imals, but not CR-Leptin animals, presented a higher feed efficien-
cy from 4-6 months than controls, and a higher adiposity index at
6 months. At this age, CR animals, but not CR-Leptin animals, also
displayed higher leptin levels than controls. Up-regulated Agou-
ti-related transcript (Agrp) and down-regulated proopiomelano-
cortin (Pomc) were identified by microarray gene expression
analysis of PBMCs between CR versus control animals and related
to feeding control. RT-qPCR confirmed the results. These altera-
tions were partially reverted in CR-Leptin animals.

**Conclusions:** Expression levels of Agrp and Pomc are revealed as potential blood-cell transcript-based biomarkers of predisposition to excess fat accumulation in adulthood due to alterations in energy homeostasis control. Notably, these transcript levels are sensitive to oral leptin supplementation during lactation, in accordance to its ability to revert most of the detrimental effects on energy homeostasis control caused by inadequate fetal nutrition.

**Keywords:** PBMCs, maternal undernutrition, metabolic programming, feeding control.

**Conflict of Interest Disclosure:** A. Palou, C. Picó and J. Sánchez are authors of a patent held by the University of the Balearic Islands entitled "Use of leptin for the prevention of excess body weight and composition containing leptin" (WO 2006089987 A1) (Priority data: 23 February 2005).

**Further collaborators:** Nara Szostaczuk has been granted a PhD fellowship entitled "beca para la formación de personal investigador", co-funded by the Regional Government (Conselleria d'Educació, Cultura i Universitats, CAIB) and the European Social Fund (FSE).

144/1842

ROLE OF MICRORNAS MIR-155 AND LET-7B ON
INFLAMMATION IN THP-1 CELLS: EFFECTS OF
PRO- AND ANTI-INFLAMMATORY FATTY ACIDS

**Background and objectives:** Our group has previously shown that a Mediterranean-based nutritional intervention is able to induce changes in the expression of Let-7b and miR-155-3p in white blood cells of individuals with metabolic syndrome. In addi-

tion, a low consumption of lipids and saturated fat has been associ-
ated with higher expression of Let-7b. However, to our knowledge
there are no evidences about the role of anti- and pro- inflammatory
fatty acids (FAs) on the expression of these microRNAs. In this
sense, the main objective of the current study was to investigate
the regulatory roles of miR-155-3p and Let-7b on the expression
of inflammation-related genes in monocytes, macrophages and
LPS-activated macrophages (AcM). Moreover, we explored the
regulatory role of pro- and anti-inflammatory fatty acids on the
expression of these miRNAs in the three cell types.

**Methods:** Human acute monocytic leukemia cells (THP-1) were differentiated into macrophages and activated with LPS for 24 hours. Monocytes, macrophages and AcM were transfected with miR-Let-7b-5p and miR-155-3p mimics or a negative control. The expression of the miRNAs and selected genes involved in inflammatory pathways (TNF, IL6, SERPINE1 and TLR4) was measured by qRT-PCR. The three cell types were also incubated with palmitic, oleic, docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids.

**Results:** miR-155-3p mimic increased the expression of IL6 in the three cell types. In the same way, SERPINE1 was upregulated in monocytes and macrophages. However, TLR4 was downregulated in miR-155-3p-transfected monocytes and macrophages. Let-7b mimic downregulated TNF/IL6 in monocytes and SERPINE1 in AcM. However, TNF, IL6 and SERPINE1 were upregulated in macrophages. Oleic acid was able to increase the expression of miR-155 in monocytes when compared with DHA but not when compared with non-treated cells. On the other side, oleic acid increased the expression of Let-7b in macrophages and AcM.

**Conclusions:** Overall, these findings suggests a pro-inflammatory role for miR-155-3p and an anti-inflammatory role for Let-7b in THP-1 cells. However, these effects depended on the cell type. Moreover, some of the beneficial properties of oleic acid in non-activated and LPS-activated macrophages might be mediated by increasing Let-7b expression.

**Keywords:** TNF, SERPINE1, monocyte, macrophage, oleic acid

**Further collaborators:** This study was supported by research grant to JLM-R (CAPES Foundation, Ministry of Education of Brazil, PDSE process nº 6409-13-0), and CIBERobn and MINECO (ref. AGL2013-45554-R).

