and those who refer that they don't like regular milk because they suffer intestinal discomfort after consumption without perceiving themselves as intolerant.

**Conclusions:** People that are diagnosed as lactose intolerant turned out to be the group with the least consumption of lactose-free milk. This leads to an interesting observation regarding the real market of this product that requires further research. Moreover, there is a group that has permanently ceased to include milk in their diets due to a self-perception of being lactose intolerant or a lack of medical diagnosis. This could be a psychological factor that could expose them to an unnecessary nutritional risk.

**Keywords:** auto-percepción, self-perception, lactose intolerance, milk consumption.

**Further collaborators**

Bachelor of Science in Food Technology Laura Rolón

## SELF-PERCEPTION OF LACTOSE INTOLERANCE AND ITS INFLUENCE ON MILK CONSUMPTION

**Background and objectives:** Lactose intolerance is not a disease; it is a normal physiological condition. However, the strategy of avoiding milk consumption may lead to an unnecessary nutritional risk. The purpose of this study was to evaluate lactose intolerance self-perception and its influence on milk consumption.

**Methods:** A population of 2170 individuals between 18-83 years old performed an online survey to gather information on

<footnote>(1) Murphy, Marcela; (2) Gonzalez, Marcelo; (3) Roldán, Guadalupe;</footnote>

<footnote>(4) López, Mariela Victoria.</footnote>

<footnote>(1) Bachelor of Biological Sciences. Instituto Nacional de Tecnología Industrial, Lácteos. Argentina.; (2) Chemical technician. Instituto Nacional de Tecnología Industrial. INTI-Lácteos. Argentina.; (3) Bachelor in Psychology. Instituto Nacional de Tecnología Industrial. INTI-Lácteos. Argentina.; (4) Bachelor in Nutrition. Instituto Nacional de Tecnología Industrial. INTI-Lácteos. Argentina.</footnote>
# DETERMINANTS OF FOOD CHOICE IN IRANIAN ADULTS: A LIFE COURSE PERSPECTIVE

(1)Haghighian Roudsari, Arezoo; (2)Omidvar, Nasrin; (3)Amiri, Parisa;

(4)Kalantari, Naser; (5)Vedadhir, Abouali; (6)Eini-Zinab, Hassan;

(7)Milani Bonab, Ali.

(1)PhD. Nutritionist. Faculty of Nutrition Sciences and Food Technology. National Nutrition and Food Technology Research. National Nutrition and Food Technology Research Institute. Shahid Beheshti University of Medical Sciences. Iran.; (2)PhD. Nutritionist. Department of Community Nutrition. Faculty of Nutrition Sciences and Food Technology. National Nutrition and Food Technology Research Institute. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (3)PhD in Health Education. Department for Social Determinants of Health & Obesity. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (4)MD. Department of Community Nutrition. Faculty of Nutrition Sciences and Food Technology. National Nutrition and Food Technology Research Institute. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (5)PhD. Anthropologist. Department of Anthropology. Faculty of Social Sciences. Tehran University. Tehran. Iran.; (6)PhD. Sociologist. Department of Community Nutrition. Faculty of Nutrition Sciences and Food Technology. National Nutrition and Food Technology Research Institute. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (7)PhD student in Food & Nutrition Policy. Department of Community Nutrition. National Nutrition and Food Technology Research Institute. Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.

**Background and objectives:** Food choice is a vital and common practice in everyday life that all the people deal with it. In Iran, as a country that experiencing nutrition transition, identifying the aspects, thought and contexts of food choice are necessary to design and investigate trends in the quantity and quality of food consumption. This study aimed to understand the causal process of food choice in Iranian adults.

**Methods:** a qualitative study was carried out using Grounded Theory approach with thirty-three adults aged 30-64 years who were chosen using purposive sampling with maximum diversity (in terms of age, place of residence and socioeconomic status). An in-depth semi-structured interview was conducted with each subject based on Life course approach to explore participants' current and past eating habits from childhood to adulthood and dietary change at different life courses. Data were analyzed by constant comparative analysis. Interview transcriptions were reviewed and imported into the qualitative software, MAXQDA 11, for open and axial coding. Main themes emerged by integrating the categories which explored from axial coding.

**Results:** The finding revealed that determinants of food choice in Iranian 30-64-year old adults can be categorized into five main themes:

1) Individual mood, traits and habitus (sub-themes: biological traits, childhood habits, mood, food tendency and physical activity level)

2) Ecologic and environmental characteristics (sub-themes: seasonal and environmental conditions, place of living)

3) socio-cultural determinants (sub-themes: Cultural context and patterns, Social Structure and Norms, Household and Family structure, Information Resources and Media, Transition in Nutrition)

4) Perceived desirability (as core variable with sub-themes: economic possibility, meeting needs and satisfaction of children, health),

5) Food characters and features (sub-themes: sensory aspects of food, food safety, food contents)

**Conclusions:** Different experiences and periods in people lives, including childhood, adolescence, adulthood, parenthood, work, military service, pregnancy, and marriage could be effective in their food selection(s). Some of these determinants might adjust during the lifespan and affect their personal and social contexts.

**Keywords:** food choice, qualitative, life course perspective, Iran

# RECOMMENDED AND INAPPROPRIATE BEVERAGE INTAKE IN MEXICAN INFANTS AND TODDLERS

(1)Afeiche Zehil, Myriam; (2)Eldridge, Alison; (3)Fries, Lisa R.; (4)Reidy, Kathleen; (5)Villalpando, Salvador.

(1)PhD. Institute of Nutritional Science. Nestlé Research Center. Switzerland.; (2)Institute of Nutritional Science. Nestlé Research Center. Switzerland.; (3)PhD. Institute of Material Science. Nestlé Research Center. Switzerland.; (4)PhD. Nutrition and Regulatory Affairs. Nestlé Nutrition Florham Park. New Jersey. United States of America.; (5)MD. Children's Hospital of Mexico. National Institute of Health. Nestlé Infant Nutrition. Mexico City. Mexico.

**Background and objectives:** While 94% of Mexican infants receive breastmilk before 6 months, only 14% are exclusively breastfed, and inappropriate beverages are often concurrently given. Recent research among 6-11m shows that 34% are fed sugar-sweetened beverages (SSBs) and cow's milk is introduced to approximately one-third of infants before 12 months of age. The objectives of this study were to examine the consumption of age-appropriate beverages among 0 to 2 years of age Mexicans and to evaluate whether SSBs or inappropriate milks were substituting for age-appropriate milks.

**Methods:** Dietary intake data were collected via one proxy-reported 24-hr recall in the 2012 Mexican National Health and Nutrition survey among 0-5m (n=182), 6-11m (n=229), and 12-23m (n=538) old. Beverages were classified as breast milk, infant formula, cow's milk, water, 100% fruit juice and SSBs. These categories were then grouped as age-appropriate or age-inappropriate beverages based on national and international feeding recommendations.

**Results:** While 66% of 0-5m olds exclusively consumed breastmilk and/or infant formula, 30% were concurrently fed water (mean=56g) and/or other age-inappropriate beverages (mean=127g) such as 100% fruit juice, cow's milk, and SSBs.
Among infants 6-11 months, recommended beverages include breastmilk and infant formula, along with the introduction of water and 100% fruit juice. Only 45% of met recommended beverage guidelines. Compared to 0-5m olds, a higher percentage of 6-11m old were fed water (36%), but a large percentage also consumed age-inappropriate beverages, including cow's milk (29%) and SSBs (34%). Infants 6-11m consumed 2.7 times more cow's milk compared to water and nearly the same amount of SSBs compared to water. After 1 year of age, the World Health Organization and the Mexican Norm on Nutrition recommend the consumption of water ad libidum, introduction of cow's milk, a limited amount of 100% fruit juice and SSBs. Among 12-23m olds, 54% consumed milk, 62% consumed SSBs and 45% consumed water.

**Conclusions:** Many infants and young children are not compliant with Mexican and international complementary feeding recommendations. Communication about the guidelines and parental education on age-appropriate beverage feeding could be improved.

**Keywords:** complementary feeding, infants, milks, beverages, Mexico

144/2536

THE MEDIA INFLUENCE ON BODY IMAGE OF BRAZILIAN TEACHERS

(1)Gori, Mariana; (2)Furlan Viebig, Renata.

(1)Master's degree in pediatric. Nutritionist. Centro Universitário São Camilo. Brazil.; (2)PhD in Science. Nutritionist. São Camilo University Center. Brazil.

**Background and objectives:** Sociocultural influences can influence individuals of all ages, especially women, to desire a slimmer body and they can feel unsatisfied with their bodies. The difference between the actual body and a body which is considered “ideal”, can provoke low self-esteem, thus triggering several eating disorders. OBJECTIVE: To evaluate how satisfied teachers in infants and primary private schools of Sao Paulo are with their own body image and analyse their possible messages given to students about health, weight and eating habits.

**Methods:** It was a transversal study about infant and primary teachers in 4 schools in the city of Sao Paulo. Teachers were submitted to an anthropometric evaluation: weight, height, Body Mass Index (BMI) and body fat percentage. To evaluate the corporal image the Figure Rating Scales by Kakeshita (2009) was translated and validated. The sociocultural attitude questionnaire was applied to check how media can influence the individual's appearance (SATAQ-3) (Amaral, 2011). The present study followed ethical values and was approved by the ethic, research committee at the Centro Universitário São Camilo.

**Results:** Fifty-five teachers with mean age of 37,49 years old took part in the study. The mean BMI was 26,6Kg/m2 and the average percentage of body fat was 41,9%. Eighty-nine percent of the teachers showed dissatisfaction with their body image, mostly the older ones and with children. Teachers who were more influ-

enced by the media were older, had a higher socioeconomic status and a higher percentage of body fat. It was discovered that the longer the professional period the lower the SATAQ (p=0,030) score.

**Conclusions:** The results showed a high level of body dissatisfaction of schoolteachers with great influence on social media. It is possible that teachers reveal their dissatisfaction to their students in the classes, as they are behaviour models to them, triggering eating disorders.

**Keywords:** Teachers. Body image. Eating disorders. Social Media.

144/2546

MATERNAL OBESITY DETERMINES THE OFFSPRING'S METABOLIC PROFILE AT BIRTH

(1)Jaramillo Ospina, Angela Marcela; (1)Muñoz Muñoz, Estefania;

(2)Soto, Gustavo; (3)Dominguez De Landa, Angélica; (4)Uauy, Ricardo;

(5)Krause Leyton, Bernardo Javier; (6)Casanello Toledo, Paola;

(7)Castro-Rodríguez, José.

(1)PhD(c). Institute of Nutrition and Food Technology. Chile University. Chile.; (2)Biochemist. Department of Neonatology. Division of Pediatrics. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (3)MSc. Department of Public Health. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (4)MD. PhD. Institute of Nutrition and Food Technology. Chile University. Department of Neonatology. Division of Pediatrics. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (5)MSc. PhD. Department of Neonatology. Division of Pediatrics. School of Medicine. Biochemist. Pontificia Universidad Católica de Chile. Chile.; (6)Paola Casanello Toledo. MSc. PhD. Department of Neonatology. Division of Pediatrics. Division of Obstetrics and Gynecology. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (7)José Castro Rodríguez. MD. Division of Pediatrics. School of Medicine. Pontificia Universidad Católica de Chile. Chile.

**Background and objectives:** The effects of maternal obesity on the metabolic and inflammatory state of their offspring at birth remains to be fully defined. The aim of this study was to compare cord blood levels of insulin, leptin, adiponectin and cytokines in offspring from normal weight and obese mothers, and relate these to maternal and neonatal biological characteristics.

**Methods:** A group of healthy pregnant women, with BMI >30 kg/m2 (obese) and BMI between 18.5- 24.9 kg/m2 (normal weight) at the first trimester of pregnancy and their healthy neonates were recruited at the time of delivery (36 - 41 wks) after signing an informed consent. Umbilical cord blood samples were obtained at birth. The concentration of insulin, leptin, cytokines (Milliplex® Human Cytokine/Chemokine and Human Adipokine, Merck Millipore, Billerica, MA, USA), and adiponectin (ELISA, HMW & Total Adiponectin ELISA. ALPCO, USA) were determined in umbilical cord plasma. Distribution of variables was assessed with Shapiro-Wilk test. The comparison between groups
was done using t-student and Chi2 tests. Multiple linear regression models were used to examine the association between the neonatal outcomes and maternal BMI. p-value <0,05 was considered statistically significant. A power of >80% for leptin and adiponectin was calculated.

**Results:** Offspring from obese mothers had higher birth weight (3585 g vs. 3446 g) and ponderal index (2.92 vs. 2.78). When comparing the gender of the neonates from obese mothers, boys exhibit higher birth weight (g) (3726 vs. 3423) and height (cm) (50.3 vs. 48.9) Neonates from obese mothers had higher concentrations of leptin (ng/mL) (57.0 vs. 36.6), adiponectin (ug/mL) (33.9 vs. 29.0) and IL-12p40 (pg/mL) (117.3 vs. 98.3). Girls from obese mothers had higher leptin than girls from normal weight mothers (71.8 vs. 47.6) and boys from obese mothers (71.8 vs. 44.1). Boys from obese mothers had higher adiponectin than boys from normal weight mothers (34.6 vs. 28.5). Cytokines did not exhibit a significant differential pattern among groups.

**Conclusions:** Offspring from early gestation obese mothers had higher leptin and adiponectin. Maternal obesity affects principally the metabolism in girls and the size at birth in boys.

**Keywords:** Maternal obesity

Leptin

Adiponectin

Umbilical cord blood

Cytokines

ative stabilization in 2013 (36.6%, 52.1% and 45.4%, respectively). The BF2y indicator had a relatively stable prevalence from 1986 to 2006 (around 25%) followed by a subsequent increase, reaching 31.8% in 2013.

**Conclusions:** The time series of breastfeeding in Brazil had an increasing trend from 1986 to 2006, with stabilization in 2013 of three out of four indicators studied. These results can be considered an alert sign to stakeholders, indicating the need of reevaluation and strengthening of existing breastfeeding promotion, protection and support policies and programs. New strategies should be considered to retake the breastfeeding uptrend seen in the previous decades.

**Keywords:** breastfeeding, time series studies, population surveys, epidemiology.

## 144/2548

### FASTING DURING THE SUCKLING-WEANING TRANSIENT PERIOD IN RATS INDUCES METABOLIC ABNORMALITIES IN ADULTHOOD

(1)Honma, Kazue; (2)Ikeda, Misa; (2)Mawatari, Riko; (3)Mochizuki, Kazuki; (4)Goda, Toshinao.

(1)PhD. Japan.; (2)Nutritionist. Japan.; (3)Ph.D. Japan.; (4)Ph.D. School of Food and Nutritional Sciences. The University of Shizuoka. Japan.

## 144/2547

### TRENDS ON BREASTFEEDING INDICATORS IN BRAZIL IN THREE DECADES

(1)de Moraes Mello Boccolini, Patricia; (2)Boccolini, Cristiano Siqueira Boccolini; (3)Regina Justo Giugliani, Elsa; (4)Isoyama Venâncio, Sônia; (5)Ramos Monteiro, Fernanda.

(1)PhD. Petrópolis Medicine School. Brazil; (2)PhD. Institute of Scientific and Technological Information and Communication in Health. Fiocruz. Brazil.; (3)PhD. School of Medicine. UFRGS. Brazil.; (4)PhD. Heath Institute of São Paulo. Brazil.; (5)MSc. Health Ministry of Brazil. Brazil.

**Background and objectives:** Objective: we aim to study the breastfeeding indicators trends in the last 3 decades, using informations recently obtained from the 2013 National Health Survey (Pesquisa Nacional de Saúde, in Portuguese).

**Methods:** this is a time series study with secondary data obtained from 4 national surveys with breastfeeding information (from years 1986, 1996, 2006 e 2013). The following WHO standardised indicators were studied: prevalence of exclusive breastfeeding in children under 6 months of life (EB6mo); prevalence of breastfeeding in children under 2 years old (BFtotal); continued breastfeeding at 1 year (BF1y); and continued breastfeeding at 2 years (BF2y).

**Results:** prevalences of EBF6mo, BFtotal and BF1y had an increasing trend until 2006 (from 4.7%, 37.4% and 25.5% in 1986 to 37.1%, 56.3% and 47.2% in 2006, respectively), followed by a rel-

**Background and objectives:** Nutritional status during developmental stages could be associated with subsequent development of metabolic abnormalities. This theory is known as the Developmental Origins of Health and Disease (DOHaD). Many studies have reported the relationship between nutritional deficiency during developmental stages and metabolic abnormalities in animal models including intrauterine calorie restriction (IUCR) in their mothers in the last week of rat pregnancy. In this study, we have examined whether malnutrition by fasting for 3 days in the weaning period alters glucose tolerance in adulthood.

**Methods:** Male Sprague-Dawley rats were fasted from 18 to 21 days after birth, and subsequently they are fed a high-fat, high-sucrose (HF) or low-fat, high-starch (LF) diet for 14 weeks from 17wk of age. The mRNA levels of inflammation-related genes in the peripheral leukocytes were measured at 0 h and 2 h after oral glucose load at 30 wk of age. Serum monocyte chemoattractant protein-1 (MCP-1) concentration and the mRNA levels of inflammatory cytokine and related genes were assessed in mesenteric adipose tissues were at 31 wk of age. Furthermore, the mRNA levels of the genes related to lipid and sugar metabolism related genes were assessed in the liver.

**Results:** At 16 wk of age, body weight and glucose tolerance in rats fasted for 3 days in the weaning period were similar to those in control rats. At 31 wk of age, the animals fasted in the weaning period showed a higher MCP-1 protein concentration when they were fed a LF diet but not when they were fed a HF diet. HF diet-induced increase in the mRNA levels of tumor necrosis factor-α, interleukin-1β and S100 proteins in peripheral leukocytes
at 2 h after glucose load was greater in rats fasted in the weaning period than controls. In the animals fasted in the weaning period, liver triglyceride contents were enhanced in adulthood when they were fed a HF diet, and the expression of gluconeogenesis-related genes were enhanced in adulthood when they were fed a LF diet.

**Conclusions:** These results suggest that malnutrition in the weaning period induces an enhanced inflammation and impaired glucose tolerance in adulthood.

**Keywords:** DOHaD, Metabolic abnormalities, Malnutrition, Inflammation.

144/2549

ASSOCIATION BETWEEN PROTEIN INTAKE AND FRAILTY IN THE KOREAN ELDERLY OF KFACS

(1)Park, Yongsoon; (2)Lee, Yeonjoo.

(1)PhD. Professor. Department of Food and Nutrition, Hanyang University. South Korea.; (2)PhD. Research Professor. Hanyang University. South Korea.

**Background and objectives:** With a rapidly aging population, frailty defined as geriatric syndrome that increases the risk of falls, disability, hospitalization and mortality, is a major health concern. Malnutrition, which is very prevalent in geriatric populations, is one of the main risk factors for the onset of frailty. Previous studies suggest that protein supplementation is an effective dietary strategy to decrease frailty by positively influence aspects of sarcopenia in elderly. However, protein intake for preventing or delaying development of frailty is still a controversial issue. The present study was investigated to evaluate the association between protein intake and frailty in the elderly.

**Methods:** This study was approved by the Institutional Review Board of Hanyang University (HYI-15-228). A total of 265 free-living elderly aged between 70 and 85 years were recruited at three senior citizen welfare centers in Seoul, Korea. The inclusion criteria were ability to communicate independently, and no medical conditions affecting protein intake, such as chronic kidney or liver disease. The frailty status was assessed with the Cardiovascular Health Study (CHS) frailty criteria (weight loss, exhaustion, low physical activity, slowness and low handgrip strength), and three day of 24-hr dietary recall and the Mini Nutritional Assessment (MNA) were evaluated.

**Results:** Elderly participants were categorized into 4 groups: non-frail (n=82), frailty score 1 (n=90), 2 (n=58) and 3-4 (n=35). The daily intakes of energy and protein, protein intake per bodyweight, physical activity, grip strength and gait speed were negatively associated with frailty score. Protein intake was significantly lowered in frailty stage 3-4 than frailty state 1 and non-frail group after adjusting for energy intake. There was significantly less well-nourished elderly (MNA score ≥24) in frail or pre-frail elderly. Intakes of energy, protein, protein per bodyweight, body mass index, frailty score and physical activity were significantly higher in well-nourished elderly than malnourished elderly.

**Conclusions:** Protein intake was significantly inversely associated with frailty and MNA score in Korean elderly, suggesting that protein intake may play an important role for prevention of frailty.

**Keywords:** Protein intake. Frailty. Malnutrition. Elderly

Further collaborators

This study was supported by a Korean Health Industry Development Institute grand funded by the Korean Government (HI15C3207).

144/2554

EVALUATION OF METAPHORS (LIFE AND SELF) OF OBESE & OVERWEIGHT PEOPLE IN COMPARISON WITH THE PEOPLE WITH NORMAL WEIGHT

(1)Ajami, Marjan; (2)Alimoradi, Mohammad; (3)Abdollahi, Morteza;

(3)Vazirijavid, Roya; (4)Pazoki Toroudi, Hamidreza; (5)Ghanati, Kiandokht.

(1)Assistant Prof. Dept. of Food & Nutrition Policy. Planning Research. National Nutrition & Food Technology's Research Institute. Faculty of Nutrition & Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (2)National Nutrition & Food Technology's Research Institute. Faculty of Nutrition Sciences & Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (3)Dept. of Nutrition Research. National Nutrition & Food Technology Research Institute. Faculty of Nutrition Sciences & Food Technology. Social Determinants of Health Research Center. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (4)Physiology Research Center. Iran University of Medical Sciences. Tehran. Iran.; (5)Research Department of The International affairs of Shahid Beheshti University of Medical Sciences & Health Services. Iran.

**Background and objectives:** Overweight and obesity have become an epidemic and a community health problem. In Iran, the prevalence of obesity is increasing dramatically. While the cost for obesity treatment on health is increasing, accordingly, the presence & nature of the relationship between obesity & mental health is less obvious. Metaphors are found in everyday human thoughts & action; they reflect the person's thinking process& ultimately, affect the performance. In this study the relationship between the severity of obesity and healthy behaviors and beliefs was studied.

**Methods:** 120 women randomly selected from nutrition and diet therapy clinics in North of Tehran. All patients who fulfilled the selection criteria divided in to 3 groups (obese, overweight and normal weight). Demographic questionnaires were completed by volunteers. Osgood semantic differential test questionnaire and GHQ mental health questionnaire were completed by the interviewer for each participant. After completing the questionnaires, quality control was re-examined and in case of a problem questionnaires were completed again.

**Results:** On this basis, women with obesity have more negative "self metaphor" than the general population (56.3% vs 42.3%) and
this women have more negative “life metaphor” (62.5% vs 38.5%) than the general population. 37.5% of obese individuals used negative emotional concept metaphors to describe themselves. Most codes with more negative metaphorical content have more repeat in obese subjects than normal weight subjects that psychological condition is very different in obese people.

**Conclusions:** The findings of this study show that overweight and obese individuals have more negative perceptions of their conditions of life, and the intensity of the negative perceptions increase along their weight increase. Negative and closed concepts of the metaphors suggest lack of freedom and mastery in individuals' lives. Their unpleasant subjective sensation of living and feeling stuck are clearly reflected in metaphors. In all groups there is a direct relationship between their attitude to life and to themselves(-self) and overweight and obesity, and the more negative their attitude is, the weight control is more difficult. Other studies have confirmed these results.

**Keywords:** Obesity, Metaphors, Mental health

144/2578

NUTRITION THROUGH LIFE COURSE - NUTRITION DURING PREGNANCY (TIME OF CONCEPTION TO DELIVERY) - A CASE STUDY IN TESHIE, A SUBURB OF ACCRA

Akita, Morkor C.

PhD. Sociologist. FAO. Ghana.

**Background and objectives:** The “Life Course Perspective” proposes that environmental exposures, including biological, physical, social, and behavioral factors, as well as life experiences, throughout the entire life span, influence health outcomes in current and future generations. Nutrition, from preconception to adulthood, encompasses all of these factors and has the potential to positively or negatively shape the individual or population health trajectories and their intergenerational differences. A well-balanced diet is important for adequate nutrition to address common nutrient deficiencies among pregnant women that include iodine, iron, vitamin A and zinc.

**Methods:** The research sought to gain a better understanding of the importance of nutrition during pregnancy. The study adopted a phenomenological case study approach. The voices of pregnant women were used in a form of narratives. The experiences of these women, during pregnancy forms the basis of this study. Twenty-five (25) participants were purposively sampled for the study, aged between 18 and 45. Both primary and secondary data were used. The study was conducted through one-on-one interviews using semi-structured interviews and women's focus group discussion in Teshie, a suburb of Accra in the Greater Accra region of Ghana.

**Results:** The research findings revealed different foods eaten by these pregnant women during pregnancy. Almost 75 percent of women between the ages of 18 – 25 years were eating what they were able to buy, whilst the remaining 25 percent were following

the prescribed menu from the antenatal clinics. This confirms what Right (2014) said about poverty contributing to the kind of diets people eat. Other findings were the social-cultural practices in that community.

**Conclusions:** Adults should consume a balanced diet to maintain a healthy and active lifestyle. This is essential for preventing various diet-related non-communicable diseases such as diabetes, hypertension, and cardiovascular diseases. Taking a life course perspective, consuming a balanced diet has great potential for improving the health and nutritional well-being of the population. While nutrition education remains important, a balanced diet can only be achieved if healthy alternatives are available, accessible, might meet the nutritional needs as well as be affordable for all at all times.

**Keywords:** Nutrition, deficiency, balanced diet, life cycle and environmental exposures

144/2585

LEVELS OF VITAMIN B12 AT EARLY PREGNANCY AND THE RISK OF EXCESS WEIGHT AT BIRTH

(1)Arija, Victoria; (2)Aranda, Nuria; (3)Miralles, Bernat; (4)Abajo, Susana; (4)March, Gemma; (5)Fargas, Francesc; (6)Aparicio, Estefania; (7)Iglesias, Lucia.

(1)Rovira i Virgili University. Spain.; (2)PhD. Pharmacology. Nutrition and Public Health Unit. Rovira i Virgili University. Reus. Spain.; (3)MS. Nutritionist. Nutrition and Public Health Unit. Rovira i Virgili University. Reus. Spain.; (4)Midwife. Sexual and reproductive health service. Institut Català de la Salut. Spain.; (5)PhD. Gynecologist. Sexual and reproductive health service. Institut Català de la Salut. Spain.; (6)PhD. Nutritionist. Nutrition and Public Health Unit. Rovira i Virgili University. Reus. Spain.; (7)Biology. Nutrition and Public Health Unit. Rovira i Virgili University. Reus. Spain.

**Background and objectives:** Vitamin B12 (VitB12) during pregnancy plays a key role in the development of the newborn. There is some controversy about the effect of VitB12 levels on newborn weight. Recently, some authors observed that VitB12 deficiency is related to excess birth weight (Sukumar et al., 2016). Objective: To describe the prevalence of VitB12 deficiency in the first trimester of gestation and its association with the weight of the newborn in the Mediterranean population.

**Methods:** Prospective study in healthy pregnant women from week 12 of gestation until delivery. Mother data collected: clinical history, anthropometry, socioeconomic level, parity, ethnicity, age, smoking and alcoholic habits and food consumption.) At week 12, VitB12 was determined by electrochemiluminescence and was classified as optimal levels (>220pmol/L) and deficiency (margin- al (150-220pmol/L) and low levels (<150pmol/L)) (Allen, 2009; de Benoist, 2008). Newborn data collected: sex, gestational age (GA) and birth weight. Birth weight was classified as: macrosomia (>4000g) or low birth weight (<2500g); and large-for-GA (>P90) or small-for-GA (<P10) according to the reference tables (AEP, 2008; DGSP, 2008).
**Results:** 301 pregnant women of age 30.8+/-4.9, 80.1% Caucasian, 58% medium-high educational level, 20.6% smokers and 7.1% alcoholics and with a BMI 24.9+/-4.3kg/m2 were enrolled. The intake of VitB12 was 4.7+/-1.7µg/day. At week 12, the 65.2% had optimal VitB12level (a mean of 298.5+/-64.7 pmol /L; the 29.1% marginal-levels (192.8+/-19.2pmol/L) and the 5.7% low levels (122+/-25.0pmol/L). The percentage of VitB12 supplementation was 15.5%, 12.8% and 5.9% respectively. According to VitB12 levels, the risk of macrosomia was: a 4.7% in optimal level group, a 10.5% in marginal group and a 17.6% in low level group; and the risk of a large-for-GA was 11.1%, 7.3% and 29.4% respectively. In logistic regressions adjusted, vitB12 deficiency (marginal+low levels) were associated with an increased risk of macrosomia (B=1,833; p=0.01) and large-for-GA (B=1.508;p=0.004) in newborn.

**Conclusions:** The prevalence of vitB12 deficiency in the first trimester of pregnancy affects 34.8% of the women in a Mediterranean country. This deficiency is related to a lower supplementation of this vitamin and a higher risk of macrosomia and large-for-GA in the newborn.

**Keywords:** Vitamin B12, pregnancy, birth weight

**Further collaborators**

ECLIPSES Project Research Group: Josep Basora, Nuria Serrat, Josefa Canals, Carmen Hernández, Nuria Voltas, Manolo Murillo, Miriam Leiva, Carmen Fonollosa, Rosa Alzuria, Irene Aguilar, Eusebia Romano, Beatriz Fenández, Maria Leiva, Elisabet Bru, Inés Sombrero, Judit Bertrán, Silvia Martínez, Demetria Patricio, Eusebia Romano, Montse Carreras, Teresa Pinto, Sonia Argiles, Pilar Coronel, Mercedes Gimeno, Francisca Diaz.

144/2591

BREASTFEEDING AND COGNITIVE DEVELOP-
MENT DURING THE FIRST YEAR OF LIFE

(1)Arija, Victoria; (2)Jardí, Cristina; (3)Hernández, Carmen; (4)Aranda, Nuria; (5)Bedmar, Cristina; (6)Voltas, Núria; (5)Aparicio, Estefania; (5)Ribot, Blanca; (6)Tous, Mònica; (7)Canals, Josefa.

(1)Rovira i Virgili University. Spain.; (2)Nutritionist. Research Group on Nutrition and Mental Health (NUTRISAM). Rovira i Virgili University. Reus. Spain.; (3)PhD. Psychologist. Research Group on Nutrition and Mental Health (NUTRISAM). Rovira i Virgili University. Reus. Spain.; (4)PhD. Pharmacologist. Research Group on Nutrition and Mental Health (NUTRISAM). Rovira i Virgili University. Reus. Spain.; (5)PhD. Nutritionist. Research Group on Nutrition and Mental Health (NUTRISAM). Rovira i Virgili University. Reus. Spain.; (6)PhD. Biologist. Research Group on Nutrition and Mental Health (NUTRISAM). Rovira i Virgili University. Reus. Spain.; (7)Prof. Dr. Research Group on Nutrition and Mental Health (NUTRISAM). Rovira i Virgili University. Reus. Spain.

**Background and objectives:** Breastfeeding (BF) confers numerous benefits on the developing infant in both the short and the long term including psychological development, but there are

multiple other factors that must be taken into account when these relationships are studied. To analyse how breastfeeding during the first 4 months of life affects infant cognitive development (CD) at 6 and 12 months in a group of healthy infants from a Mediterranean Spanish city considering many important potential confounds.

**Methods:** Prospective longitudinal study. A total of 154 healthy infants were evaluated by Hospital Paediatric Unit in Spain.

Data collection: at birth, at 6 and 12 months of age.

Were assessed: Clinical history and sociodemographic data (Hollingshead index) of mothers. Obstetrical and perinatal data (Infant gender, gestational age at birth). Newborn data: Type of feeding (months of breastfeeding and/or infant formula), anthropometry (weight, height and cranial perimeter), iron status (haemoglobin by Coulter, serum Ferritin by turbidimetric immunoassay) and Mental Development Index (MDI) and Psychomotor (PID) by Bayley Scale of Infant Development.

Student's t-test, one-way ANOVA post-hoc test (Scheffé) were used; and also Multiple Linear Regression Models were applied adjusting for prenatal, perinatal and postnatal confounds potential Maternal age, maternal education and socioeconomic status, prenatal nicotine exposure, infant gender, mode of delivery, gestational age at birth, anthropometric measurements, iron status).

**Results:** 46% of whom were boys. At 4 months, 24% of infants received BF, 50% infant formula and 26% mixed feeding (MF). At 6 moths, exclusive BF during the first 4 months of life increased PDI by 7.712 points (p=0.019), while MF increased PDI by 6.393 points (p=0.039).

At 12 months, exclusive BF during the first 4 months of life increased PDI by 7.223 points (p=0.033). We also observed that high haemoglobin levels at 6 months increased PDI (p=0.015). BF did not affect MDI at 6 nor 12 months.

**Conclusions:** In conclusion, after the adjustment of important potential confounds, BF during at least four months and adequate infant iron status are related to better psychomotor development during the first year. No associations were found between BF and mental development.

**Keywords:** Breastfeeding; Mental and Psychomotor Development; Infant Iron Status

**Further collaborators**

Joaquín Escribano, Rosa Jiménez, Josep Maria Barroso, Natalia Ferrer
# ROLE OF THE BREASTMILK MICROBIOME IN COLONISATION OF THE INFANT GUT: A SYSTEMATIC REVIEW

**Background and objectives:** The gut microbiome has been associated with a wide range of chronic diseases including obesity, diabetes and cardiovascular disease, inflammatory and neurological diseases. Early colonisation of the infant gut may be key to the development of gut microbiome in later life but our understanding of the factors which determine the colonisation process and how that links to later/adult health is still incomplete. Many studies have suggested that the human milk microbiome contributes significantly but it is unclear how the bacteria detected in breastmilk are derived and if they survive in the infant gut. We explored the evidence in a systematic review.

**Methods:** A systematic review was carried out to answer 'What evidence exists with regards to early colonization of the infant gut by bacteria coming from breast milk?'

Search terms included: (("Microbiota"[Mesh] OR "Metagenome"[Mesh] OR "Dysbiosis"[Mesh]) AND "Anti-Bacterial Agents"[Mesh]) AND ("Infant"[Mesh] OR "Infant, Extremely Premature"[Mesh] OR "Infant, Extremely Low Birth Weight"[Mesh] OR "Infant, Low Birth Weight"[Mesh] OR "Infant, Very Low Birth Weight"[Mesh] OR "Infant, Small for Gestational Age"[Mesh] OR "Infant, Premature"[Mesh] OR "Infant, Postmature"[Mesh] OR "Infant, Newborn"[Mesh] OR "Infant, Premature, Diseases"[Mesh])AND (microbiota OR bacteria OR microflora OR microbes) AND (dysbiosis) AND (infant OR neonate OR baby) AND (health) AND (disease) AND (birth OR parturition) AND (breastmilk OR breast milk OR human milk) AND (breastfeeding OR breast feeding OR breastfed) AND (formula fed OR infant formula OR bottle fed OR bottle feed) AND (lactation). Searches were carried out using PUBMED, OVID, LILACS and PROQUEST.

**Results:** After initial removal of duplicates and not-relevant papers, 66 papers remained for detailed review. This was carried out independently by three authors before final evaluation of the evidence. Papers were considered for information on sample collection, avoidance of contamination procedures, specified bacterial analysis methods and kits used, and if they discussed maternal and infant events that may influence colonisation including mastitis and antibiotic use.

**Conclusions:** Many studies reported a range of different bacteria in breastmilk. There remains a need to understand the breastmilk microbiome and the modifiable factors which influence this to support health promoting microbial development in the offspring.

**Keywords:** gut microbiome, breastmilk, bacteria, breastfeeding, infant

**Further collaborators**

This expert group is supported by the Early Nutrition and Long-Term Health Task Force of ILSI Europe. Dr Bettina Schelkle is the scientific project manager of this task force and handles the administrative part of the abstract submission.

# BINGE EATING DISORDER IN ADULT WOMEN

**Background and objectives:** Binge Eating Disorder (BED) is a psychological disturbance characterized by recurrent episodes of eating large quantities of food, feeling loss of control during the binge; experiencing shame, distress or guilt afterwards and not regularly using unhealthy compensatory measures. It is associated with severe obesity, psychiatric morbidity, and increased risk for cardiovascular diseases. The aim was to determine the proportion of BED on a sample of women residing in Buenos Aires.

**Methods:** Observational cross-sectional study achieved by a voluntary self-administrated survey among women between 30 - 65 years old in a community-based site during July - August 2016. It was evaluated BED by Binge Eating Scale (BES), biological stage (pre and postmenopause) by self-reference, body mass index (BMI) (being altered when ≥ 25 kg/m2), cardiometabolic risk according to waist circumference (WC) (very high risk when > 88 cm), regular physical activity according to WHO recommendation, BED frequency and favorite kind of food and mood perceived during the binge. Data was described by mean (SD) or percentage and comparisons were made by X2 and Fisher test (α= 0,05) by statistical software SPSS 19.0.

<footnote>(1)Edwards, Christine; (2)Gil, Ángel; (3)van der Beek, Eline;</footnote>

<footnote>(4)Schoemaker, Marieke; (5)Ozanne, Susan; (6)Belzer, Clara; (7)Stanton, Catherine; (8)van Loo-Bouwman, Carolien; (9)Marinello, Vittoria;</footnote>

<footnote>(10)Rueda, Ricardo.</footnote>

<footnote>(1)PhD. Professor of Nutritional Physiology. University of Glasgow. United Kingdom.; (2)PhD. Professor of Biochemistry and Molecular Biology. University of Granada. Spain.; (3)PhD. Research Director Early Development. Nutricia Research. Utrecht. The Netherlands. Professor Nutritional Programming. University Medical Center Groningen. The Netherlands.; (4)PhD. Senior Scientist/Project Leader. Mead Johnson Nutrition. The Netherlands.; (5)PhD. Professor of Developmental Endocrinology. University of Cambridge. United Kingdom.; (6)PhD. Assistant Professor of Microbiology. University of Wageningen. The Netherlands.; (7)D.Sc. Research Professor. APC Microbiome Institute. Teagasc. Ireland.; (8)PhD. Project Leader. Yili Innovation Center Europe. The Netherlands.; (9)MSc. Research Assistant. University of Glasgow. United Kingdom.; (10)MD, PhD. Head Scientific Affairs EMEA, Research and Development. Abbott Nutrition. Spain.</footnote>

<footnote>(1)Rossi, María Laura; (1)Belen, Lorena; (2)Alebuena, Daiana;</footnote>

<footnote>(2)Andrada, Javier; (2)Larronda, Eugenia; (2)Saporiti, Daniela;</footnote>

<footnote>(3)Torresani, María Elena.</footnote>

<footnote>(1)MSc. Nutritionist. School of Nutrition. Faculty of Medicine. University of Buenos Aires. Argentina.; (2)BSc. Nutritionist. School of Nutrition. Faculty of Medicine. University of Buenos Aires. Argentina.; (3)PhD. Nutritionist. School of Nutrition. Faculty of Medicine. University of Buenos Aires. Argentina.</footnote>
**Results:** The sample (n=101) had a mean age of 43,3 ± 11,1 years old and a mean BMI of 25,3 ± 5,27 kg/m2. The 41% were in post menopause and the 15,8% presented moderated BED. The 48,5% presented overweight and 49,5% high cardiovascular risk by WC. The 37,5% had binges occasionally. The 71,3% did not practice regular physical activity. The most chosen foods were baked food and deli-meat/cheeses. It was found statistically significant association between BED and biological stage (p=0,013) and between BED and anxiety (p=0,03), but not with the rest of the variables studied.

**Conclusions:** Perimenopause indeed may be a vulnerable period for the development of an eating disorder. Nutritional education and psychotherapy should be considered to minimize the associated risks.

**Keywords:** binge eating disorder, women, perimenopause, anxiety, overweight.

(1) Ramos, Cláudia de Cássia; (2) Maximino, Priscila Maximino; (3) Vieira Machado, Rachel Helena; (3) Bozzini, Ana Beatriz; (4) W. Ribeiro, Letícia; (5) Fisberg, Mauro.