144/1843

ASSOCIATION BETWEEN FOOD INSECURITY
AND NUTRITIONAL STATUS OF ADULT WOMAN

**Background and objectives:** The Food and Agriculture Organisation (FAO) Voices of the Hungry (VOH) developed an

<footnote>(1)Marques Rocha, Jose Luiz; (2)García-Lacarte, Marcos; (2)García, Mírian Samblas; (3)Bressan, Josefina; (4)Martínez, J. Alfredo;</footnote>

<footnote>(5)Milagro, Fermin I.</footnote>

<footnote>(1)Nutritionist. Department of Integrated Education of Health. Federal University of Espírito Santo. Vitória. Brazil.; (2)B.Sc. Department of Nutrition. Food Science and Physiology. Center for Nutrition Research. University of Navarra. Pamplona. Spain.; (3)Ph.D. Nutritionist. Department of Nutrition and Health. Federal University of Viçosa. Viçosa. Brazil.; (4)PhD. Physician. Department of Nutrition. Food Science and Physiology. Center for Nutrition Research. University of Navarra. Pamplona. Spain. CIBERobn, Fisiopatología de la Obesidad y la Nutrición. Carlos III Health Institute. Madrid. Spain.; (5)PhD. Department of Nutrition. Food Science and Physiology. Center for Nutrition Research. University of Navarra. Pamplona. Spain. CIBERobn, Fisiopatología de la Obesidad y la Nutrición. Carlos III Health Institute. Madrid. Spain.</footnote>

<footnote>(1)Kodavalla, Venkayya; (2)I I, Meshram; (3)T, Longvah; (4)Kuhnlein, Harriet; (5)Roy, Phrang.</footnote>

<footnote>(1)MSc. Bio-statistics. National Institute of Nutrition. Indian Council of Medical Research. Telangana. India; (2)M.D Social and Preventive Medicine. NIN.Telangana. India; (3)MSc. Food Chemistry. NIN. Telangana. India; (4)PhD.Nutritionist.India; (5)PhD. Nutritionist.India.</footnote>
experience-based measure called the Food Insecurity Experience Scale (FIES). The FIES consists of a set of eight questions that focus on reported food-related behaviours associated with difficulties in accessing food due to resource constraints. The paper examines the association between food insecurity and nutritional status of Chakhesang people, an indigenous tribe of Nagaland, Northeast India.

**Methods:** Data on Food insecurity was assessed using pre-tested questionnaire from a representative sample of adult women to provide the information in order to (a) test the coherence of the selected questions and explore the degree of food insecurity, (b) classify the respondents into different classes of food insecurity (secure, moderately insecure, and severely insecure) and (c) estimate the prevalence of people experiencing food insecurity at various levels. R-program was developed to build the Rasch model for the analysis of FIES data.

**Results:** Different scoring methods (Raw and Weighted) were used to obtain the prevalence rates of food insecurity. A significant association between the prevalence by raw scores and Rasch model (<0.001) was observed indicating the synergy between the two methods in estimating the food insecurity prevalence rates. Rasch model suggests a higher prevalence of mild and moderate food insecurity (72%) whereas it was 59% with the raw scores. Approximately, 72% of the households experienced food insecurity at different levels and only 28% of the households are food secured. The prevalence of Food Insecurity is significantly (p<0.01) associated with Literacy rate, per capita income and family size. Food insecurity was higher among illiterate subjects (74%) as compared to literates (47%), low income groups (74%) as compared to high income groups (33%) and with family size of >=9 members (74%) as compared to family size of 1-4 members (54%). However, no significant association was observed between Chronic Energy Deficiency (CED) food insecurity levels.

**Conclusions:** Food Insecurity is heavily depending up on socio-demographic profile of the households.

**Keywords:** Food insecurity, Association, Rasch model, nutritional status, tribal population

**Background and objectives:** A cornerstone of governments' policies to reduce the risk of non communicable diseases is to encourage population change towards healthier diet and lifestyle. However, monitoring dietary changes in response to policy recommendations is based on self-reported dietary assessment tools, which are known to have high misreporting rates. We have developed a novel analytical pipeline capable to independently of recorded food intake, classify people into consumers of a healthy or unhealthy diet based on urinary metabolic patterns (Garcia-Perez et al., Lancet Diabetes Endocrinology, 2017).