(1) Bsc. Speech Therapist. Centro de Dificuldades alimentares. Instituto PENSI/Hospital INFantil Sabará/Fundação José Luiz Egydio Setúbal. Brazil.; (2) MSc. Nutritionist. Centro de Dificuldades alimentares. Instituto PENSI/Hospital INFantil Sabará/Fundação José Luiz Egydio Setúbal. Brazil.; (3) MD. Pediatritian. Centro de Dificuldades alimentares. Instituto PENSI/Hospital INFantil Sabará/Fundação José Luiz Egydio Setúbal. Brazil.; (4) BSc. Nutritionist. Centro de Dificuldades alimentares. Instituto PENSI/Hospital INFantil Sabará/Fundação José Luiz Egydio Setúbal. Brazil.; (5) PhD. Pediatritian. Centro de Dificuldades alimentares. Instituto PENSI/Hospital INFantil Sabará/Fundação José Luiz Egydio Setúbal. Brazil.

**Background and objectives:** Background: Delays in gross motor development, sensory processing issues, organic and behavioral problems are known to interfere in the development of feeding skills; and - therefore - in the success of the whole process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of feeding skills. Objectives: Assessment of five feeding skills (FS) in Brazilian children with Feeding Difficulties (FD), and search of possible associations with different types of FD.

**Methods:** Cross-sectional study with 70 children below 10 years old. Data was obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and type of FD. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric

equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%.

**Results:** There was no difference in FS (p>0,05) or in the number of FS inadequateness (p=0,84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; and 1/3 presented delays in more than half of the FS evaluated. Feeding complaints first appeared at 10,9m ± 11,4, and picky eating was the most prevalent type of FD (37,1%). Most children were fed in inadequate environments (55,2%), in inappropriate feeding positions (78%), without the company of adults (78%); did not practice self-feeding (97,7%), although used proper feeding equipment (65,2%); used prolonged bottle feeding (56,9%). Transition to solid foods occurred at 16m ± 5,6. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p=0,95), and from complementary feeding to solid foods (p=0,43) to did not vary according to FD diagnosis.

**Conclusions:** Feeding skills development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

**Keywords:** feeding difficulties, feeding skills, childhood, complementary feeding, feeding behavior

**Conflict of Interest Disclosure:**

• The PI of the project (Mauro Fisberg) conferences in events such as – Abbott, CPW, EMS, Danone, Nestlé, Nutrociencia, PICME, Sanofi, Wyeth; scientific board member of Danone Institute International, Danone Research, Mondelez. Supports research projects at Abbott, CNPq, Coca-Cola, CPW, Danone Institute International, Danone Research, Fapesp, Fap Unifesp, Nestlé.

• Priscila Maximino consults for Hyproca Nutrition Nutrição Infantil Ltda.

• Authors have no participation in food, nutrition or pharmaceutical companies, and there is no influence of any company in any of the projects, conferences or publications conducted.

**Further collaborators:** Dr. Patrícia Junqueira, who participated in the data collection
# PREVALENCE OF EXCLUSIVE BREASTFEEDING IN THE FIRST MONTH OF LIFE IN CRUZEIRO DO SUL, ACRE

(¹)Mosquera, Paola; (²)Hatzlhoffer Lourenço, Bárbara; (³)Barreto Malta, Maíra; (⁴)C. Castro, Marcia; (⁵)Augusto Cardoso, Marly; (⁶)MINA-Brazil Working Group.

(¹)Nutritionist. Department of Nutrition. School of Public Health. University of São Paulo. São Paulo. Brazil.; (²)PhD. Department of Preventive Medicine. Escola Paulista de Medicina. Federal University of São Paulo. São Paulo. Brazil; (³)PhD. Department of Nutrition. School of Public Health. University of São Paulo. São Paulo. Brazil.; (⁴)PhD. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. United States.; (⁵)Department of Nutrition. School of Public Health. University of São Paulo. São Paulo. Brazil.

**Background and objectives:** Early life feeding practices can directly affect nutritional status, growth, development, and child survival. The prevalence of exclusive breastfeeding up to 6 months of age is fundamental for monitoring actions to promote, protect and support breastfeeding. The present study aims to investigate the prevalence of exclusive breastfeeding in the first month of life in Cruzeiro do Sul, Acre.

**Methods:** Cross-sectional analysis of data from the MINA-BRAZIL birth cohort study in the urban area of Cruzeiro do Sul, Acre state, Western Brazilian Amazon. Mothers of babies born from July 1, 2015 to June 30, 2016 at the only maternity hospital in the region were enrolled in this study (n=1,328). Women were interviewed soon after giving birth and by telephone at 30-45 days postpartum. For this analysis, the outcome of interest was exclusive breastfeeding in the first month, classified according to the World Health Organization guidelines when the baby receives only breast milk, including milk expressed or from a wet nurse, without other liquids or solids, except for drops or syrups containing vitamins, oral rehydration salts, mineral supplements or medicines. Information on breastfeeding practices was used to calculate the prevalence of exclusive breastfeeding, using Stata software 14.0.

**Results:** Data on breastfeeding practices in the first month were obtained from 964 mothers and their babies (72.6% of eligible participants). Reasons for the 344 losses of follow-up were: six dropouts (0.45%), 11 without telephone (0.82%), 327 the call was not answered (24.6%), three children (0.22%) and one mother (0.07%) died, two moved out of the municipality (0.15%), and 15 moved to the rural area (1.12%). Although 97.7% (n=942) of the study babies were breastfed at the first month of life, the prevalence of exclusive breastfeeding was 33.1% (n=319), predominant breastfeeding (breastmilk with water, pounded cassava, juice or tea) was 32.6% (n=314), and 32% (n=309) were receiving breastmilk and other type of milk.

**Conclusions:** The exclusive breastfeeding rate in the first month of life in Cruzeiro do Sul was considerably below the World Health Organization recommendations. These preliminary findings highlight the need of intensive actions for promotion, support and protection of breastfeeding before the first month of life.

**Keywords:** Exclusive breastfeeding, breastfeeding prevalence, nutritional status, neonatal outcomes.

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

# SUSTAINABLE UNDERNUTRITION REDUCTION IN ETHIOPIA (SURE) PROGRAMME EVALUATION (2016-2019): CROSS-SECTIONAL BASELINE SURVEY

(¹)Kuche, Desalegn; (¹)Hailu, Tesfaye; (²)Ayana, Girmay; (³)Abera, Andinet; (³)Eshetu, Solomon; (³)Beyene, Yosef; (⁴)Allen, Cami; (⁵)Salasibew, Mihretab; (⁶)Allen, Elizabeth; (⁷)Dangour, Alan.

(¹)M.Sc. Nutritionist. Food Science and Nutrition Research Directorate. Ethiopian Public Health Institute. Ethiopia.; (²)M.Sc. Nutritionist. M.Sc. Nutritionist. Food science and nutrition research directorate. Ethiopian public health institute. Ethiopia.; (³)M.Sc. Food scientist. Food science and nutrition research directorate. Ethiopian public health institute. Ethiopia.; (⁴)M.Sc. Nutritionist. Department of population health. London school of hygiene and tropical medicine.UK.; (⁵)PhD. Epidemiologist. Department of population health. London school of hygiene and tropical medicine.UK.; (⁶)PhD. Medical statistician. Department of medical statistics. London school of hygiene and tropical medicine.UK.; (⁷)PhD. Professor in food science and nutrition. Department population health. London school of hygiene and tropical medicine.UK.

**Background and objectives:** Sustainable Undernutrition Reduction in Ethiopia (SURE) program is the first Government-led multi-sectoral integrated health and agriculture sector program for nutrition outcomes. The program will deliver an enhanced Community-Based Nutrition (CBN) program. The objective was to establish baseline characteristics at the outset of the program and assess the comparability in intervention and comparison districts.

**Methods:** A cross-sectional survey was carried out in four agrarian regions of Ethiopia from April to July 2016. The survey used multistage cluster sampling at the village and household levels. The sample size calculations for the survey was based on detecting a change at end line in nutritional status and key IYCF practices that can be attributed to the SURE intervention. A total of 4980 children 0-47 months old in 4299 households were involved in the survey. The survey covered 36 intervention and 36 comparison districts, a total of 72 districts.

**Results:** The prevalence of stunting among children 6-23 months old was 31.3% and 27.9%; whereas underweight prevalence was 19% and 16.5% and wasting was 9% and 8% in the intervention and comparison districts, respectively. Among children 24-47 months old, stunting prevalence was 46.9% and 40.5%, underweight was 23.7% and 21.6% and wasting was 4% in the intervention and comparison districts, respectively.
Breastfeeding was nearly universal in both groups. Over 60% of children initiated breastfeeding within an hour of birth and nearly 80% of children in both arms were exclusively breastfed. About three-quarters of all children initiated complementary feeding between 6 to 9 months of age but 4.5% and 7.8% of all children had access to the minimum diversified diet in the intervention and comparison districts, respectively. About 41% and 45% of all households were food insecure in the intervention and comparison districts, respectively. About 5% in intervention and 8% in comparison districts of all mothers interviewed had access to minimum diversified diet.

**Conclusions:** The intervention and comparison districts are comparable in most of the demographic and socio-economic characteristics. The prevalence of undernutrition, child feeding practices, food insecurity and women dietary diversity practices are more or less comparable between the two groups.

**Keywords:** Complementary Feeding, Dietary diversity, Stunting, Ethiopia

**Further collaborators**

Adamu Belay (M.Sc. Food Scientist. Food Science and Nutrition Research Directorate. Ethiopian Public Health Institute. Ethiopia.)

Mekonnen Sisay (M.Sc. Nutritionist. University of Gondar. Ethiopia.)

144/2697

## FOOD CONSUMPTION SOURCE EVALUATION OF CALCIUM, IRON AND OMEGA 3 DURING PREGNANCY IN MOTHERS IN LABOR INTERNED IN SANATORIO DE LA TRINIDAD

(1)Garcia, Stella Maris; (2)Perri, Noemi; (2)Rodriguez Fanlo, Eugenia;

(3)Leal, Marcela.

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

**Background and objectives:** Women's nutrition during pregnancy is vital for her and the baby in gestation; an inappropriate nutritional status, both preconception and pregnancy, will impact negatively on the ability to carry out that pregnancy and also the health of the mother and the child.

This study aims to determine the percentage of adequacy for calcium, iron, and Omega 3 and determine if it covers requirements for the biological moment, in mothers in labor interned in Sanatorio de la Trinidad.

**Methods:** Quantitative, descriptive, observational, cross-sectional, retrospective; sample non probabilistic of 328 women in labor interned in Sanatorio de la Trinidad. The information was collected through a structured questionnaire of consumption frequency of foods source in calcium, iron and Omega 3.

**Results:** 75% of the sample does not cover the calcium requirements with an average consumption of 666,56 mg (±16, 6), mean percentage of adequacy of 55.5%. The total sample does not cov-

er the recommendation for iron, noticing that 96% of the sample does not reach 50% of adequacy. Only 2.4% of the sample covers the requirements for Omega-3, and 31.1% refers not to consume it at all.

**Conclusions:** A well qualitatively and quantitatively fed mother, is capable of providing sufficient energy reserves, micro and macronutrients for protection and normal development of the fetus. Prior and during pregnancy nutritional assessment and relevant food education should be routine practices incorporated obstetric consultation and also to the education of the population in general, to improve the conditions of pregnancy and puerperium of the mother as well as to achieve optimum embryo development.

**Keywords:** Pregnancy, Requirements, Calcium, Iron, Omega 3.

**Further collaborators:** Service of nutrition sanatoriums of the Trinidad Palermo, Ramos Mejia and San Isidro.

144/2701

## MODIFiable RISK FACTORS PREsENT FROM CONCEPTION TO AGE 2 YEARs AND THEIR ASOCIATION WITH OBESITy AT 5 YEARs OLD

(1)Bove, Maria Isabel; (2)Zelmonovich, Caren; (3)Bia, Daniel; (4)Iturralde, Adriana; (4)Ghiachetto, Gustavo; (2)Klaps, Leticia; (2)Guillermo, Valentina.

(1)PhD Health and Welfare Institute. Catholic University Uruguay. Uruguay; (2)MSc. Nutritionist. Health and Welfare Institute. Catholic University Uruguay. Uruguay; (3)PhD. MD. Medicine Physiology Chair. Republic University Uruguay. Uruguay.; (4)MD. Medicine Pediatric C Chair. Republic University Uruguay. Uruguay.

**Background and objectives:** The origins of childhood obesity can be found as early as the "first 1,000 days". The main goal of this investigation is to study some modifiable risk factors present from conception to age 2 years and their association with obesity at 5 years old.

**Methods:** Multistage stratified random sampling was used for the selection of children. Public kindergartens of Montevideo-Uruguay were randomly selected and then, a group randomly selected from each school. Trained team measured weight using an electronic scale(SECA) and height non-elastic measuring tape(SECA). From health services, we registered maternal gestational weight, birthweight and weight and height at the age of 6,12,18,24 and 36 months. Dependent variable was current obesity BMI/Age≥2SD(WHO). Analyses were adjusted by high maternal pre-pregnancy BMI(≥25kg/m2), prenatal tobacco exposure, maternal excess gestational weight gain(IOM criteria), high infant birthweight(≥4000 g), short breastfeeding(<9 month), introduction of solid food intake(<4 months) and accelerated infant weight gain(Z-score-change greater than 0.67 in Weight/Age since birth to 24 months).

**Results:** We studied 452 children, 5.9±0.3 years old, approximately half was boys (51.8%). We observed high prevalence of obesity 17.5%(13.6-20.6). Obesity was significantly higher for children which mothers had high pre-pregnancy BMI 24.4%(14.9-33.9), excess gestational weight gain 21.2%(14.2-28.1) and smok-
ing during pregnancy 28.0%(13.3-30.6); those born with high birthweight 20.0%(14.2-28.1) and introduced solid food intake before 4 months 26.3%(14.5-48.1). Obesity wasn't significantly higher in children breastfed less than 9 months.

Accelerated weight gain was the higher obesity risk. Children who upward weight percentile change since birth to 24 months had between 2.6 and 10 times higher likelihood obesity than their non-accelerated weight gain counterparts OR:5.1(IC 95% 2.6-10.1)p<0.001. On other hand, early introduction of solid food intake OR:3.5(IC 95% 1.05-11.92)p=0.041; prenatal tobacco exposure OR:2.5(IC 95% 1.2-5.0) p=0.014 and high maternal pre-pregnancy OR:2.3(IC 95%1.1-4.6)p=0.022 also were significant childhood obesity risk.

**Conclusions:** The present results indicate that accelerate weight gain during the first 1,000 days is the main risk for obesity at 5 years old. It's necessary to prevent accelerated weight gain by good infant feeding practices and to optimize maternal diet and composition before and during pregnancy.

**Keywords:** Obesity, Accelerated growth

**Further collaborators**

Laura Estable, Marine Picasso, Adriana Capel, Martin Saave-
dra, Tatiana Bravo, Valentina Testa, Valentina Coalla,

Angelica Arieta Maya

± 5,99). When comparing the BMIBP with BMIP, bivariate analysis showed result significant (p<0,001). It was observed that 18% (22) of pregnant women have changed NS, and half (11) gained weight and the other half lost weight. These 22 pregnant women who have changed of NS, it was observed that 15,6% (19) this change was undesirable. When compared this modification in the NS with the demographic variables, just age obtained result significant (p=0,051).

**Conclusions:** The results point to the need for monitoring the NS in high risk pregnancy. It is also necessary to establish specifics nutritional care protocols in this prenatal care service, in order to contributing for reduce unfavorable outcomes in this group.

**Keywords:** High-risk pregnancy.

Nutritional status.

Weight gain.

144/2711

HIGH RISK PREGNANCY: EVIDENCE FOR THE
NUTRITIONAL APPROACH

(1)Carmo Rodrigues Barbosa, Míriam; (2)Cantão dos Santos, Hully;

(2)Carlos da Silva, Lauriete; (2)Nascimento Norete, Diésse; (1)Perim de
Faria, Carolina.

(1)PhD. Nutritionist. Federal University of Espirito Santo (UFES). Health Sciences Center of the UFES. Brazil.; (2)BSc. Nutritionist. Federal University of Espirito Santo (UFES). Health Sciences Center of the UFES. Brazil.

**Background and objectives:** Pregnancy is characterized by changes in the standards physiological and metabolic, may reflect in the nutritional status (NS). This natural process can be surrounded by pathological outcomes associated with the NS.

The present study aimed investigating the alterations in the NS along the pregnancy in women assisted in a reference prenatal care service.

**Methods:** Cross section study accomplished in a reference prenatal care service, in the Espirito Santo (Brazil), in which 122 pregnant women participated. For the classification of the body mass index before-pregnant (BMIBP) and BMI pregnant (BMIP) was used the proposed by Atalah (1997). For the statistical analysis was used the program SPSS version 21.0. Significance was set at p<0.05. This study was approved by the local Ethics Committee (CEP - CCS/ UFES; CAAE 45328215.4.0000.5060).

**Results:** Pregnant women had age between 13 and 44. Among these 25,4% were adolescents and 74,6% were adult. It was observed that the average weight gain gestational was higher among pregnant women who started pregnancy with low weight (11,10

144/2720

AGREEMENT OF EXCLUSIVE BREASTFEEDING
DURING THE FIRST 6 MO BY MOTHER'S RECALL
VERSUS THE DOSE-TO-MOTHER ISOTOPE DILU-
TION METHOD

(1)Pongcharoen, Tippawan; (1)Winichagoon, Pattanee; (2)Karim, Norimah A.; (3)Hettiarachchi, Manjula; (4)Yameen, Ayesha.

(1)PhD. Institute of Nutrition. Mahidol University. Thailand.;

(2)PhD. Nutritional Sciences & Dietetics Programme. School of Healthcare Sciences. Universiti Kebangsaan. Malaysia.; (3)PhD. Medicine Unit. Faculty of Medicine. University of Ruhuna.

Sri Lanka.; (4)PhD. Pakistan Institute of Nuclear Science and Technology. Pakistan Atomic Energy Commission. Pakistan.

**Background and objectives:** Exclusive breastfeeding (EBF) for the first six months is promoted worldwide for infant feeding, especially in developing countries. WHO/UNICEF used mother's recall of whether their infants were exclusively breastfed or not. Evidence from small scale studies showed inconsistent finding when using the deuterium oxide dose-to-mother (DTM) method. The objective of this study was to investigate the agreement between the reported EBF and EBF by the DTM method.

**Methods:** Lactating women who reported that they were EBF at 3 months were recruited in 8 participating countries. Mothers reported whether they were EBF using a questionnaire. The EBF was verified using the (DTM) technique. Ninety-one mother-infant pairs from 4 countries were included in the present analysis. Breast milk intakes and non-milk water (NMW) were calculated using the Bayesian approach. The cutoffs used to define EBF were <25 g according to IAEA recommendation, or 82.6 g from the unpublished study using DTM and home observation (Houghton, et al).

**Results:** The result showed that at 3 month, from 91 mother-infant-pairs, only 12.1% and 58.2% were confirmed as EBF using the DTM technique at cutoffs <25 and <82.6 g NMW. At 6 months, 54 mothers recalled they were EBF, and only 5.6 and 18.5%, by respective cutoffs were confirmed as EBF.
**Conclusions:** There was very low agreement in mother's recall of EBF and that by the DTM method, both at 3 and 6 months. This has an important implication to monitoring and program evaluation of breastfeeding promotion.

**Keywords:** exclusive breastfeeding, recall, isotope dilution, agreement

**Further collaborators:** Munirul Islam, Ermin Katrin Winarno, Tetra Fadjarwati, Enkhzul Purevsuren, Tran Thuy Nga, Christine Slater and Alexia Alford

144/2727

ESTIMATION OF THE DIETARY REQUIREMENT FOR VITAMIN D IN PREGNANCY: A DOSE-RESPONSE, DOUBLE-BLIND, RANDOMIZED PLACEBO-CONTROLLED TRIAL

(1)O' Callaghan, Karen; (2)Hennessy, Áine; (3)Dowling, Kirsten G.; (2)Hull, George; (4)Kenny, Louise C.; (5)Cashman, Kevin D.; (6)Kiely, Mairéad E.