Here we aim to apply this methodology based on metabolic profiling to improve the accuracy of monitoring dietary intake and adherence to diet guidelines for free living people and evaluate its utility for establishing inter-individual variation in response to diet.

**Methods:** We used a randomised controlled trial in 19 volunteers to develop metabolite models of eating patterns. Volunteers were admitted to a clinical research unit for four day periods. Participants were provided with all food and drink representing 25, 50, 75 and 100% of healthy eating recommendations to increase fruits, vegetables, carbohydrates, dietary fibre and to decrease total fats, sugars, and salt. A cohort of 20 volunteers collected spot urine samples once a week for six months and a matching 24-hours food diaries for each day of the sample collection. Metabolic profiles were measured by 1H-NMR spectroscopy. MetaboNetworks has been used to investigate the metabolic coverage based on inter-individual variation.

**Results:** Analysis of 1H-NMR spectroscopy data indicated significant differences in the urinary metabolic profiles of the four diets. These were used to predict the healthiness of the dietary habits of free-living people and tracking adherence to healthy eating recommendations over time. Missreporting of dietary data has been investigated using dietary biomarkers against the food records.

<footnote>(1)Garcia Perez, Isabel; (2)Posma, Joram M; (3)Gibson, Rachel;</footnote>

<footnote>(1)Chambers, Edward S; (4)Nicholson, Jeremy K; (5)Holmes, Elaine;</footnote>

<footnote>(6)Frost, Gary.</footnote>

<footnote>(1)Dr. Research Fellow. Department of Medicine. Nutrition and Dietetic Research Group. Division of Endocrinology and Metabolism. Imperial College London. W12 0NN, U.K.; (2)Dr. Research Fellow. Department of Surgery and Cancer. Division of Computational and Systems Medicine. Imperial College London. SW7 2AZ. U.K.; (3)Dr. Nutritionist. Department of Medicine. Nutrition and Dietetic Research Group. Division of Endocrinology and Metabolism. Imperial College London. W12 0NN, U.K.; (4)Professor. Chair in Biological Chemistry, Head of Department. Department of Surgery and Cancer. Division of Computational and Systems Medicine. Imperial College London. SW7 2AZ. U.K.; (5)Professor of Chemical Biology. Head of Computational and Systems Medicine. Department of Surgery and Cancer, Division of Computational and Systems Medicine, Imperial College London, SW7 2AZ, U.K.; (6)Professor. Chair in Nutrition and Dietetics. Department of Medicine. Nutrition and Dietetic Research Group. Division of Endocrinology and Metabolism. Imperial College London. W12 0NN, U.K.</footnote>
In addition, significant differences in metabolite concentrations
were investigated to assess individual's variability in response to diet.

**Conclusions:** This study demonstrates the utility of applying our methodology to monitor adherence to healthful diets and assess individuals' variability in response to dietary changes.

**Keywords:** metabolic profiling, dietary patterns, dietary assessment, dietary adherence.

144/1903

AN EPIGENOME-WIDE ASSOCIATION STUDY
(EWAS) OF OBESITY-RELATED TRAITS

(1)Braun, Kim; (2)Dhana, Klodian; (3)Nano, Jana; (4)Voortman, Trudy;

(5)van Meurs, Joyce; (6)Uitterlinden, Andre; (6)Hofman, Albert;

(7)Franco, Oscar; (8)Dehghan, Abbas.

(1)RD, MSc. Department of Nutrition. Harvard T.H. Chan School of Public Health. USA.; (2)MD, PhD. Department of Nutrition. Harvard T.H. Chan School of Public Health. USA.; (3)MD, MSc. Department of Epidemiology. Erasmus University Medical Center. The Netherlands.; (4)PhD. Department of Epidemiology. Erasmus University Medical Center. The Netherlands.; (5)PhD. Department of Internal Medicine. Erasmus University Medical Center. The Netherlands.; (6)MD, PhD. Department of Epidemiology. Harvard T.H. Chan School of Public Health. USA.; (7)MD, PhD. Department of Epidemiology. Erasmus University Medical Center. The Netherlands.; (8)MD, PhD. Department of Epidemiology. Imperial College London. UK.

**Background and objectives:** Obesity is a complex phenotype that arises as a result of interaction between lifestyle and genetic factors. Epigenetics has been proposed as a molecular mechanism that accommodates genes to the environment and potentially could describe further the link between obesity and its complications. We conducted an epigenome-wide association study (EWAS) on obesity-related traits.