(1)BSc. Research Nutritionist. Cork Centre for Vitamin D and Nutrition Research. University College Cork. Republic of Ireland;

(2)PhD. Research Nutritionist. Cork Centre for Vitamin D and Nutrition Research. University College Cork. Republic of Ireland;

(3)MSc. Research Nutritionist. Cork Centre for Vitamin D and Nutrition Research. University College Cork. Republic of Ireland;

(4)Professor of Obstetrics and Consultant Obstetrician and Gynaecologist. Irish Centre for Fetal and Neonatal Translational Research. University College Cork. Republic of Ireland;

(5)Professor of Food and Health. Cork Centre for Vitamin D and Nutrition Research. University College Cork. Republic of Ireland;

(6)Professor of Human Nutrition. Cork Centre for Vitamin D and Nutrition Research. University College Cork. Republic of Ireland.

**Background and objectives:** Pregnancy-specific dietary recommendations for vitamin D have not been established to date, owing to a lack of sufficient experimental evidence to confirm whether an increased vitamin D intake is required during pregnancy. Given the high prevalence of vitamin D deficiency reported among gravidae and neonates worldwide, estimation of the dietary requirement to prevent maternal and neonatal deficiency is a research priority. The aim of this study was to provide the experimental evidence to determine the nutritional requirement for vitamin D during pregnancy and the early neonatal period.

**Methods:** The DMAT Study (Nutritional Requirements for vitamin D in Pregnant Women, NCT02506439) was a three-arm, parallel, dose-response, double-blind, randomized trial of vitamin D3 versus placebo. One-hundred and forty-four healthy pregnant women were randomly assigned to receive either 10 or 20 µg vitamin D3/d or placebo from ≤18 weeks' gestation until late gestation. Vitamin D metabolites in maternal sera at a mean gestational age of 14, 24 and 36 weeks' gestation and in cord sera were quantified by liquid-chromatography-tandem mass spectrometry. A curvilinear regression model was used to predict the total vitamin D intake required to maintain serum 25-hydroxyvitamin D (25(OH)D) above a range of predefined thresholds (25, 30 and 50 nmol/L).

**Results:** Mean baseline serum 25(OH)D was 54.9 ± 10.7 nmol/L. Serum 25(OH)D increased in all groups from the first to the final visit, and mean ± SD maternal concentrations at 36 weeks' gestation were 24.3 ± 5.8 and 29.2 ± 5.6 nmol/L higher in the 10 and 20 µg/d groups, respectively, than in the placebo group (P < 0.001). The estimated vitamin D intakes required to maintain serum 25(OH)D > 25, 30 and > 50 nmol/L in 97.5% of gravidae were 12.4, 15.1 and 29.5 µg/d, respectively. At a minimum maternal threshold of 44 – 55 nmol/L, neonatal circulating 25(OH)D concentrations did not fall < 25 – 30 nmol/L.

**Conclusions:** A vitamin D intake of at least 29.5 µg/d is sufficient to maintain serum 25(OH)D concentrations ≥ 50 nmol/L in 97.5% of women throughout gestation, which in turn will prevent neonatal deficiency at the 25 – 30 nmol/L threshold.

**Keywords:** Vitamin D, pregnancy, requirements, RCT, dose-response

144/2735

MATERNAL PROTEIN RESTRICTION INDUCES SALT SENSITIVITY AND ALTERS RENAL DNA METHYLATION OF THE PTGER1 GENE IN SHRSP OFFSPRING

(1)Miyoshi, Moe; (2)Sato, Masayuki; (2)Saito, Kenji; (2)Otani, Lila; (2)Jia, Huijuan; (3)Kato, Hisanori.

(1)Ph.D. student. Graduate School of Agricultural and Life Sciences. The University of Tokyo. Tokyo. Japan; (2)Researcher. Food for Life. The University of Tokyo. Tokyo. Japan; (3)Professor. Food for Life. The University of Tokyo. Tokyo. Japan

**Background and objectives:** We have previously reported that maternal protein restriction during pregnancy increases the salt sensitivity in stroke-prone spontaneously hypertensive rat (SHRSP) offspring. By a genome-wide methylation analysis in the offspring's kidney, we have revealed that the highly methylated regions were located in the gene of prostaglandin E2 receptor (ptger1), which is known to be associated with hypertension. This study evaluated DNA methylation in the ptger1 gene region by bisulphite sequencing and expression of the ptger1-related genes.

**Methods:** Female SHRSP rats during pregnancy were fed a 20% casein diet (CN group) or a 9% casein diet (LP group). After birth, male pups were reared on a commercial diet and water ad libitum. They were given water (W group) or 1% saline solution as drinking water (S group) from 10 weeks of age. Kidneys were collected after 12 weeks from birth, which were used for mRNA expression analysis by RT-PCR and DNA methylation analysis of ptger1 (+1315-1614 region) by bisulphite sequencing.

**Results:** In response to saline drinking, the blood pressure of pups in LP-S was significantly elevated compared to that in CN-S. There was no significant difference in the blood pressure between CN-W and LP-W. The expression of ptger1 in LP-S and LP-W were significantly increased compared to that in CN-S and CN-W, respectively. DNA methylation of the Ptger1 of LP-S and LP-W showed markedly hyper-methylated state compared with CN-S and CN-W,
respectively. Moreover, in LP-S the expression of enacα (epithelial
sodium channel α, ENaC α), which encodes a sodium channel, was
significantly decreased compared to that in CN-S.

**Conclusions:** These results indicate that maternal protein restriction during pregnancy may alter renal DNA methylation of the ptger1 in SHRSP offspring. Our findings also suggest that the DNA methylation changes in the ptger1 might be associated with the regulation of ptger1 gene expression. In addition, a Ptger1-mediated down-regulation of ENaC α may be involved in the enhancement of salt sensitivity.

**Keywords:** hypertension, maternal protein restriction, DNA methylation

144/2739

ASSESSMENT OF PERCEIVED SOCIAL SUPPORT,
FOOD INSECURITY AND NUTRITIONAL STATUS
OF THE ELDERLY IN THE SAGNARIGU DISTRICT
OF THE NORTHERN REGION, GHANA

(1)Adam, Patrick Wumpini; (2)Colecraft, Esi; (3)Otoo, Gloria;

(4)Dwamena, Francesca.

(1)MPhil. Nutrition. Department of Nutrition and Food Science. University of Ghana. Ghana; (2)DrPH. Faculty. Department of Nutrition and Food Science. University of Ghana. Ghana; (3)PhD. Faculty. Department of Nutrition and Food Science. University of Ghana. Ghana; (4)MD. Professor and Chair. Department of Medicine. Michigan State University. USA.

**Background and objectives:** Despite a growing elderly population, there is a paucity of information on the living conditions of elderly persons in Ghana. With limited institutional social support services and declining extended family support systems, elderly Ghanaians may be vulnerable to food insecurity and malnutrition. We assessed social support, food security and nutritional status of elderly persons in the Sagnarigu District of Northern Ghana.

**Methods:** Cross-sectional survey with a randomly selected sample of 120 elderly persons categorized as young-old (60-64y), middle-old (65-70y) and old-old (>70y) from 3 communities in the Sagnarigu District. Structured questionnaires were used to interview participants about their socio-demographic characteristics, food security situation (using USDA household food security module-short form) and perceived social support. Additionally, participant's weights and heights (or armspan) were measured and BMI or BMA computed and participants categorized as being

Underweight (BMI or MBA< 18.5kg/m2), normal weight (BMI or BMA 18.5-24.9kg/m2) or overweight/obese (BMI or BMA >25kg/m2). Descriptive statistics, bivariate associations and logistic regression for predictors of food insecurity and nutritional status were used to summarize the data.

**Results:** Mean age of participants was 69.5 ± 7.7yrs, 38% were young-old (60-64y), 24.2% middle-old (65-70y) and 37.5% old-old (70y+). There were more females (56.7%) than males (43.3%) and the majority (55.9%) were married. Although a majority (58%) of participants perceived themselves as having strong social support, fewer females than males had strong perceived social

support (48.6% vs. 51.4%; $\chi^2=4.48$; P=0.03). Prevalence of food insecurity was 61.7%. Mean BMI and BMA were 22.3 ± 4.8kg/m2 and 20.0 ± 4.2kg/m2, respectively: Approximately 18.3% of participants were underweight and 24.2% were overweight or obese. Prevalence of underweight was significantly (P=0.006) higher among the old-old participants while women (58.6%) were more likely than men (41.4%) to be overweight or obese (P=0.005). Current income above 250 Ghana cedis but not social support was protective against food insecurity (OR=-1.4: P= 0.029).

**Conclusions:** Cash transfers to elderly persons may help curb the prevalence of food insecurity among the elderly persons in this district. Overweight and obesity was more prevalent than underweight in this elderly population.

**Keywords:** nutritional status, elderly, food security, perceived social support, Ghana

144/2751

CHALLENGES AND OPPORTUNITIES IN DESIGN-
ING WEEKLY IRON AND FOLIC ACID SUPPLE-
MENTATION PROGRAMS FOR ADOLESCENT
GIRLS IN AND OUT OF SCHOOL IN 3 AFRICAN
COUNTRIES

(1)Roche, Marion; (2)Mekuria Lewetie, Ermias; (3)Tidiane Niang, Cheikh; (4)Murage, Lucy; (5)Holte-McKenzie, Merydth; (6)Aziz Adish, Abdul; (7)De Regil Velez, Luz Maria.

(1)PhD. Senior Technical Advisor. Research & Evaluation Unit. Nutrition International. Canada.; (2)MPH. Senior Project Officer. Nutrition International. Ethiopia.; (3)MD. Senior Project Officer. Nutrition International. Senegal.; (4)MPH. Senior Project Officer. Nutrition International. Kenya.; (5)MCH. Technical Advisor. Research & Evaluation Unit. Nutrition International. Canada.; (6)PhD. Deputy Regional Director. Africa Regional Office. Nutrition International. Kenya.; (7)Nutrition International. Canada.

**Background and objectives:** The 600 million adolescent girls living in developing countries have to become a focus of anemia reduction efforts to reach the WHA target of a 50-percent reduction in anemia by 2025. Despite the 2011 WHO recommendation for weekly iron folic acid supplementation (WIFAS), national policies and operational guidelines are lacking and national programs are not being implemented in most African countries. Our objective was to design demonstration programs informed by context specific formative research, to assess feasibility of delivery platforms that could inform national scale up to reach adolescent girls in and out of school system in Ethiopia, Kenya, and Senegal.

**Methods:** Formative research protocols were adapted for each country and studies were implemented with local partners in 2016 and 2017 to identify contextual opportunities for reaching adolescent girls with WIFAS and factors that could influence coverage and adherence. Purposive sampling guided the selection of adolescents, teachers, health workers, decision makers and influencers. Methods included focus group discussions (FGDs) and in-depth interviews (IDIs): Ethiopia–30 FGDs and 85 IDIs; Kenya– 45 FGDs and 36 IDIs; and Senegal–83 FGDs and 301 IDIs.
**Results:** As adolescent girls have low access of the health system for preventative services, the delivery of WIFAS through the school system was the most efficient platform for greatest reach in all settings. Engagement of teachers and school attendance have the greatest influencers on coverage and adherence. Attendance is often much lower than enrollment due to family and community pressures and a lack of basic amenities, such as female-friendly latrines and safe water. Reaching disperse out-of-school girls with health extension workers will be more resource and time intensive. Awareness of anemia is high, yet misconceptions are common. WIFAS benefits that motivate adolescent girls are related to current school performance, strength and health, rather than future reproductive potential; yet, distinct segments exist within adolescent girls.

**Conclusions:** Reaching adolescent girls with WIFAS requires multi-sector collaboration between health and education. Impact of these anemia reduction efforts requires overcoming gendered barriers to school attendance and youth-specific barriers to the health system, while recognizing the specific motivators of diverse adolescents in each country.

**Keywords:** Adolescent Nutrition, Anemia, Weekly Iron Folic Acid Supplementation, Formative Research, Program Design

**Further collaborators:** Funding was provided by Nutrition International through a grant from Global Affairs Canada of the Canadian government.

144/2756

PRENATAL NUTRITION, STIMULATION, AND
EXPOSURE TO PUNISHMENT ARE ASSOCIATED
WITH EARLY CHILD MOTOR, COGNITIVE, AND
SOCIOEMOTIONAL DEVELOPMENT IN DAR ES
SALAAM, TANZANIA

(1)Pitchik, Helen; (2)Fawzi, Wafaie; (3)McCoy, Dana Charles; (4)Darling, Anne Marie; (5)Abioye, Ajibola I.; (6)Tesha, Florence; (7)Smith, Emily R.;

(8)Mugusi, Ferdinand; (7)Sudfeld, Christopher R.

(1)MSc. Division of Epidemiology. School of Public Health. University of California. Berkeley. Berkeley. CA. USA.; (2)MBBS DrPH. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. USA; (3)PhD. Harvard Graduate School of Education. Cambridge. MA. USA.; (4)MSc. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. USA.; (5)MBBS. MPH. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. USA.; (6)Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. USA.; (7)ScD. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. USA.; (8)MD. Department of Internal Medicine. Muhimbili University of Health and Allied Sciences. Dar es Salaam. Tanzania.

**Background and objectives:** Despite growing evidence that early life experiences and exposures can impact child development, there is limited research on prenatal determinants in resource-limited settings. This study examines the association between prenatal

factors, birth outcomes, and early life stimulation with motor, cognitive/language and socioemotional development in Tanzania.

**Methods:** We assessed motor, cognitive/language and socioemotional development among a cohort of 198 children aged 18-39 months in Dar es Salaam, Tanzania, whose mothers were previously enrolled in a randomized, placebo-controlled trial of prenatal vitamin A and zinc supplementation. Linear regression models were used to assess standardized mean differences in child development scores for randomized prenatal regimen and pregnancy, delivery, and early childhood factors.

**Results:** Children born to mothers randomized to prenatal vitamin A had significantly lower motor scores in minimally adjusted and multivariate analyses (-0.28 SD; 95% CI: -0.53- -0.03; p=0.03) as compared to children whose mothers did not receive vitamin A. There was no significant effect of randomized prenatal zinc on child development. In terms of observational factors, greater caregiver-child stimulation was associated with better cognitive/language scores (p<0.01), while children who experienced both verbal and physical punishment were reported as 0.29 SD (95% CI -0.53- -0.06; p=0.02) lower in socioemotional development than their peers who did not experience both verbal and physical punishment. Further, children of mothers who were <155cm tall had 0.27SD (95% CI -0.54- -0.01; P=0.05) lower scores on the cognitive/language subscale when compared with children of mothers who were ≥155cm tall.

**Conclusions:** Prenatal vitamin A supplements in a setting with low levels of vitamin A deficiency may not provide child development benefits. However, integrated environmental, educational, parenting, and stimulation interventions may have positive implications across child development domains in resource-limited settings.

**Keywords:** Early child development, Low-income countries, Prenatal Supplementation, Vitamin A Psychosocial Stimulation

144/2765

CHARACTERIZATION OF UNDERNUTRITION
AND ASSOCIATED FACTORS AMONG CHILDREN
AGED 6 TO 24 MONTHS IN RURAL MALAWI

(1)Kang, Yunhee; (2)Hurley, Kristen; (3)Ruel-Bergeron, Julie; (3)Oemcke, Rachel; (4)Monclus, Assumpta; (3)Wu, Lee Shu; (3)Mitra, Maithilee; (5)Phuka, John; (6)Klemm, Rolf; (7)West, Jr., Keith.

(1)PhD. Postdoctoral fellow. Department of International Health. Johns Hopkins School of Public Health. USA.; (2)PhD. Assistant Professor. Department of International Health. Johns Hopkins School of Public Health. USA.; (3)MSc. Department of International Health. Johns Hopkins School of Public Health. USA.; (4)MD. Department of International Health. Johns Hopkins School of Public Health. USA.; (5)MD. Senior Lecturer. University of Malawi. Zomba. Malawi.; (6)DrPh. Helen Keller International. USA.; (7)DrPh. Professor. Department of International Health. Johns Hopkins School of Public Health. USA.

**Background and objectives:** Given the high prevalence of child undernutrition in Malawi, this study aimed to examine the burden and risk factors of stunting and wasting using data from an impact evaluation study collected at baseline.
**Methods:** Using a cross-sectional dataset for 2,364 children, multivariable logistic regression analysis was conducted to identify risk factors of stunting and wasting at household, maternal, and child level separately among infants (6-<12 mo; n=778) and children (12-23 mo; n=1586). In all 42 risk factors were examined.

**Results:** The prevalence of stunting (LAZ<-2) was 45.3% and 56.4%, and wasting (WLZ<-2) was 1.6% and 3.0% among infants and children (12-23 mo), respectively. Among infants, stunting was positively associated with male sex (OR=1.66), age (OR=1.12), having no toilet (OR=1.65), and inappropriate hand washing (OR=1.32) [all 95%lower limit (LL)>1.0] and negatively associated with mother's age≥25 y and <35 y (OR=0.62; referent: age<25 y) [all 95%upper limit (UL)<1.0]. These variables were found also to be risk factors, except for having no toilet, among children (12-23mo): male sex (OR=1.58), age (OR=1.06), inappropriate hand washing (OR=1.30) (all 95%LL>1.0) and mother age≥25 y and <35 y (OR=0.77; referent:<25 y) (95%UL<1.0). Perceived small birth size (OR=1.41), having no TV (OR=2.01), previous child death (OR=1.53), not breastfeeding within 1-hour of life (OR=1.55) (all 95%LL>1.0) and housewife mother (OR=0.65; referent: farming) (95%UL<1.0) were additional risk factors for stunting among children (12-23 mo). Among infants, wasting was positively associated with having no kitchen (OR=7.45) and pre-lacteal feeding (OR=14.89) (all 95%LL>1.0) and negatively related to owning land for producing foods (OR=0.16) (all 95%UL<1.0). Of these variables, having no kitchen (OR=2.31) was only related to wasting among children (95%LL>1.0). Having no mobile phones (OR=2.85), unsafe water source (OR=0.38), having ≤2 rooms (OR=2.16), mother age>35 y (OR=2.27; referent:<25 y), and perceived small birth size (OR=2.02) were additional risk factors for wasting among children (all 95%LL>1.0).

**Conclusions:** More risk factors for stunting and wasting were found related to socio-economic status, size at birth, and mothers' feeding behaviors among children in their second year of life than in infancy in rural Malawi. Understanding age-specific risks of undernutrition would help refine approaches and interventions for prevention.

**Keywords:** stunting, wasting, risk factors, children, Malawi

**Further collaborators:** Corresponding author: Parul Christian, DrPh. Bill and Melinda Gates Foundation. USA.

Supported by Children's Investment Fund Foundation, UK

of the age; as the body composition changes (increase of fat mass, decreased lean mass and loss of functionality) next to distinctive pathophysiological factors that are added to the base nutritional status. To recover nutritionally an elderly deteriorated is very difficult, hence the importance of valuing nutritionally this group and detecting early risks to take measures of action.

To assess the risk and nutritional vulnerability and functionality of musculo-skeletal tissue, in elderly hospitalized in Sanatorio La Trinidad during February - March, 2017

**Methods:** Quantitative research, descriptive, observational and cross-sectional.

**Population:** Adults ≥ 75 years interned in Sanatorio La Trinidad, excluding patients who had pathologies that by itself altered the base nutritional status.

Sample= 141, non probabilistic.

The selected sample was evaluated by different methods and tools: Mini Nutritional Assessment Questionnaire (MNA), Geriatric Nutritional Risk Index (GNRI), Nutritional Vulnerability Survey and grip force by dynamometry, subsequently data was tabulated and carried out an analysis of the same.

**Results:** Average age 82 years (SD±6). 61% was female. 74% lived with relatives and/or caregivers at the time of the internment, 25% lived alone and 1% in private geriatrics. The Nutritional Risk obtained by MNA: 43% normal, 45% risk and 12% malnutrition; according GNRI: 50% without risk, 18% under, 20% moderate and 11% high.

Nutritional Vulnerability Degree: 3% didn't present, 91% mild, 6% moderate.