**Methods:** We used data from two prospective, population-based cohort studies: the Rotterdam Study (RS) and the Atherosclerosis Risk in Communities (ARIC) Study. We used RS (n=1,454) as the discovery panel and ARIC (n=2,097) as replication panel. Linear mixed-effect models were used to assess the association between genome-wide DNA methylation in leukocytes with body mass index (BMI) and waist circumference (WC) adjusting for sex, age, smoking, leukocyte proportions, array number, and position on array.

**Results:** Fourteen CpG sites were associated with BMI and 26 CpG sites with WC in RS after Bonferroni correction (P <10-7), of which 12 and 14 CpG sites successfully replicated in ARIC Study, respectively. The most significant novel CpG sites were located at MSI2 (cg21139312) and LARS2 (cg18030453) and were associated both with BMI and WC. CpG sites at BRDT, PSMD1, IFI44L, MAP1A, and MAP3K5 were associated with BMI and CpG sites at LGALS3BP, MAP2K3, DHCR24, CPSF4L, and TMEM49 were associated with WC.

**Conclusions:** We report novel associations of methylation at MSI2 and LARS2 with obesity-related traits. These results provide

further insight in mechanisms underlying obesity-related traits,
which can enable identification of new biomarkers in obesity-re-
lated chronic diseases.

**Keywords:** DNA methylation, EWAS, BMI, waist circumference, cohort

**Conflict of Interest Disclosure:** The authors Kim V. E. Braun, Trudy Voortman, and Oscar H. Franco work in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.), Metagenics Inc. and AXA. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript.

**Further collaborators:**

co-authors from ARIC

Ellen W. Demerath¹, Weihua Guan², Myriam Fornage³.

¹PhD. Division of Epidemiology and Community Health. University of Minnesota, USA.

²PhD. Division of Biostatistics. University of Minnesota School of Public Health. USA.

³PhD. Human Genetics Center. School of Public Health. University of Texas Health Sciences Center at Houston. USA. Human Genome Sequencing Center. Baylor College of Medicine. USA.

144/2080

ASSOCIATION OF THE FTO FAT MASS AND OBE-
SITY - ASSOCIATED GENE RS9939609 POLY-
MORPHISM WITH REWARDING VALUE OF FOOD
AND EATING BEHAVIOR IN CHILEAN CHILDREN

(1)Obregon Rivas, Ana Maria; (2)Santos, José Luis; (3)Valladares, Macarena; (4)Goldfield, Gary.

(1)PhD. Nutritionist. San Sebastian University, Concepción. Chile;

(2)PhD. Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; (3)PhD. Centro Integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O Higgins, General Gana 1702, Santiago 8370854, Chile.; (4)PhD. Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.

**Background and objectives:** FTO is the strongest known genetic susceptibility locus for obesity. Experimental studies in animals suggest a potential role of FTO in regulating food intake and eating behavior. Objective: The aim of this study is to assess the association between the genetic variant rs9939609 in the FTO gene and homeostatic and non-homeostatic eating behavior patterns in Chilean children.

**Methods:** Cross-sectional study in 258 Chilean children (44% female; 8-14 years-old) showing a wide variation in BMI. Anthropometric measurements (weight, height, Z-score of BMI and waist circumference) were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ); Child Eating Behavior Questionnaire (CEBQ); Three Factor Eating Questionnaire (TFEQ) and the Food Reinforcement Value Questionnaire (FRVQ). Genotype of the
rs9939609 in FTO was determined by a Taqman assay. Statistical Analysis: Association of the rs9939609-A allele with eating behavior was assessed using non-parametric tests.

**Results:** Allelic frequencies of the rs9939609 was estimated as 77% for the A allele and 23% for the T allele in Chilean children. We found that normal weight girls carrying the A-allele have higher scores of Satiety Responsiveness and higher scores of the Slowness in Eating subscale. In normal-weight boys, carriers of the A-allele showed significantly higher scores of the Negative Affect sub-scale and lower scores of the Desire to Drink sub-scale, in relation to the non-carriers. In the overweight group we found that carriers of the A-allele showed higher scores of the Food Responsiveness, Emotional Overeating, Enjoyment of Food and Food Choice sub-scales and lower scores of the Satiety Responsiveness and Slowness in Eating sub-scales. In the obese group we found higher scores of the Cognitive Restrained subscale and significantly lower Food Choice.

**Conclusions:** The rs9939609-A allele is associated with eating behavior traits that may predispose obese children to increased energy intake and obesity.

**Keywords:** Fat Mass and Obesity Related (FTO), Children, polymorphism, eating behavior.

**Acknowledgements:** The authors would like to express their gratitude for the funding given by the National Fund of Scientific and Technological Development (Fondo Nacional de Desarrollo Científico y Tecnológico – FONDECYT Grants 11130200), CONICYT.

SHORT TERM EFFECT OF EARLY OVERNUTRITION IN THE TRANSCRIPTOME OF WISTAR RAT HYPOTHALAMUS (RATTUS NORVEGICUS)

**Background and objectives:** The postnatal overnutrition (PON) influences the generation of metabolic disorders such as obesity and dyslipidemia. Recent reports in animal models with hypercaloric diet show changes in the concentration of peptides that regulate the activation or inhibition of neurons that induced behaviors of appetite and satiety, resulting in hyperfagia after treatment.

The objective of this work was analyze the short-term effect of the PON in the hypothalamus and adipose tissue transcriptome. Particularly analyzing metabolic pathways related to the regulation of the processes of hunger, satiety and inflammation.

**Methods:** Overnutrition model in Wistar rats by overlactation from day 3 to day 21 of life by litter size reduction method using pup male was generated: control group (n=5) and overnutrition group (n=5). Transcritome was analyzed with microarrays of expression technology (Ratgene ST 2.2, Affymetrix®), with a coverage of 28,407 transcripts. The pathway analysis was performed with the Ingenuity Pathway Analysis software (IPA). Bioinformatic analysis was performed on the R statistical software, statistical analysis for phenotypic and biochemical parameters were analyzed in Graphpad Prism 6* software, it was applied Student's t test with p < 0.05.

**Results:** Treatment group shows overweight, and high concentration of triglycerides, glucose and leptin serum. Transcriptome analysis in hypothalamus showed 226 deregulated transcripts of which 98 are under-expressed transcripts and 128 overexpressed with a cutoff of fold change (Log fold change) of 1.5 were found. Furthermore the adipose tissue transcriptome showed 161 deregulated transcripts of which 61 are overexpressed and 100 are underexpressed. Analysis of the pathways expressed in hypothalamus showed a deregulation of the pathways of lactation, inflammation, circadian rhythms and leptin resistance. The desregulated vias in adipose tissue was associated to inflammation, disorder of lipid metabolism and hyperleptinemia.

**Conclusions:** Early postnatal overnutrition generates insulin resistance and dyslipidemia. We show for the first time the effects of early postnatal overnutrition in the hypothalamus and adipose tissue transcriptomes to 21 days. Some of differentially expressed transcripts controls neuronal circuits involving the hypothalamus control circadian rhythms and endocrine regulation (leptin vias), this is an evidence of metabolic disruption in hypothalamus and adipose tissue.

**Keywords:** Hypothalamus, adipose-tissue, metabolic-programming, whole-transcriptome.

DO MEASURES OF SWEET TASTE INTENSITY AND HEDONIC LIKING OF GLUCOSE PLAY A ROLE IN DIETARY INTAKE OF SWEET FOOD?

**Background and objectives:** A range of psychophysical taste measurements are used to characterise an individual's sweet taste

<footnote>(1)Espinoza Camacho, Miguel Angel; (2)Sánchez-García, Gerardo;</footnote>

<footnote>(3)López-Victorio, Carlos Javier; (4)Varela-Echavarría, Alfredo; (4)Ayala-</footnote>

<footnote>Sumuano, Jorge Tonatiuh; (5)Castro-Reyes, Luis Antonio; (5)González-</footnote>

<footnote>Zambrano, Elena; (6)Tejero, Maria Elizabeth; (2)Hong-Chong, Enrique;</footnote>

<footnote>(6)del Bosque-Plata, Laura.</footnote>

<footnote>(1)Phd Studentet, National Institute Of Genomic Medicine Mexico, National Autonomous University Of Mexico University;</footnote>

<footnote>(2)Phd. Student. Center of Research and Advanced Studies. Mexico City. Mexico.; (3)PhD. Autonomous University Juárez Tabasco. Tabasco. Mexico.; (4)PhD. Institute of Neurobiology (UNAM). Queretaro. Mexico.; (5)PhD. National Institute of Medical Sciences and Nutrition "Salvador Zubirán". Mexico City. Mexico;</footnote>