Grip Force: 41% weak, 38% normal, 21% strong.

**Conclusions:** Detecting the needs and the difficulties and challenges that the elderly live to procure food; along with the nutritional status evaluation and functionality of muscle-skeletal tissue, is essential for the decision-making during the internment and patient following after hospitalization.

**Keywords:** Food Vulnerability; Malnutrition; Muscle-skeletal functionality.

**Further collaborators:** Nutrition Service Sanatorio La Trinidad Palermo and San Isidro Thames and Fleming. BSc Nutritionist Micaela Scuri.

<footnote>(1)Garcia, Stella Maris; (2)Perri, Noemi; (3)Leal, Marcela.</footnote>

<footnote>(1)PhD. Nutritionist. Service of Nutrition. Sanatorio de la Trinidad.
Argentina.; (2)BSc. Nutritionist. Maimonides University. Argentina;</footnote>

<footnote>(3)MSc. Faculty of Health Sciences. Maimonides University. Argentina.</footnote>
## OMEGA6:OMEGA3 FATTY ACIDS IN THE DIET: RESULTS FROM A POPULATION-BASED STUDY

(1)Simonian Rodrigues Valente Ghedini, Natália; (2)de Assumpção, Daniela; (3)Berti de Azevedo Barros, Marilisa; (4)Martins Álvares Domene, Semíramis.

(1)Dietitian. Federal University of São Paulo. Baixada Santista Campus. Institute of Health and Society. Graduate Program in Food. Nutrition and Health. Santos. Brazil.; (2)PhD. Dietitian. Department of Collective Health. School of Medical Science. State University of Campinas. Campinas. Brazil.; (3)PhD. Doctor. Department of Collective Health. School of Medical Science. State University of Campinas. Campinas. Brazil.; (4)PhD. Dietitian. Department of Public Policies and Collective Health. Federal University of São Paulo. Santos. Brazil.

**Background and objectives:** Although the effect of diet on health status is widely recognized, few Brazilian studies have evaluated the profile of fat consumption by the Brazilian population. The imbalance in the consumption of omega-6:omega-3 (n6:n3) fatty acids is related to inflammatory processes that increase the risk of developing non-communicable chronic diseases.

The aim of this study was to analyze the associations between the ratio of n6:n3 fatty acids and sociodemographic variables, health related behaviors and morbidity.

**Methods:** This is a cross-sectional population-based study, with a sample stratified by clusters and in two stages, conducted between 2008-09, in the city of Campinas, SP, Brazil. Fat intake was estimated using the 24-Hour Recall, and data were entered into the Nutrition Data System for Research software. In the analysis, the means of the n6: n3 ratio were calculated according to the independent variables, using simple and multiple linear regression, with a significance level of 5%. The food records of 3,303 individuals, aged 10 years or more, were analyzed.

**Results:** Lower values of the n6: n3 ratio were found in the strata of adults and the elderly, in those who ate fruit and milks daily, and in those who were physically active at leisure. The prevalence of inadequate omega 3 in the diet reached 13% of the population, and the omega 6 reached 100% among adult women.

**Conclusions:** The results reveal that the groups most vulnerable to the inadequate intake of omega-6 and omega-3 fats were adolescents, those who did not eat fruit and milk every day and those who did not practice physical activity at satisfactory levels. These findings show a concomitance of unhealthy behaviors and may contribute to the elaboration of strategies aimed at the adoption of changes in lifestyle.

**Keywords:** Fatty acid omega 6; fatty acid omega 3; ratio omega6:omega3; sociodemographic profile; dietary surveys.

## IMPACT OF ANTIBIOTICS ON MICROBIOME DEVELOPMENT & INSTEAD OF LATER HEALTH

(1)Van Daele, Emmy; (2)Belzer, Clara; (3)Knol, Jan; (4)Vlieger, Arine M.;

(5)van Elburg, Ruurd M.; (6)Oosterloo, Neelke.

(1)PhD candidate. Laboratory of Microbiology. Wageningen University. The Netherlands.; (2)PhD. Laboratory of Microbiology. Wageningen University. The Netherlands.; (3)Prof PhD. Laboratory of Microbiology. Wageningen University. The Netherlands.;

(4)MD PhD. Department of Pediatrics. St. Antonius Hospital. The Netherlands.; (5)MD Prof PhD. Department of Pediatrics. Academisch Medisch Centrum Universiteit van Amsterdam. The Netherlands.; (6)MD. Department of Pediatrics. Academisch Medisch Centrum Universiteit van Amsterdam. The Netherlands.

**Background and objectives:** Neonatal colonization drives postnatal gut maturation and induces the immune system, thus possibly impacting (long term) health. The exact impact of early life factors on later intestinal microbiota colonization and health remains unclear especially when disruptive factors like antibiotic use come into play. This study aims to provide insights into the development of the early life microbiome, especially for infants that received antibiotic treatments during the first week of life.

**Methods:** We will investigate the early life microbiome composition with 16S Illumina sequencing within the observational cohort of the INCA study. In this study, stool samples were collected from 450 term infants, of whom 150 had received an antibiotic treatment during their first week of life. Fecal samples and clinical outcomes were followed up until the age of 2 years, including 9 time points. Around the time of birth, the mothers also collected a fecal sample and both parents sampled the skin and oropharynx with a swab. Additional metagenomics studies will be used to study the transmission of micro-organisms from the parents to the infant.

**Results:** An overview will be made of the microbial development of the gut during the first 2 years of life, especially after short (2-3 days) or long (7 days) antibiotic treatment during the first week of life. A comparison based on the delivery mode (vaginal delivery, primary or secondary caesarean section) and the feeding mode (breastfed or formula fed) will be included.

**Conclusions:** Possible clinical effects of early life conditions like antibiotic use could be demonstrated with this data set. Such findings could help with the development of pre-, pro- and synbiotics to support an ecological balance in the infant gut microbiota when some life conditions are not optimal. This could resolve disease in later life, especially because of the tight interplay of the gut and immune system's development.

**Keywords:** Gut microbiota, Early life, Antibiotic use

**Conflict of Interest Disclosure:** Jan Knol and Ruurd van Elburg work for Danone Nutricia Research, part of the Danone Group and Danone Nutricia Research financed part of this study.
(1)Huynh, Dieu Thi Thu; (2)Tran, Nga Thuy; (3)Nguyen, Lam Thi;

(4)Berde, Yatin; (5)Low, Yen Ling; (6)Tey, Siew Ling.

(1)MD. PhD. Senior Lead Scientist. Abbott Nutrition Research and Development Asia-Pacific Center. Abbott. Singapore.; (2)MD. PhD. Head of Department. Micronutrient Research and Application. National Institution of Nutrition. Vietnam.; (3)MD. PhD. Deputy Director of National Institution of Nutrition. Clinical Nutrition. National Institution of Nutrition. Vietnam.; (4)MS. Biostatistician. Statistical Services. Cognizant Technologies Solution Pvt. Ltd. India.; (5)PhD. Director. Abbott Nutrition Research and Development Asia-Pacific Center. Abbott. Singapore.; (6)PhD. Senior Clinical Scientist. Abbott Nutrition Research and Development Asia-Pacific Center. Abbott. Singapore.

**Background and objectives:** Nutritional demands significantly increase during pregnancy to support healthy fetal growth and development. Understanding nutritional adequacy during pregnancy may help to identify appropriate approach to promote optimal nutrition for better pregnancy outcomes. The objective of the present study was to describe maternal nutritional adequacy and gestational weight gain among pregnant women in Vietnam.

**Methods:** A total of 226 singleton mothers aged 20 to 35 years at 26 to 29 weeks gestation took part in a prospective, multicenter, randomized controlled trial, parallel design with two treatments: (A) daily maternal nutritional supplementation containing macronutrients and a variety of micronutrients starting from 26 to 29 weeks gestation (i.e. baseline) to 12 weeks postpartum and a breastfeeding program (experimental group) or (B) standards of care which is to continue taking iron and folic acid supplementation daily until delivery (control group). Maternal nutritional intake was assessed at baseline using a standardized 24-hour diet recall method. Gestational weight gain during the first and second trimesters was calculated by subtracting pre-pregnancy weight from weight at 26 to 29 weeks.

**Results:** Ninety-five percent of the pregnant women had concurrent inadequacies for more than five nutrients and approximately one in two (i.e. 44%) pregnant women had concurrent inadequacies for more than ten nutrients at baseline. Almost two-thirds (i.e. 62%) of the pregnant women did not meet the recommended gestational weight gain defined by the Institute of Medicine. Infants in the maternal nutritional supplementation group had significantly higher birth weight, birth weight-for-age z-score, and birth head circumference-for-age z-score, compared with those in the iron and folic acid supplementation group (all $P \le 0.049$).

**Conclusions:** Nutrient inadequacies are very common in pregnant women in Vietnam and often occur as concurrent inadequacies across multiple nutrients. The high percentage of women who failed to meet recommended gestational weight gain during pregnancy is of concern. Maternal nutritional supplementation which provides macronutrients and various micronutrients is

more effective than the routine iron and folic acid supplementation and can be used as a means to promote maternal nutritional status in order to improve birth outcomes.

**Keywords:** Pregnancy. Nutritional adequacy. Gestational weight gain. Maternal nutritional supplementation. Birth outcomes.

**Conflict of Interest Disclosure:** The study was funded by Abbott Nutrition. Yen Ling Low, Siew Ling Tey, and Dieu Thi Thu Huynh are employees of Abbott Nutrition. Yatin Berde is an employee of Cognizant Technologies Solution Pvt. Ltd., which provides statistical services to Abbott Nutrition.

(1)Rocha Simonin De Souza, Vagner; (2)Da Silva Daineses, Karen;

(3)Nunes Rosa Borges, Graciely.

(1)PhD. Nutritionist. Department of Nutrition. Redentor Univeristy. Brazil.; (2)Nutritionist student. Redentor University. Brazil.; (3)Nutritionist. Redentor University. Brazil.

**Background and objectives:** The study aimed to evaluate a body self-image of adolescents under the influence of the media, and how much this influence alters your perception of your body.

**Methods:** Twelve adolescents between the ages of 15 and 18 participated in the study, at the High School of the Redentor College in Itaperuna, who returned to the Duly signed Free and Informed Consent Form. Two questionnaires were applied: a body self-image test, based on the self-image scale, developed and validated by KAKESHITA et al, 2006. The test was constructed by three self-image scales, each scale being 9 silhouettes, each silhouette corresponding to an average BMI, where the Teenager indicated on the scale 1, the figure that best represented the silhouette of his own body at the moment, and at scale 2, he indicated which silhouette he would like to have. Weight and height of each adolescent were collected to define their BMI, Thus defining the image that represented the real silhouette of the same. Afterwards, a questionnaire containing 29 questions was applied in order to evaluate the influence of the media on the body self-image, developed and validated by AMARAL et al, 2015. Subsequently, Pearson correlation analysis, ANOVA and Tukey, with significance of $p < 0.05$, between each scale and the questionnaire questions. The three self-image scales, S1, S2 and S3, were also compared for the determination of distortions between them. After the application of the test and questionnaire, an educational lecture was given, where the topics "Fashion Diets" and "Eating Disorders" were discussed.

**Results:** The TV was defined, according to the results, as an object of greater influence, followed by Magazines, Movies and Movie Stars. As predicted, this influence is stronger in females, but there is a distortion of body self-image in both sexes, suggesting, dissatisfaction with body image also in both.
**Conclusions:** From the results found, it is concluded that the influence of the media in the self-image of adolescents is existing and very significant in both Sexes.

**Keywords:** body image; media; Teenagers

**Further collaborators:** This study was supported by scientific committee of REDENTOR University

ANTHROPOMETRY AND BIOIMPEDANCE ANALYSIS: COMPARISON IN PREDICTING INTRA-ABDOMINAL FAT

**Background and objectives:** Abdominal obesity, more specifically increased intra-abdominal adipose tissue, is strongly associated with increased risk of metabolic disease. Bioelectrical impedance analysis (BIA) may provide a better reliability non-invasive measure of visceral fat level (VFL) than anthropometric assessment of waist circumference (WC) considering the possible intra-observer and inter-observer technical errors which can be presented by this latter. The aim of this study was the evaluation of anthropometric measurements in comparison to multifrequency tetrapolar BIA in adult women.

**Methods:** Cross-sectional study of 406 women, attending a nutritional consultation at the Metabolic and Endocrine Diseases Research Foundation (Buenos Aires City, Argentina). An anthropometric profile was assessed by body mass index (BMI) and WC, considering increased values greater than or equal to 25 kg/m2 and greater than 88 cm, respectively. The VFL analysis was performed in a 3-h fast, by a four-way multifrequency bioelectrical impedance analyzer (model InBody 570). Statistical analysis with SPSS 19.0 using Spearman correlation, Mann Whitney test and chi2 test (p value <0.05).

**Results:** The mean age was 41.1 (SD = 15.2) years, stratified into two groups: 20-39 years (n = 220) and 40-65 years (n = 186). Mean BMI values for each group were: 25.4 (SD = 4.6) kg/m2 and 27.6 (SD = 4.9) kg/m2, respectively. WC was 81.1 cm (SD = 11.1) and 87.7 cm (SD = 11.0) for each age group, respectively. The prevalence of altered VFL was 50.0% (95% CI, 43.5-56.5%) and 76.9% (95% CI, 70.3-82.3%) respectively (p = 0.000). The greater age range the higher VFL. The correlation between VFL and WC was high positive (r= 0.84, p <0.0001). In the total of the sample 31.8%

presented altered WC, while 62.3% presented VFL altered by bioimpedance and both variables were not independent (p <0,001). Stratifying by BMI, neither showed independence (Overweight/obese p=0,02; Normal weight p= 0,01). In overweight or obese women, 53.4% had altered WC, and 94.4% presented VFL altered by bioimpedance. In normal weight women, 4,07% had altered WC, and 18.6% had altered VFL by bioimpedance.

**Conclusions:** Positive correlation was found between WC and VFL and both variables were not independent beyond the nutritional status.

**Keywords:** anthropometry, bioelectrical impedance, intra-abdominal fat, women

ADOLESCENT MOTHERS' HEIGHT AND BMI GROWTH VELOCITY IN CHILDHOOD PREDICT NEXT GENERATION'S ANTHROPOMETRICS IN ETHIOPIA, INDIA, PERU AND VIETNAM: A THREE-GENERATIONAL APPROACH

**Background and objectives:** Previous studies have shown maternal birth weight and childhood growth predicts next-generation birth weight; few have considered adolescent mothers or have examined associations across three-generations, including children, mothers and grandmothers.

**Methods:** "Young Lives" is a longitudinal study of children growing up in poverty in Ethiopia, India, Peru, and Vietnam. We used data from 285 girls of the older cohort who had been visited at ages 8, 12, 15 and 19 approximately, and had given birth, in order to examine the predictive value of their body size and growth between 8 and 15 years on their infants anthropometrics. We analyzed height-for-age z-scores (HAZ), body-mass-index-for-age-z-scores (BMIZ) and conditional HAZ growth (measured as residuals in regressions of HAZt on HAZt-1, denoted cHAZ) and conditional BMI z-score (BAZ) growth (denoted cBAZ) on their infant's on infant's birth weight, birth weight z-score (BWZ), and conditional growth in weight-for-age-z-score (cWAZ), and HAZ. We also examined the grandmaternal BAZ and HAZ, as predictors of third-generation anthropometrics. We included controls for all three generations.

**Results:** One standard deviation increase in cHAZ growth between ages 8 and 15 years predicted 128.5g higher third-generation birth weight, 0.30 standard deviation higher BWZ, and 0.41 standard deviation higher cWAZ, but not third-generation HAZ.

<footnote>(1)Janjetic, Mariana; (2)Rossi, María Laura; (2)Oliva, María Laura;</footnote>

<footnote>(2)Squillace, Celeste; (2)Belen, Lorena; (2)Alorda, María Beatriz;</footnote>

<footnote>(3)Maffei, Laura; (4)Torresani, María Elena.</footnote>

<footnote>(1)PHD. Nutritionist. Universidad de Buenos Aires. Facultad de Medicina. Escuela de Nutrición. Buenos Aires. Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Argentina;</footnote>

<footnote>(2)MSc. Nutritionist. Escuela de Nutrición. Facultad de Medicina. Universidad de Buenos Aires. Argentina.; (3)MD. Directora Médica de Fundación de Investigación para el Estudio de Enfermedades Endocrino Metabólicas (FIEEM). Buenos Aires. Argentina;</footnote>

<footnote>(4)PhD. Nutritionist. Escuela de Nutrición. Facultad de Medicina. Universidad de Buenos Aires. Argentina.</footnote>

<footnote>(1)Schott, Whitney; (2)Aurino, Elizabeth; (3)Penny, Mary Penny;</footnote>

<footnote>(4)Behrman, Jere.</footnote>

<footnote>(1)BA. MA. PhD. Research Scientist. Population Studies Center. University of Pennsylvania. USA.; (2)BA. MA. PhD. Applied Microeconomist. Centre for Health Economics and Policy Innovation. Imperial College. London. UK.; (3)MA. MBChB. Director and Researcher. Instituto de Investigación Nutricional. Peru.; (4)BA. PhD. Professor. School of Economics. University of Pennsylvania. USA.</footnote>
Maternal BMI z-score (BAZ) aged 8 was associated with 0.21 higher BWZ (and birth weight, though at p<0.10), but not with third-generation cWAZ or HAZ growth. Maternal cBAZ predicted third-generation cWAZ and HAZ. Grandmaternal BAZ and HAZ did not predict the grandchild anthropometric outcomes that we measured but grandmaternal schooling did predict higher grandchild birth weight and BWZ (p<0.05).

**Conclusions:** Adolescent mother's size and growth during childhood predicted their offspring's birth weight, BWZ, HAZ and cWAZ. Grandmaternal schooling, but not size, predicted third generation anthropometrics.

**Keywords:** Adolescent growth, offspring anthropometrics, three generations, "Young Lives" study

144/2825

OPPOSING PREDICTIONS OF BIRTHWEIGHT AND PRE-PUBERTAL ANTHROPOMETRICS FOR AGE AT MENARCHE IN INDIA, PERU AND VIETNAM, RESULTS FROM THE "YOUNG LIVES" STUDY

**Background and objectives:** Evidence on the associations of birthweight and pre-pubertal nutritional status with age at menarche for low- and middle-income countries is limited.

**Methods:** "Young Lives" is a longitudinal study of children growing up in poverty. We used data from 2001 Indian, Peruvian and Vietnamese girls of the younger cohort, born 2001-2002, who had been visited at approximately ages 1, 5, 8 and 12 years. We investigated the relation between birthweight and pre-pubertal anthropometrics, and age at menarche. Weibull survival models estimated hazards of earlier menarche based on birth weight z-scores (BWZ), and age 8-years BMI-for-age z-scores (BAZ) and height-for-age z-scores (HAZ). Estimates controlled for potential individual-, mother- and household-level confounders, and for changes in anthropometry between 1 and 8 years.

**Results:** In adjusted models, BWZ predicted later age at menarche (Hazard Ratio, HR=0.90, 95%CI: 0.83 - 0.97). Conversely, HAZ (HR=1.66 95%CI 1.5 - 1.83) and BAZ at 8 years (HR=1.28, 95% CI: 1.18 - 1.38) predicted earlier menarche. Changes in HAZ and BAZ between 1 and 8 years were not associated with earlier menarche. Associations were consistent across the three countries, though with variation in estimated magnitudes. The girl's mother's height and age were associated with later menarche.

**Conclusions:** This evidence points to consistently robust and opposite associations of birthweight versus pre-pubertal attained

height and BMI with age at menarche age in three diverse settings in terms of nutrition, ethnicity and socio-economic status.

**Keywords:** Birthweight, menarche, nutritional status, prepubertal growth

144/2834

EFFICACY OF A COGNITIVE BEHAVIORAL TREATMENT VERSUS A TRADITIONAL INTERVENTION TO REDUCE ADIPOSITY WITHIN A NUTRITIONAL INTERVENTION PROGRAM IN OBESE SCHOOL CHILDREN

**Background and objectives:** Obesity is a major health issue right now. The overweight epidemic worldwide has a fast growth, in rich and poor countries, and among all segments of society for the last decades. There is an urgent need for efficient methods to prevent and treat obesity among children. The aim of this study was to compare the efficacy of a cognitive behavioral treatment [CBT] versus a traditional intervention [TI] trials to reduce the adiposity within a nutritional intervention program in obese children.

**Methods:** A clinical trial to reduce the adiposity and to modify the dietary and physical activity habits was conducted in 25 obese children attending an elementary school in Guadalajara, Mexico. They were randomly assigned to TI or CBT intervention groups. The outcome variables of this report were measured at times 4, 8 and 12 months of intervention

**Results:** Most of the differences were found intra-group. Adjusted BMI value with z scores showed a decrease in the intervention group almost at all times (basal vs. 4months p=0.048, vs. 12months p=0.013 and vs. 16months p=0.018) and an increase for the control group at four months (p=0.021). Arm fat index had a significant decrease for the intervention group (basal vs. 12 months p=0.041), and after adjusting the arm anthropometric indicators with z scores, a significant increase of the muscular area (basal vs. 12months p=0.030) was observed along with a decrease in the fat index (basal vs. 16meses p=0.023). The energy adequacy percentage revealed changes mostly in the intervention group with an energy intake decrease at basal vs. 4 months (p=0.013) and vs. 16 months (p=0.013), and the lipids intake (basal vs.4. months p=0.046). The evaluation of PA by the EUROFIT battery test adjusted values with age and sex percentiles showed practically no differences.

**Conclusions:** The effectiveness of the intervention showed higher intra-group statistical differences in the intervention group

<footnote>(1)Aurino, Elizabetha; (2)Schott, Whitney; (3)Penny, Mary Penny; (4)Behrman, Jere.</footnote>

<footnote>(1)BA. MA. PhD. Applied Microeconomist. Centre for Health Economics and Policy Innovation. Imperial College. London. UK;</footnote>

<footnote>(2)BA. MA. PhD. Research Scientist. Population Studies Center. University of Pennsylvania. USA.; (3)MA. MBChB. Director and Researcher. Instituto de Investigacion Nutricional. Peru.; (4)BA. PhD. Professor. Department of Economics. School of Arts and Sciences. University of Pennsylvania. USA.</footnote>

<footnote>(1)Salazar Preciado, Laura Leticia; (2)Larrosa Haro, Alfredo; (3)Colunga Rodríguez, Cecilia; (4)Romero Velarde, Enrique; (5)Fernández Castillo, Brenda.</footnote>

<footnote>(1)PhD. Nutritionist. Public Health Department. University of Guadalajara. Mexico.; (2)PhD. Gastroenterologist. Human Nutrition Institute. University of Guadalajara. Mexico.; (3)PhD. Psychologist. Medical Research Unit. Mexican Social Security Institute. Guadalajara. Mexico; (4)PhD. Pediatrician. Human Nutrition Institute. University of Guadalajara. Mexico.; (5)Educator. Public Health Department. University of Guadalajara. Mexico.</footnote>
with a decrease of the values of adiposity and energy intake. The inter-group comparison showed practically no statistical difference. The null hypothesis could not be rejected entirely because the differences were mostly intra-group, however, results have clinical relevance due to the decrease of adiposity and energy consumption.

**Keywords:** Cognitive Behavioral Treatment, obesity, children, food habits, physical activity habits

**Further collaborators:** Juan Ramón Vallarta Robledo. Nutritionist. Human Nutrition Institute. University of Guadalajara. Mexico.

food” had the strong effects directly and indirectly on QOL total score and on improvement of “desire to learn and learning attitude” by covariance structural analysis.

**Conclusions:** The present analytical results indicated that teachers and parents should work together to develop an “interest in cooking” and “importance of food” as “Shokuiku” program in schoolchildren so as to promote their healthy growth and development.

**Keywords:** dietary habit, life-style, QOL, schoolchildren, interest in cooking

144/2850

DIETARY HABITS AND LIFE-STYLE FACTORS INFLUENCE THE HEALTH-RELATED QUALITY OF LIFE AND THE LEARNING ATTITUDE IN SCHOOL-CHILDREN

(1)Shinohara, Hisae; (2)Okuda, Toyoko; (3)Tanaka, Noriko;

(4)Hamaguchi, Ikue.

(1)PhD. Associate professor. Faculty of Education. University of Miyazaki. Japan.; (2)PhD. Professor. Faculty of Human Sciences. Tezukayama Gakuin University. Japan.; (3)PhD. Professor. Faculty of Home Economics. Kobe Women's University. Japan.; (4)PhD. Associate professor. Faculty of Human Sciences. Konan Women's University. Japan.

**Background and objectives:** Since the Food Education Basic Law “Shokuiku” was enacted to promote childhood nutrition education, nowadays many “Shokuiku” programs are performed in school. Recently, many common health problems such as a decline in physical strength, underweight, or obesity in Japanese children and adolescents are caused by their polarized amount of exercise. The purpose of this study was to elucidate the influence of the dietary habits and life-style factors on quality of life and the learning attitude in schoolchildren.

**Methods:** From March to May 2015, the survey was conducted in 941 schoolchildren (459 boys and 482 girls aged 9–13 years) from nine schools in Miyazaki. Dietary habits and life-style factors were anonymously assessed through a self-administered questionnaire and brief self-administered diet history questionnaires for 10-year-olds (BDHQ10y) and for 15-year-olds (BDHQ15y). Quality of Life (QOL) were assessed by KidKINDL for children and adolescents. We performed statistical analysis by Chi-square test, factor analysis by the least-square method, and covariance structural analysis. This study has been approved by the research ethics committee of the University of Miyazaki.

**Results:** QOL of “self-esteem score” and “school score” were lower in 12-13y old groups. By the factor analysis by the least-square method, three factors were extracted and named“interest in cooking”, “importance of food” and “enjoyment of sports”. According to each category score, the children were divided into high- and low-score groups. Food intake and nutrient intake were mainly better in the high score group of “interest in cooking”. QOL total score was higher in the high score group of “importance of food” and “enjoyment of sports”. “Interest in cooking” or “importance of

144/2854

CODEX: PROTECTING INFANT AND YOUNG CHILD HEALTH OR FACILITATING THE MARKETING OF FOODS FOR INFANTS AND YOUNG CHILDREN?

Sterken, Elisabeth.

International Baby Food Action Network (IBFAN). Canada.

**Background and objectives:** The UN body, Codex Alimentarius, with parent bodies, World Health Organization (WHO) and Food and Agricultural Organization (FAO) sets standards for food products and food commodities including infant formulas and foods for infants and young children. Codex is mandated to promote fair practices in the trade of food and the protection of public health. However in implementing these two mandates, Codex frequently finds itself facing conflicting priorities in its decision making to set food standards.

Although the participants in the process include government representatives of the UN member states, the parent organizations WHO and FAO and non-governmental organizations (NGOs), it is the latter where large numbers of industry based “NGOs” primarily consisting of food and drinks industries exert extensive influence on Codex standards. In effect outcomes routinely reflect and support the trade and marketing interests of the food and drinks industries.

**Methods:** The presentation will focus on the standard setting of infant formulas and foods for infants and young children to highlight the conflict of public health protection and, in this case the globe's most vulnerable population, infants and young children and the facilitation of trade in baby foods. The presentation will demonstrate how trade priorities marginalize the protection of health and safety and in the special case of setting standards for formulas and baby foods, the protection of breastfeeding.

**Results:** Codex Standards are the benchmarks for the World Trade Organization and in effect are mechanisms for harmonizing trade in foods, with resultant loss of national regulatory and policy setting. In the special case of infant formulas and foods for infants and young children, national regulatory loss may result in a government's lack of ability or willingness to implement legislative measures - the International Code of Marketing of Breastmilk Substitutes, the WHA resolutions and other key safety mechanisms to protect breastfeeding and subsequent maternal and child health.
**Conclusions:** Examples will be presented to demonstrate the impact on measures to protect infants and young child health.

**Keywords:** Codex. breastfeeding. health. protection. policy.

(1)Kuche, Desalegn; (2)Hailu, Tesfaye; (3)Ayana, Girmay; (4)Abera, Andinet; (4)Eshetu, Solomon; (4)Beyene, Yosef; (4)Belay, Adamu;

(5)Sisay, Mekonnen.

(1)M.Sc. Nutritionist. Food science and nutrition research
directorate. Ethiopian public health institute. Ethiopia.; (2)M.Sc.
Nutritionist. Food science and nutrition research directorate.
Ethiopian public health institute. Ethiopia.; (3)M.Sc. Nutritionist.
M.Sc. Nutritionist. Food science and nutrition research directorate.
Ethiopian public health institute. Ethiopia.; (4)M.Sc. Food scientist.
Food science and nutrition research directorate. Ethiopian public
health institute. Ethiopia.; (5)M.Sc. Nutritionist. University of
Gondar. Ethiopia.

**Background and objectives:** Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is the first Govern- ment-led multi-sectoral integrated health and agriculture sector programme for nutrition outcomes. The programme will deliver an enhanced Community-Based Nutrition (CBN) program. The objective was to establish baseline characteristics at the outset of the programme and assess the comparability in intervention and comparison district.

**Methods:** A cross-sectional survey was carried out in four agrarian regions of Ethiopia from April to July 2016. The survey used multistage cluster sampling at the village and household levels. The sample size calculations for the survey was based on detecting a change at end line in nutritional status and key IYCF practices that can be attributed to the SURE intervention. A total of 4980 children 0-47 months old in 4299 households were involved in the survey. The survey covered 36 intervention and 36 comparison districts, a total of 72 districts.

**Results:** The prevalence of stunting among children 6-23 months old was 31.3% and 27.9%; whereas underweight was 19% and 16.5% and wasting was 9% and 8% in the intervention and comparison districts, respectively. Among children 24-47 months old, stunting prevalence was 46.9% and 40.5%, underweight was 23.7% and 21.6% and wasting was 4% in the intervention and comparison districts, respectively.

Breastfeeding was nearly universal in both groups. Over 60% of children initiated breastfeeding within an hour of birth and nearly 80% of children in both arms were exclusively breastfed. About three-quarters of all children initiated complementary feeding be- tween 6 to 9 months of age but only 4.5% and 7.8% of all children had access to the minimum diversified diet in the intervention and comparison districts, respectively. About 41% and 45% of all

households were food insecure in the intervention and compari-
son districts, respectively. Only about 5% in intervention and 8%
in comparison districts of all mothers interviewed had access to
minimum diversified diet.

**Conclusions:** The intervention and comparison districts are comparable in most of the demographic and socio-economic characteristics. The prevalence of undernutrition, child feeding practices, food insecurity and women dietary diversity are more or less comparable between the two groups.

**Keywords:** Infant and Young Child Feeding Practices, Com-
plementary Feeding, Dietary diversity, Stunting, Ethiopia
## Track 3: Public Health Nutrition and Environment

144/205

### SOCIOECONOMIC DISPARITIES IN THE CONSUMPTION OF UNPROCESSED FOOD (FRUITS AND VEGETABLES): NATIONAL SURVEY OF THE NUTRITIONAL STATUS IN COLOMBIA, 2010

(1)Gamboa, Edna; (2)Herrán Falla, Oscar Fernando; (3)Patiño Benavides, Gonzalo Alberto.

(1)PhD. Nutritionist. Department of Nutrition. Universidad Industrial de Santander. Colombia; (2)MSc. Nutritionist. Department of Nutrition. Universidad Industrial de Santander. Colombia; (3)PhD. Economist. Department of Economy. Universidad Industrial de Santander. Colombia.

**Background and objectives:** Establish the prevalence and frequency/day and estimate inequalities in consumption of fruits and vegetables (F&V).

**Methods:** Design. Multilevel analysis based on cross-sectional data from the National Survey of the Nutritional Situation (ENSIN-2010)

Setting. Colombia.

Subjects. Adults between 18 and 64 years old (n=5,217) and geodemographic units (n=33).

**Results:** 88.7% and 72.7% respectively consume fruit juice and cooked vegetables. At the individual level the consumption of whole fruits and juice in women is no different than men; Adjusted prevalence ratio (PR), 0.91 (95% CI; 0.75 to 1.10) and PR=0.91 (95% CI; 0.71 to 1.17), respectively. In women the consumption of raw and cooked vegetables is higher, PR=1.28 (95% CI; 1.05 to 1.56) and PR=1.27 (95% CI; 1.08 to 1.50), respectively. Women reached the highest frequency/day of consumption in fruit juice, 1.02 (95% CI; 0.98 to 1.07), and the smallest man in the consumption of cooked vegetables, 0.31 (95% CI; 0.28 to 0.33). At the ecological level results on consumption they are similar. At the individual level the Gini coefficient for the prevalence was between 0.09 and 0.16 and for frequency/day between 0.51 and 0.62. At the ecological level, the Gini index for the prevalence was between 0.04 and 0.14, for frequency/day between 0.03 and 0.11.

**Conclusions:** Colombian population does not meet the recommendations of F&V consumption. Men and women prefer drinking fruit juice. Inequality is evident in the consumption of vegetables, to the disadvantage of men. The poorest consume fewer fruits and vegetables. Reducing poverty would increase the frequency/day of consumption.

**Keywords:** Consumption, Fruits and Vegetables, disparities, unprocessed food.

144/208

### WAIST-TO-HEIGHT RATIO AND ITS RELATION WITH CARDIOMETABOLIC RISK FACTORS IN CHILDREN FROM BUCARAMANGA, COLOMBIA

(1)Gamboa, Edna; (2)Domínguez, Clara; (3)Quintero, Doris.

(1)PhD. Nutritionist. Department of Nutrition. Universidad Industrial de Santander. Colombia; (2)Nurse. Union temporal CaRDIECOL. Colombia; (3)PhD. Nutritionist. Research Center. Fundación Cardiovascular de Colombia. Colombia.

**Background and objectives:** Currently, the waist-to-height ratio has emerged as a practical and useful indicator for identifying cardio-metabolic risk in child and adolescent population. Objective: To evaluate the association between the waist-to-height ratio and the cardiometabolic risk factors in a cohort of children in Bucaramanga, Colombia.

**Methods:** Analytical cross-sectional study. Child population between 6-10 years old from Bucaramanga (n = 1,282). Independent variable: waist-to-height ratio. Dependent variables: hypertension, pre-hypertension, overweight/obesity, impaired glucose, insulin resistance, dyslipidemia. The association between dependent and independent variables was evaluated using logistic regression models. Data analyzed in Stata 12.0.

**Results:** 9.77% of the children presented a waist-to-height ratio of risk (95% CI: 8.19 to 11.52). After adjustment for age, sex, socioeconomic status and physical activity, the waist-height index of risk was significantly associated with lower HDL levels and higher levels of triglycerides, insulin resistance, hypertension and prehypertension (OR=2.95 IC 95%: 1.82 to 4.79, p=0.000, OR=2.60 IC 95%: 1.59 to 4.26, p=0.000, OR=10.68 IC 95%: 4.88 to 23.36, p=0.000, OR=8.36 IC 95%: 1.99 to 35.15, p=0.004 and OR=2.98 IC 95%: 1.66 to 5.36, p=0.000, respectively).

**Conclusions:** Children with waist-to-height ratio of risk were more likely to develop high levels of blood pressure and triglycerides, insulin resistance and lower levels of HDL. Interventions are needed for cardio-metabolic risk prevention in children and teenagers.

**Keywords:** Child. metabolic syndrome x. waist-height ratio.

144/227

### FOOD SECURITY NUTRITION AND HEALTH: THE PLIGHT OF NEGLETED MAJORITY IN A DEVELOPING COUNTRY

Adeyemo, Remi.

Agricultural Economics.

**Background and objectives:** The world has more than enough food, yet many are food insecure in sub Saharan Africa. Agriculture plays a key role in providing abundant food and fiber nationally in agricultural based countries and providing food for
**Results:** LS BMD was classified as low and normal; where low represented osteopenia and osteoporosis. The prevalence of low LS BMD among DMPA users and non-hormonal users was 52.0% and 35.3% respectively. Four dietary patterns were derived: the bread, cereal and milk (BCM) pattern, plant and animal protein pattern, Fruit and vegetable pattern and the traditional Ugandan pattern. After adjustment for potential confounders, low consumption of the BCM pattern was associated with higher odds of low LS BMD among DMPA users (AOR: 10.6, 95%CI: 2.00, 56.73; p=0.006) and not in non-hormonal contraceptive users. We found no significant association between the other dietary patterns and low LS BMD.

**Conclusions:** Low LS BMD is highly prevalent in DMPA users compared to non-hormonal contraceptive users. However, our findings suggest that increased consumption of bread, cereals and milk could ameliorate the effects of bone loss in the lumbar spine among women who use DMPA.

**Keywords:** Dietary patterns, BMD, DMPA, contraceptives, Kampala

144/233

CREATIVE AND FUN EDUCATION TO IMPROVE
KNOWLEDGE OF NUTRITION IN SCHOOL CHIL-
DREN IN BEKASI, INDONESIA

(1)Syah, Muhammad Nur Hasan; (2)Perdana, Silvia Mawarti; (2)Asna, Alfi Fairuz.

(1)M.Kes, Nutritionist. Departement of Nutrition. Mitra Keluarga School of Health Science. Indonesia; (2)MSi. Nutritionist. Departemen of Nutrition. Mitra Keluarga School of Health Science. Indonesia.

**Background and objectives:** The lack of fruits and vegetables consumption occurs in the entire population of Indonesia, that occurred from children to adults. Lifestyle and growing fast food and lack of knowledge about nutritious foods make dietary changes that are not healthy and nutritious dietary pattern. This study aims to improve the knowledge on elementary school children through nutrition education interesting and creative.

**Methods:** The study design was cross-sectional. The total sample was 78 in elementary school at Bekasi City. The sample was divided into two groups and given the same education. Before education, student was taking pre-test to determine their prior knowledge. Furthermore, education is given in the form of games and dances. Games and dances was conceptualized so that students can understand the nutrition, particularly of fruits and vegetables. After educating students directly given post-test. The nutritional status of students is determined by measuring the weight, height, and BMI for age and was analyzed by WHO Antro. Differences of knowledge were analyzed with SPSS.

**Results:** Samples were children aged 8-10 years. Most of the samples were girl (71.8%). Based on BMI for age, 6.4% are obese children, 28.2% are underweight and 11.5% are severe underweight. Research found that proportion of less knowledge (pre-test) in underweight and severe underweight children was 54,5% and 88.9%. The average pre-test score was 63.62 and the average

score of post-test 82.43. There are differences in the average value of pre and post test with p <0.05.

**Conclusions:** The provision of nutrition education by games and dancing can improve children's knowledge. This study suggests needs further evaluation and measuring the children's knowledge on a regular basis to ensure knowledge of nutrition has not disappeared.

**Keywords:** Nutrition Education Knowledge School Childreen

144/257

IS SALT CONSUMPTION IN LOCAL FOODS A
PUBLIC HEALTH CONCERN AMONG MAURITIAN
ADULTS?

Sohawon, Hanaa Amiirah.

MSc. Nutritionist. Naturhouse Dietetic Centre. Mauritius.

**Background and objectives:** Salt is the main source of sodium in the diet. A small amount of salt is important for good health. However, salt consumption has increased nowadays and most of the sodium we eat comes from processed, ready-to-eat foods and this can lead to high blood pressure in sensitive individuals. The main objectives of this study are to investigate whether or not Mauritians are aware of the local recommendations of salt to be consumed per day based upon the World Health Organisation (WHO) recommendations; to know the attitudes of Mauritian adults towards salt consumption and its recommended daily intake; and to evaluate the reported daily consumption of salt among Mauritian adults.

**Methods:** A cross-sectional study was carried out to evaluate the reported daily consumption and to know the attitudes towards salt consumption and its recommended daily intake. The study was carried out among 300 respondents chosen at random, aged between 30 and 60 years old and consisted of both males and females. A survey-based questionnaire was designed to carry out the investigation, and the results obtained were interpreted and analysed using the Statistical Packages for Social Sciences (SPSS 20.0).

**Results:** The results obtained showed that 51.3 % of the respondents were aware of the local daily salt intake recommendation, and reported putting 1 teaspoon (5 grams) of salt during their food preparation. 85.7 % of the respondents also found this recommendation adequate. However, another 27.4 % of respondents were neither aware of the fact that 1 teaspoon of salt is the daily recommended amount to be consumed nor did they consume the 5 grams of salt as recommended. Furthermore, the food frequency questionnaire included in the survey revealed that the consumption of highly salted processed foods was quite high among the respondents.

**Conclusions:** The study demonstrates that nutrition education programmes need to be set up so as to raise awareness on the recommended daily intake for good health as well as on the risks associated with excessive intake of highly salted processed foods given that we have noted that it is the consumption of these foods which is the major culprit.

**Keywords:** Salt, high blood pressure, highly salted processed foods.
## MEAL QUALITY AND SOCIODEMOGRAPHIC CONDITIONS ASSOCIATIONS DIFFERS ACCORDING TO LOCATION OF MEAL PREPARATION

(1)Gorgulho, Bartira; (2)Santos, Roberta O; (2)Teixeira, Juliana A;

(3)Pereira, Adélia; (4)Baltar, Valéria T; (5)Marchioni, Dirce.

(1)PhD position. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (2)MSc. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (3)MSc. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (4)Professor. Department of Epidemiology and Biostatistics. Institute of Collective Health. Fluminense Federal University. Brazil.; (5)Professor. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** The choice of foods that are consumed in the same meal occurs in a very complex way, being modulated by several determinants, such as sociodemographic conditions, gender, age, nutritional status, place of consumption, food preparation, and cultural habits. In this context, the study aims to estimate the association between sociodemographic conditions and nutritional quality of main meals consumed by Brazilian adults, stratifying by the location of meal preparation (home/away from home).

**Methods:** We used individual food consumption data (food intake record) of 16,096 adults, of both gender, from the National Dietary Survey/Brazilian Household Expenditures Survey. The main meal was defined as the meal with the highest contribution to overall energy intake. In this case, it was lunch, classified by period of consumption (11AM-15PM). To evaluate the meal quality, we applied the Main Meal Quality Index (MMQI), 0 to 100 points, which consists of 10 items of equal weights; the items were the following: fruits (in grams), vegetables (excluding potatoes, in grams), animal protein/total protein ratio, fiber (in grams), carbohydrate (% of energy), total fat (% of energy), saturated fat (% of energy), processed meats (in portions), sugary beverages and desserts (in portions), and energy density. The association between main meal quality and each variable was measured by multiple linear regression models, adjusted by main meal energy.

**Results:** MMQI was positively associated with males and age; and negatively associated with years of education, family income and meals prepared away from home. Meals prepared at home (58 points) maintained the association with gender, age and family income; while meals prepared away from home (55 points), with years of education.

**Conclusions:** Main meal prepared away from home had a worse quality. Furthermore, we found different associations between MMQI and sociodemographic conditions between the locations of meal preparation.

**Keywords:** meal quality; nutrition; eating away-from-home, sociodemographic conditions.

## ASSOCIATION BETWEEN BODY MASS INDEX AND INFANT BIRTH WEIGHT AMONG PREGNANT WOMEN FROM A RURAL AREA IN NIGERIA

(1)Oladiran, Sunday A.; (2)Okekunle, Akinkunmi Paul; (3)Fadupin, Grace T.

(1)BSc. MPH. Graduate Student. Department of Human Nutrition. University of Ibadan. Nigeria.; (2)BSc. MPH. Graduate Student. 1. Department of Nutrition and Food Hygiene. Harbin Medical University. China. 2. Department of Human Nutrition. Faculty of Public Health. University of Ibadan. Ibadan Nigeria.; (3)RN. BSc. MSc. PhD. Reader. Department of Human Nutrition. Faculty of Public Health. University of Ibadan. Nigeria.

**Background and objectives:** Maternal anthropometry is a significant determinant of fetal outcomes. Suboptimal and excessive maternal weight gain (MWG) during pregnancy is a risk factor for poor pregnancy outcomes. For example, suboptimal MWG is reported to be associated with low birth weight (LBW); a risk factor for slow cognitive development, onset of chronic disease in adulthood, neonatal morbidity and mortality. Because the relationship between maternal body mass index (BMI) and fetal outcomes differ by race, we explored the relationship between MWG among pregnant women and infant birth weight (IBW) from a rural setting located Southwestern part of Nigeria.

**Methods:** 603 singleton pregnant women who attended two antenatal clinics from 2008-2014; in Ibarapa East local government area of Oyo State Nigeria were systematically sampled, with a retrospective review of case records and retrieval of socio-demographic and obstetric information by trained health professionals, using a pre-defined protocol after due ethical considerations. Pearson's correlation (p<0.05) was applied to assess the relationship between MWG, BMI before delivery and IBW.

**Results:** About 10.4% were adolescent women (ADW) at conception (18.0±1.1 years) and mean age of adult women (ALW) was 27.0±5.0 years at conception. MWG was significantly higher (t=2.0, p=0.04) among ADW (5.5±3.4kg) compared to ALW (4.8±3.1kg). Contrariwise, mean IBW was significantly lower (t=-4.1, p=0.000) among infant delivered by ADW (2.9±0.4kg) compared to those of ALW (3.1±0.5 kg). Furthermore, the prevalence of LBW (IBW<2.5kg) was higher (χ2=3.5, p=0.06) among infant delivered by ADW (10.0%) compared to those of ALD (4.8%). IBW positively correlated with BMI (r=0.1, p=0.004) after adjusting for age, parity and MWG.

**Conclusions:** While Optimal MWG is necessary for optimal fetal outcomes, excessive MWG is also associated with LBW. Further research is necessary to determine the range of MWG suitable for optimal maternal health and fetal outcomes in this setting.

**Keywords:** Maternal weight gain, Infant birth weight, Rural area, Nigeria.
MORTALITY ATTRIBUTABLE TO OVERWEIGHT AND OBESITY IN PARAGUAY, PERIOD 2010-2014

(1)Fretes Centurión, Gabriela; (2)Sequera, Guillermo; (3)Turnes, Catherine; (4)Santacruz, Ethel; (5)Cañete, Felicia.

(1)MSc. Nutritionist. Ministry of Public Health. Paraguay.; (2)MD. MPH. Epidemiologist. Ministry of Public Health. Paraguay.;

(3)Nutritionist. Ministry of Public Health. Paraguay.; (4)Statistics. Ministry of Public Health. Paraguay.; (5)MD. Ministry of Public Health. Paraguay.

**Background and objectives:** Due to the high prevalence of overweight and obesity currently present in our country, this study aims to describe the mortality attributable to overweight and obesity in people older than 15 years in Paraguay, according to sex and age group, between 2010 and 2014.

**Methods:** For the purpose, secondary data sources were used: the National Survey of Risk Factors and Non-Communicable Diseases (NSRF) in 2011 and the vital statistics for that period. For the estimation of mortality attributable to overweight and obesity, the prevalence-dependent method was used, based on the calculation of the Population Attributable Fraction (PAF).

**Results:** The main results indicate that during the study period, 13,359 people died (2672 deaths per year) due to causes attributable to overweight and obesity, which corresponds to 10.0% of the total deaths occurring during the 5 years of study. 7.4% and 13.5% of the deaths attributable to excess weight correspond to men and women respectively. The main cause of death attributable is diabetes, accounting for 74.1% and 73.3% of deaths in males and females respectively. The cause of death coded by ICD-10 as obesity showed a progressive increase from a couple of cases during 2010 to more than 50 cases per year for both sexes in 2014.

**Conclusions:** This study shows that almost 1 in 10 deaths occurring in the country are associated with being overweight. It is an important data for public health to estimate costs and plan more radical intervention strategies in this area.

**Keywords:** Mortality, overweight, obesity, non-communicable diseases.

A SOCIO-ECOLOGICAL EXAMINATION OF WEIGHT-RELATED CHARACTERISTICS IN HOME ENVIRONMENTS OF FAMILIES WITH YOUNG CHILDREN

(1)Byrd-Bredbenner, Carol; (2)Quick, Virginia; (2)Martin-Biggers, Jennifer.

(1)Rutgers University New Brunswick. NJ. USA; (2)Nutritional Sciences. Rutgers University. New Brunswick. NJ. USA.

**Background and objectives:** The prevalence of childhood obesity is a great public health concern. Obesity's pervasiveness is due, in part, to myriad socio-ecological factors (i.e., intrapersonal, interpersonal, and environmental) that are modifiable via public health interventions. The home environment and lifestyle patterns are understudied, yet critical to childhood obesity prevention. Thus, this study aimed to systematically examine the home environment and lifestyle patterns using a socio-ecological framework.

**Methods:** Parents (n=489; 93% female; 32.3±5.7SD yr) of pre-school children completed an online survey that comprehensively assessed weight-related intrapersonal, interpersonal, and environmental factors using valid, reliable instruments.

**Results:** Healthy intrapersonal dietary behaviors identified in this study population were parent and child intakes of 100% fruit/ vegetable juice in amounts congruent with recommendations and low intakes of sugar-sweetened beverages. In contrast, milk intake was low and parent fat intake was high. The home environment's food supply supported healthy intakes of juice and low sug- ar-sweetened beverage intakes, but also provided little milk and generous amounts of salty/fatty snacks. Physical activity levels, time spent in sedentary activity, and the home's physical activity and media environment were not ideal. Environmental supports for active play inside homes were modest and were slightly better in the yard area outside homes and the neighborhood. Screentime greatly exceeded recommendations likely because homes had abundant media equipment and parents put few limits on chil- dren's use of media that promoted sedentary behavior. Most par- ents met sleep recommendations, whereas children did not. Fam- ily interpersonal/social interactions had several positive qualities, including frequent family meals eaten in a positive environment. However, parents were neutral about modeling healthy eating to their children and infrequently modeled physical activity be- havior. Parents had considerable self-efficacy with regard to their ability to perform food- and physical activity-related childhood obesity protective practices.

**Conclusions:** In this study, an array of intrapersonal, interpersonal, and environmental factors in the family home environment placed young children at increased childhood obesity risk. Public health professionals should target these factors in interventions aiming to help parents create home environments and lifestyle practices that promote optimal child development and health while reducing children's risk for obesity.

**Keywords:** home environment. parent. child. obesity. socio-ecological framework
(1)Garcia-Meza, Rosario; (2)Solomons, Noel W.; (3)Yates-Doerr, Emily.

(1)MA. Nutritionist. Center for Studies in Sensory Impairment, Aging and Metabolism. Guatemala.; (2)Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala.; (3)PhD. Anthropologist. The University of Amsterdam. Netherlands.

**Background and objectives:** It is generally recognized that goals 1-6, 12, and 17 of the Sustainable Development Goals 2015-2030 (SDGs) are related to human nutrition. In her introduction to the keynote address of the 2015 SLAN meeting organized by Dr. Francesco Branca on the topic of the SDGs, its president, Dr. María-Nieves, noted that the English word “sustainable” could be translated into Spanish as either “sostenible” or “sustentable”, a debate that had not been totally resolved within UN circles. Intrigued by whether this is an important or trivial distinction for the Spanish-speaking world, we sought here to explore and rationalize the contextual semantic connotation and consequences in each translation of “sustainability.”

**Methods:** We undertook to parse the differential meanings of “sostenible,” which connotes “persisting-through-time” (enduring) as in “a sustainable monthly payment” and “sustentable,” which connotes “supported-by-congruent-reasoning” (coherent) as in “the motion by the defense lawyer is sustained”. Connotation will differ profoundly in Spanish semantics depending on the translated format. We performed an inquiry among key-informants from grass-roots-based organizations in western Guatemala to explore the latter connotation in practical and theoretical contexts.

**Results:** The Mayan-Cosmovision worldview (“Cosmogónico”), which underpins the archetypical intrinsic-spiritual-historic guidance for quotidian life, seeks equilibrium with the environment. As such, the perspective of the informants was generally holistic and emancipatory (from foreign-language discourse), with commentaries favoring a preference for “sustentable” connotation (logically-coherent).

**Conclusions:** Although likely that SDGs' UN framers saw the word sustainability in terms of repetition of the actions and their benefits in a context that itself allows the environment to endure (sostenible), the ambiguity with the connotation of logically-coherent (sustentable) adds richness and depth to the discussion of the nutrition SDG-interventions across the next decade and a half.

**Keywords:** Sustainable Development Goals, Spanish semantics

(1)Berry, Elliot; (2)Peng, Wen.

(1)MD. FRCP. Braun School of Public Health. Hebrew University-Hadassah. Israel; (2)MD. MPH. School of Medicine. Qinghai University. China. Research Center. The Amity Foundation. China.

**Background and objectives:** Following its publication in 2008, the global nutritional index (GNI) has been updated from 1995-2015 to show the world trends in malnutrition, as it alone penalizes a country for over-nutrition.

**Methods:** We have re-calculated the GNI according to the methodology of the human development index, using geometric means, based on three indicators of nutritional status: deficits (DALY rates due to nutrition deficiency), food insecurity (FINS) (prevalence of undernourishment) and excess (prevalence of female obesity). GNI (range 0-1) was calculated for 184 countries classified into seven groups according to the World Bank and WHO.

**Results:** The collective world GNI increased progressively from 0.816 for 1995 to 0.836 for 2015. In all 7 country groups there was a decrease in deficits and FINS, and an increase in obesity. These trends caused a shift from the leading ranking country group in 1995 – high-income countries (0.869, 0.821-0.900) – to European low- and middle-income countries (LMIC) (0.841, 0.823-0.857) in 2005, and South-East Asian LMIC (0.851, 0.822-0.903) in 2015. African LMIC were the lowest ranking groups for GNI in 1995 (0.654, 0.558-0.745) and 2005 (0.716, 0.652-0.778), but were replaced by American LMIC in 2015 (0.741, 0.724-0.772). Among the top 20 ranking countries, the number of LMIC increased from 3 in 1995, to 13 in 2015; among the bottom 20 ones, no high-income countries were listed in 1995, while 5 countries appeared in 2015 and the number of African LMIC decreased from 13 to 7. Over these 20 years, African LMIC (0.654, 0.558-0.745 to 0.757, 0.703-0.801) and South-East Asian LMIC (0.794, 0.612-0.831 to 0.851, 0.822-0.903) improved significantly (P<0.001); while high-income countries (0.869, 0.821-0.900 to 0.813, 0.749-0.851), American LMIC (0.790, 0.745-0.811 to 0.741, 0.724-0.772) and Eastern Mediterranean LMIC (0.760, 0.733-0.827 to 0.744, 0.669-0.770) worsened significantly (P<0.01). European LMIC (0.823, 0.795-0.863 to 0.830, 0.807-0.855) and West Pacific LMIC (0.767, 0.605-0.818 to 0.781, 0.481-0.891) remained stable (P>0.500).

**Conclusions:** From 1995 to 2015, under-nutrition decreased, whereas over-nutrition increased steadily to become the main cause of malnutrition worldwide. The next Sustainable Development Goals should include alongside zero hunger – reduce obesity.

**Keywords:** global nutrition index, obesity, nutrition deficiency, food insecurity, time trend (1995-2015)
# FACTORS INFLUENCING ON SOFT DRINKS CONSUMPTION PATTERNS AMONG SAUDI POPULATION MEASURED BY PRINCIPAL COMPONENT ANALYSIS

Benajiba, Nada.

Clinical Nutrition Program. Department of Health Sciences.
College of Health and Rehabilitation Sciences. Princess Nourah
Bint Abdulrahman University. Riyadh. Saudi Arabia.

**Background and objectives:** Introduction: Soft drinks are considerable liquid sources of added sugars in diet which may lead to obesity and type 2diabetes. Saudi Arabia is identified as the largest consumer of soft drinks in Middle East and this market increases continuously.

Objectives: To assess the soft drinks consumption patterns and identify the association between different factors influencing on these patterns among adults Saudis.

**Methods:** A cross-sectional study conducted from July - September 2016 in KSA. 1194 eligible Saudi participants answered an online questionnaire. Data collected was on socio-demographic characteristics, patterns of soft drinks consumption, and factors influencing these patterns including availability, affordability, social gathering, TV/electronic device use, advertising, social gathering, eating out or at home. Response categories used a 5-points Likert scale. Statistical analysis was performed using SPSS to assess the correlation between different factors. Principal component analysis (PCA) (orthogonal rotation, varimax option) was applied to ascertain influencing factors. Barlett's test was significant and KMO test=0.8.

**Results:** 16% of the participants reported that they consume soft drinks either daily or usually (3-6 times/week). Frequency and quantity of soft drinks consumed were significantly and positively associated (R2= 0.4 and p<0.0001). Significant and positive correlation were found between availability and social gathering, eating out of home and habits, and eating at home and watching TV. PCA revealed two component explaining 57.8% of variance labeled as: 1- "individual" grouping eating at home and watching TV/electronic device use, 2- "social-environmental" grouping the rest of the factors.

**Conclusions:** Messages aiming to limit soft drinks consumption should consider both frequency and quantity. Reducing soft drinks consumption needs a comprehensive approach considering the following: 1- Increasing population awareness about the negative consequences of increased soft drinks consumption, 2- promoting favorable environment by making soft drinks less affordable (increasing its price), 3- Providing healthy and competitive alternatives and 4- controlling advertising.

**Keywords:** Soft drinks consumption, Adult, Saudi Arabia, PCA

# ASSOCIATION BETWEEN FOOD INSECURITY AND OBESITY IN MIDDLE AND LOW INCOME HOUSEHOLDS IN CASABLANCA, MOROCCO

**Background and objectives:** Food insecurity is usually associated with poor nutritional status. Still, reports revealed that food insecure populations are at increased risk of obesity. This study aims to investigate the prevalence of food insecurity in middle and low income households in Casablanca and examine the relationship between food insecurity and overweight.

**Methods:** A cross-sectional survey was conducted between 2011 and 2013 among low and middle income households from the South-East communities of Casablanca, Morocco. Data were collected for 607 households using a standardized and validated questionnaire. A total of 424 adult women and 183 adult men participated to the survey. Food insecurity was evaluated using a set of nine questions adapted from the the Household Food Insecurity Access Scale (HFIAS) developed by the Food and Nutrition Technical Assistance project (FANTA). Anthropometric measurements (weight, height, waist circumference) were taken according to the World Health Organization's guidelines and obesity was identified as a Body Mass Index (BMI) ≥ 30 kg/m².

**Results:** Food insecurity affected 63.2% of the households at different levels; data revealed that food insecurity was light in 12.6%, mild in 20.2% and severe in 30.4% households. Obesity was found in 40.8% of the population; 24.6% in men and 47.9% in women (p <0.001). Food insecurity was associated with gender; more households where we interviewed women (70.9%) were classified as food insecure than households where we interviewed men (43.7%) (p < 0.001). Obesity was higher in food insecure (42.7%) than in food secure people (37.7%) [odds ratio (OR) = 1.95]. Food insecurity was associated with an increased risk of obesity for women (OR = 2.5) but not for men (OR = 0.73).

**Conclusions:** Food insecurity is associated with an increased likelihood of obesity in adults from low and middle income households in Casablanca and the risk is greatest in women.

**Keywords:** Food insecurity, obesity, gender, Morocco.

**Further collaborators:**

Master Biology and Health and International Master of Health and Development Sciences, Ben M'Sik Faculty of Science, Hassan II University of Casablanca.

<footnote>(1)Jafri, Ali; (2)Derouiche, Abdelfettah.</footnote>

<footnote>(1)PhD. Research Fellow. Ben M'Sik Faculty of Science. Hassan II University of Casablanca. Morocco.; (2)PhD. Professor. Ben M'Sik Faculty of Science. Hassan II University of Casablanca. Morocco.</footnote>
## INCREASED PHYSICAL ACTIVITY IS ASSOCIATED WITH GREATER ACADEMIC GAINS IN HIGH SCHOOL THAN REDUCED SEDENTARY TIME: AN OBSERVATIONAL STUDY IN ADOLESCENTS FROM A CHILEAN INFANCY COHORT

(¹)Correa-Burrows, Paulina; (²)Rodriguez, Yanina; (³)Blanco, Estela;

(⁴)Gahagan, Sheila; (⁵)Burrows, Raquel.

(¹)PhD. Institute of Nutrition and Food Technology. University of Chile. Santiago de Chile. Chile.; (²)MSc. Nutritionist. Institute of Nutrition and Food Technology. University of Chile. Santiago de Chile. Chile.; (³)MPH. Nutritionist. Division of Child Development and Community Health.University of California San Diego. La Jolla. California. USA; (⁴)MPH. Medical Doctor. Division of Child Development and Community Health.University of California San Diego. La Jolla. California. USA; (⁵)Medical Doctor. Institute of Nutrition and Food Technology. University of Chile. Santiago de Chile. Chile.

**Background and objectives:** Adolescence is a period in which physical activity (PA) shows a great decline. PA in adolescence may be important to improve cognitive function and academic outcomes. The hippocampus, which plays a major role in learning and memory, is among the brain areas more affected by PA. We explored the association of PA and sedentary time at 16y with a number of academic indicators in the transition from high school (HS) to higher education, in youths from Santiago, Chile.

**Methods:** Observational study in an infancy cohort. In a sample of n=632 adolescents (52% males), we measured PA, accounting for exercise (Physical Education and extracurricular sports), active play and active commuting; and sedentary time, accounting for screen and sitting (excluding study time) hours. To measure this, we used a questionnaire that was validated in a previous study using accelerometry-based activity monitors in Chilean high schoolers. Academic results included HS completion, repeating a grade in HS and taking exams for college. Multivariate logistic regressions tested the relation of academic variables with PA or sedentary time, after adjusting sex, family background, type of secondary education (academic vs. vocational) and health-related confounders.

**Results:** In students devoting <2 h/week to exercise, the odds of HS completion (OR: 0.39; 95% CI: 0.21-0.73) and taking college exams (OR: 0.51; 95% CI: 0.33-0.79) were significantly lower compared to students allocating >4h/week for exercise. Also, the chances of repeating a grade in HS were negatively associated with time devoted to exercise. Last, in students devoting ≥8 h/day to sedentary activities, the odds of HS completion (OR: 0.48; 95% CI: 0.28-0.84) were significantly lower compared to students with <8h/day of sedentary activities.

**Conclusions:** In this sample, exercise was positively related with academic outcomes whereas the relation of sedentary time and academic results was negative. **Results:** **Keywords:** Physical activity, sedentary activities, exercise, academic performance, adolescents

## HARMONIZING METHODOLOGIES FOR RESEARCH ON SUSTAINABLE DIETS AND FOOD SYSTEMS

(¹)Eme, Paul; (²)Burlingame, Barbara; (³)Kuhnlein, Harriet.

(¹)Paul Eme. MSc. School of Public Health. Massey University. New Zealand.; (²)Barbara Burlingame. PhD. Professor of Nutrition and Food Systems. School of Public Health. Massey University. New Zealand.; (³)Harriet Kuhnlein. PhD. Professor Emerita of Human Nutrition. McGill University. Canada.

**Background and objectives:** "All food systems are sustainable" is the central feature of the UN's Zero Hunger Challenge, and an explicit feature of Sustainable Development Goal 2. The long title of SDG 2 also captures the essence of sustainable diets: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture. Characterising food systems is complex, with interplay involving human, economic, social, environmental and political factors, and requiring multiple indicators for effective measurements. This paper seeks to harmonize four different methodological frameworks proposed for assessing sustainable diets and food systems.

**Methods:** Several divergent methodological frameworks, indicators and indices, and model systems for characterising sustainable diets and sustainable food systems have been proposed, with little or no attempt to harmonise, standardise or align. Each is assessed for relevance, reliability, advantages and limitations. Case studies on traditional food systems of indigenous peoples and model national dietary patterns (e.g., the Mediterranean diet) provide examples for testing/validation.

**Results:** Existing methodologies each have their own advantages; and commonly used indicators have importance in areas where data are sufficient in both quality and quantity. Each also has limitations related to data availability from the relevant sectors (health, agriculture, environment), and applicability in different ecosystems.

**Conclusions:** Weaknesses in the evidence base compromise the ability to effectively address the issues of sustainable diets and food systems. Nevertheless, current evidence is sufficient to warrant the development and implementation of multi-sectoral policies, programmes and interventions. A harmonised methodological approach will allow more and better data, and facilitate comparisons across nations, ecosystems and peoples, to better inform policies and actions, and ultimately to achieve the SDGs.

**Keywords:** Sustainable diets, methodologies, sustainable food systems, indigenous peoples, Mediterranean diet.
## PROSPECT OF FOREST FOODS TO ADDRESS HUMAN NUTRITION IN THE CONGO BASIN FOREST DEPENDENT COMMUNITIES OF DR CONGO, CAMEROON AND GABON

(1)Fungo, Robert FR Fungo; (2)Ngoye, Alfred; (3)Tchatat, Mathurin;

(4)Kahindo, Jean-Marie.

(1)PhD. Nutritionist. School of Food Technology, Nutrition & Bio-Engineering. Makerere University. Kampala. Uganda; (2)Msc Forestry Institut de Recherche en Ecologie Tropicale (IRET). Libreville. Gabon; (3)PhD. Forestry. Institut de la Recherche Agricole pour le Développement (IRAD). Yaoundé. Cameroun;

(4)PhD. Forestry. Université de Kisangani RDC Faculté des Sciences. Congo.

**Background and objectives:** The potential to use forest foods from timber tree species as an effective entry point for improving human nutrition in the Congo Basin appears to be high. These products are widely accessible, culturally acceptable and typically under the control of communities

**Methods:** The most consumed forest foods were documented and examined the nutrient content and nutraceutical properties of most consumed forest foods and determined their contribution to human nutrient intake

**Results:** In Cameroon out of the 206 identified forest food species, Irvingia gabonesnsis and Baillonella Toxisperma were the most consumed. In DR Congo, out of the 272 forest foods, caterpillars were the most important and are frequently found on tree species; Entandrophragma cylindricum and Erythropleum suaveolensis. In Gabon, the most consumed species were: Baillonella toxisperma and Poga oleosa. These species contained significant levels of vitamins C and E, essential minerals and nutraceutical properties such as flavonoids, polyphenols, phytic and proanthocyanides. Nutrient intake findings indicate that if a child aged 1-3 years and a non-pregnant non-lactating woman consumed 500gms and 750gms daily respectively, their daily total vitamin C requirement of 30mg/100g for children and 45mg/100g for adults would be met by either Baillonella toxisperma, Pentaclethra macrophylla and Trichoscypha abut forest tree species.

**Conclusions:** In light of benefits of vitamins, minerals and nutraceutical properties, there is an urgent need for protecting and promoting nutrient and nutraceutical properties rich forest plant foods species, particularly those having the greatest acceptability and production potential.

**Keywords:** Nutrition, Nutraceuticals, Nutrient composition, Congo Basin

**Further collaborators:**

The authors wish to thank the Congo Basin Forest Fund (CBFF) of the African Development Bank and the CGIAR Research Programme on Forests, Trees and Agroforestry for the funding support.

## DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS ARE ASSOCIATED WITH DIETARY AND NUTRITIONAL PATTERNS IN RURAL BUT NOT URBAN AREAS IN WEST JAVA, INDONESIA

(1)Kosaka, Satoko; (2)Umezaki, Masahiro; (2)Watanabe, Chiho.

(1)PhD. Graduate School of Medicine. University of Tokyo. Japan;

(2)PhD. Graduate School of Medicine. University of Tokyo. Japan.

**Background and objectives:** Since the risk of chronic diseases involves dietary factors, understanding determinants of dietary/nutritional intake patterns would be of help for effective intervention programs. However, few studies have explored the urban-rural difference in determinants of dietary/nutritional intake patterns in developing countries. The objective of this study was to examine whether the relationships between individual characteristics and dietary/nutritional patterns in urban and rural areas are different in West Java, Indonesia.

**Methods:** A three-day weighed dietary record survey was conducted for 92 participants in Bandung (an urban area) and 202 participants in Sumedang (a rural area), together with questionnaire-based interviews and anthropometric measurement. Total energy intake and energy intake from protein, fat and carbohydrate were calculated, food items were grouped into dietary categories based on the main ingredients and energy intake from each category was calculated. The association between individual characteristics and dietary/nutritional intake was examined with the Kruskal-Wallis equality-of-populations rank test and Spearman's rank correlation test.

**Results:** In Sumedang, all the dietary/nutritional pattern indicators (total energy intake, energy intake from protein, carbohydrate, fat, grain/tubers, vegetables/legumes, meat/fish) were significantly related to individual characteristics such as age, sex, occupation, educational level and income, while on the other hand in Bandung, energy intake from vegetables/legumes and meat/fish were significantly related to age, occupation or income but neither total energy intake, energy intake from protein, carbohydrate, fat, nor grain/tubers were related with any of the assessed factors.

**Conclusions:** The results suggested that the relationship between demographic and socioeconomic characteristics and dietary/nutritional patterns are different between rural and urban areas in West Java, Indonesia. The lack of a relationship in the urban area suggested that the area has moved beyond a phase in the nutrition transition where dietary/nutritional intake patterns change drastically along with social and economic development. Different strategies are needed in each area to identify and focus on the population at risks of diet-related diseases.

**Keywords:** Nutrition transition, Nutrition, Diet, Urban/Rural, Indonesia
# CORRELATES AND TRENDS OF OVERWEIGHT AMONG CHILDREN, ADOLESCENT GIRLS AND WOMEN IN SOUTH ASIA: AN IN-DEPTH ANALYSIS OF DATA FROM ELEVEN NATIONAL SURVEYS IN SIX COUNTRIES OVER EIGHTEEN YEARS

(¹)Harding, Kassandra; (¹)Webb, Patrick; (²)Aguayo, Victor.

(¹)PhD. Friedman School of Nutrition Science and Policy. Tufts University. United States; (²)PhD. United Nations Children's Fund Programme Division. United States.

**Background and objectives:** The majority of the world's undernourished live in South Asia while the number of overweight and obese in this region is growing. This study aimed to determine the correlates and trends of overweight among pre-school age children, adolescent girls and adult women in South Asia.

**Methods:** Data from 11 national surveys from 6 countries were pooled. Generalized linear mixed models were used to analyze relationships.

**Results:** Three percent of pre-school age children were overweight (weight-for-height z-score (WHZ) > 2SD) with a mean WHZ (SD) of -0.79 (1.36). Children of overweight mothers had a higher mean WHZ [-0.36 (1.36) v. -0.83 (1.35)] and a greater likelihood of being overweight [AOR: 1.52, p <0.01] than children of mothers who were not overweight.

Four percent of adolescent girls were overweight (body mass index (BMI) ≥25.0 kg/m2 based on the International Obesity Task Force adjusted BMI values). Household wealth and urban residence were positively associated with overweight among adolescent girls (APR: 2.63, p<0.01 and 2.16, p<0.01, respectively). The strength of these relationships differed by country. Eighteen percent of women were overweight (BMI ≥25.0 kg/m2 based on International Classifications). Household wealth (1.96, p<0.02), formal education (1.49, p<0.01), and urban residence (1.75, p<0.01) were positively associated with an increased likelihood of being overweight. In Bangladesh, India and Nepal the prevalence of overweight among adolescent girls and women increased over time. However, the strength of the association between predictors and outcomes attenuated over time among women.

**Conclusions:** The condition of being overweight is becoming more prevalent across South Asia and requires immediate attention. Once a condition of the wealthier, more educated and urban, rates of overweight are increasing among poorer, less educated and even rural women.

**Keywords:** South Asia, overweight, children, adolescent girls, women

# EFFECT OF FOOD INSECURITY ON CHILD'S BEHAVIOR RESIDING IN SLUMS OF KARACHI, PAKISTAN

(¹)Safdar, Nilofer Fatimi; (²)Hussain, Mehwish; (³)Shah, Nadia;

(⁴)Rehman, Saifur.

(¹)MSc. MS. PhD. Nutritionist. School of Public Health. Dow University of Health Sciences. Karachi. Pakistan; (²)PhD. Biostatistician. Department of Research. Dow University of Health Sciences. Karachi. Pakistan; (³)MSc. Health Economist. School of Public Health. Dow University of Health Sciences. Karachi. Pakistan; (⁴)BS. Epidemiology & BioStatistics Student.

**Background and objectives:** Household food insecurity (HFI) has been paced up as a major public health problem worldwide but more so in South Asia. South Asians with food insecurity may find it difficult to bring up their children as socially desirable causing behavioral problems in them. Scarcity of literature was found on assessing relationship of household food insecurity and child behavior in urban families. Therefore, our objective was to determine prevalence of HFI and its effect on behavioral problems in children of mothers residing in urban slums of Karachi, Pakistan.

**Methods:** A cross sectional study was conducted in different towns of all six districts of Karachi using multi-stage sampling methods. Selection of households was made using systematic random sampling. The Interviewers collected data from mothers of children aged 3 -11 years. The structured and validated questionnaire included household food insecurity access scales (HFIAS) and child behavior questionnaire (CBQ) related information. Factor analysis was applied to find common behavior of children. Generalized linear regression analysis was performed to determine relationship between scores of food insecurity and child behavior.

**Results:** Overall 67% of household were found to be food insecure. 70% of households expressed concern and showed anxiety on the quantity of food being available to them, 84% of households actually had insufficient quantity of food and 95% of households consumed insufficient quality of food during the previous month at the time of interview. Overall 70% mothers from food insecure households reported different behavioral problems in their children. The two most common among these behaviors were; being aggressive and not socializing or playing with other children. Followed by behaviors that were related to; avoiding going to school, stress, impulsiveness, having fear, bully and lacking confidence. The association between household food insecurity and child behavioral problems were found to be significantly positive and with each food insecure household the likelihood of childhood behavioral problems will increase by 26.7% in urban slums

**Conclusions:** Public health strategies must be designed to assist families to cope with behavioral problems in children as well as in solving their food security related issues.

**Keywords:** Household food insecurity, child behavior, urban slum, Pakistan
NUTRIENT INTAKE IN FRENCH ADULTS: EVOLUTION DURING THE LAST 10 YEARS BETWEEN THE TWO FRENCH NUTRITION AND HEALTH SURVEYS (ENNS 2006, ESTEBAN 2016)

(1)Torres, Marion; (2)Salanave, Benoît; (3)Verdot, Charlotte;

(3)Deschamps, Valérie.

(1)PhD. Nutritional surveillance and Epidemiology Team. Santé Publique France. Université Paris 13. Centre de Recherche Epidémiologie et Statistique. COMUE Sorbonne-Paris-Cité. Bobigny. France.; (2)MsC. Nutritional surveillance and Epidemiology Team. Santé Publique France. Université Paris 13. Centre de Recherche Epidémiologie et Statistique. COMUE Sorbonne-Paris-Cité. Bobigny. France.; (3)PhD. Nutritional surveillance and Epidemiology Team. Santé Publique France. Université Paris 13. Centre de Recherche Epidémiologie et Statistique. COMUE Sorbonne-Paris-Cité. Bobigny. France.

**Background and objectives:** In France, the French National Nutrition and Health Programme (PNNS) aim to reduce chronic diseases associated with nutrition by establishing various health activities. The evaluation of its effectiveness requires studying the evolution of dietary intake in the French population. The objective of this paper was to compare the dietary intake in terms of nutrients during the last 10 years, in two national samples of 18-74-years-old adults, especially according to French recommendations.

**Methods:** Studies were based on two cross-sectional population-based surveys using a multistage sampling design: the ENNS study realized in 2006 (n=3115 adults) and the Esteban study in 2016 (n=2834 adults). Dietary information were collected through three 24h recalls realized by internet or by phone, monitored by dieticians. The two samples have been compared by linear regression and chi-2 test (gender-stratified, weighted and standardized data).

**Results:** Since ten years, the mean energy intake without alcohol (EIWA) increased significantly in women (1600.8 to 1675.9kcal/d, p<0.01) but not in men (2180.0 kcal/d vs 2155.8kcal/d in Esteban). Globally, lipids intakes (%EIWA) increased at the expense of proteins in men and women. Among men, 25.1% consumed less than 35% EIWA of lipids while they were 19.8% ten years later (p=0.02). Proportion of people eating less than 12.5% EIWA of simple carbohydrates from sweet products decreased significantly in both gender (80.6 to 68.9% in men, p<0.0001; 69.1 to 61.3% in women, p<0.001). Women had currently more often calcium intake lower than recommended compared to data ten years ago (68.8% in ENNS to 74.5% in Esteban, p<0.01). Adherence to the French recommendation regarding to fibre (>25g/d) tended to increase in men and women, but adherence regarding to salt consumption (<8g) decreased significantly in women (82.9 to 72.0%, p<0.0001) and tended to decrease in men (43.1 to 38.2%, p=0.07).

**Conclusions:** These results show that nutritional objectives of the PNNS are not achieved in the French population. As a whole, food consumption and dietary intake get worse during the last 10 years. So nutrition should be subject to next priorities of public health in France by strengthening actions of the PNNS.

**Keywords:** Nutrient, intake, evolution, France, epidemiology

PREVALENCE OF OVERWEIGHT AND OBESITY IN FRENCH POPULATION: EVOLUTION DURING THE LAST 10 YEARS BETWEEN THE TWO FRENCH NUTRITION AND HEALTH SURVEYS (ENNS-2006 AND ESTEBAN-2016)

(1)Torres, Marion; (2)Salanave, Benoît; (3)Verdot, Charlotte;

(3)Deschamps, Valérie.

(1)PhD. Nutritional surveillance and Epidemiology Team. Santé Publique France. Université Paris 13. Centre de Recherche Epidémiologie et Statistique. COMUE Sorbonne-Paris-Cité. Bobigny. France.; (2)MsC. Nutritional surveillance and Epidemiology Team. Santé Publique France. Université Paris 13. Centre de Recherche Epidémiologie et Statistique. COMUE Sorbonne-Paris-Cité. Bobigny. France.; (3)PhD. Nutritional surveillance and Epidemiology Team. Santé Publique France. Université Paris 13. Centre de Recherche Epidémiologie et Statistique. COMUE Sorbonne-Paris-Cité. Bobigny. France.

**Background and objectives:** Worldwide, overweight and obesity are becoming ever more frequent, leading to an increase of chronic diseases associated. Therefore, it is necessary to promote health public policies to reduce this burden. In France, it is one of the objectives of the French National Nutrition and Health Programme (PNNS) developed since 2001 by the Ministry of Health. To assess the nutritional status of the population according to the PNNS indicators, national nutrition and health surveys were implemented in 2006 (ENNS) and 2016 (Esteban). This paper studies the prevalence of overweight and obesity among French adults and children during the last 10 years.

**Methods:** Data from two cross-sectional population-based surveys, using a multistage sampling design, were used: ENNS-2006 (nadults=2388 and nchildren=1314) and Esteban-2016 (nadults=2467 and nchildren=1099). Anthropometry was measured according to standardized procedures from WHO recommendations. Body Mass Index was use to classify adults according to their status (≥25kg/m² overweight; ≥30kg/m² obesity). For children, the IOTF BMI cut-offs were used. The samples have been compared by linear regression and chi-2 test (gender-stratified, weighted and standardized data).

**Results:** The mean BMI was not significantly different between the two studies in adults (men: 26.1 vs 26.0kg/m²; women: 25.1 vs 25.7kg/m²; between ENNS and Esteban). In men, prevalences of overweight and obesity were 41.0% [36.7-45.5] and 16.1% [13.2-19.6], respectively in ENNS vs 37.1% [33.5-40.9] and 16.9% [14.2-19.9] in Esteban. In women, prevalence of overweight was 23.8% [21.2-26.7] in ENNS and 26.8% [23.8-30.1] in Esteban. Obesity reached 17.6% [15.2-20.3] and 17.4% [14.8-20.4], respectively. In boys, 13.6% [10.5-17.5] in ENNS were in overweight vs 11.8% [8.4-16.3] in Esteban, and 2.6% [1.5-4.5] to 4.1% [2.1-7.7] in obesity respectively. In girls, overweight was prevalent in 15.0% [11.6-19.2] in ENNS vs 14.2% [10.7-18.7] in Esteban, and obesity 4.0% [2.3-6.8] vs 3.8% [2.1-6.7] respectively.

**Conclusions:** These results show a stability of overweight and obesity in France over ten years among French adults and chil-