<footnote>(6)PhD. National Institute of Genomic Medicine. Mexico City. Mexico.</footnote>

<footnote>(1)Richter, Marilize; (2)Cao, Guojiao; (3)Jayasinghe, Shakeela; (4)Kruger, Rozanne; (5)Bernhard, Breier; (6)Walsh, Daniel.</footnote>

<footnote>(1)PhD, Dietitian, Lecturer, College of Health, Massey University;</footnote>

<footnote>(2)M.Sc Student, Massey University; (3)PhD Student, Massey University; (4)Associate Professor, Nutrition and Dietetics, Massey University; (5)Professor, Nutrition and Dietetics, Massey University; (6)Institute for Natural and Mathematical Sciences, Massey University.</footnote>
perception. The links between sweet taste perception and dietary intake of sweet foods should be explored, since it could be a link to address health outcomes. This study aims to investigate the relationship between both perceived sweet intensity and hedonic liking of sweet taste, and the relationship with dietary intake.

**Methods:** This cross sectional study recruited women (n=44) aged 20-40 years. Measures of sweet taste perception (sweet taste intensity and hedonic liking of suprathreshold concentrations) were assessed using glucose as the tastant. Dietary intake was assessed for energy, macronutrients and sugars (total sugar, glucose, sucrose, fructose, lactose and maltose) using a four-day weighed food record.

**Results:** There were significant inter-individual variations in sweet taste measurements. Mean perceived sweet taste intensity correlated inversely with mean recorded energy (r=-0.403, p=0.009), carbohydrate(r=-0.449, p=0.003), total sugar (r=-0.421, p=0.006), glucose (r=-0.411, p=0.008), fructose (r=-0.408, p=0.008) and maltose intake (r=-0.325, p=0.038). Mean hedonic liking correlated positively with mean recorded energy (r=0.324, p=0.039), carbohydrate (r=0.360, p=0.031), total sugar (r=0.437, p=0.004), glucose (r=0.418, p=0.007), fructose (r=0.391, p=0.012) and maltose intake (r=0.463, p=0.002).

**Conclusions:** To the best of our knowledge this is the first study reporting robust significant relationships between a combination of both sweet taste intensity measures and hedonic liking measures of suprathreshold concentrations with dietary intake measures. Although causality cannot be inferred due to the cross-sectional design, the increase in strength of correlations and strength of significance suggest a dose-dependent relationship between sweet taste intensity, as well as the hedonic liking and dietary intake of energy, carbohydrates and particularly glucose.

**Keywords:** sweet taste intensity; hedonic liking; dietary intake; glucose

(1)Sadeq-ur Rahman, Qazi; (2)Huda, Tanvir Mahmudul; (3)Rahman, Mohammad Masudur; (4)Raihana, Shahreen; (5)Hossain, A.K.M. Tanvir; (6)Jaman, Md. Jahiduj; (7)Tahsina, Tazeen; (8)Islam, Sajia; (9)Arifeen, Shams El; (10)Dibley, Michael.

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

**Background and objectives:** Real time data collection and management is crucial for public health research. A centralized data capturing mechanism using tablet and web based application was implemented in a large community based trial in rural Bangladesh where information was collected from 35,372 pregnant women. The goal of designing such a data capturing and storing system was to introduce an advanced tab-based technology for real time, error free and cost effective, and data collection and reporting mechanism.

**Methods:** A paper-less data management software was centrally developed for data collection, and transmission, to central server for monitoring and field management. All data collection variables were incorporated into the smartphone [with Symbian operating system (OS)] and tablets (with Android OS) with internet enabled SIM card. Separate software were developed for the smartphone and tablets. All types of display and validation conditions were built into the software to prevent errors and ensure logical flow, range check, uniqueness check and skip-rules. Data were stored locally in the tablet during interview. Data collectors upload data daily to a central server to create a pooled central database. For real time monitoring and supervision, a separate web-browser based interface was developed. Password protected login identifications and audits were incorporated to ensure data safety.

**Results:** Such a digital data capturing system ensured high quality, reliable data. This allowed evasion of conventional way of manual data entry, data filing and stocking. A built-in GPS tracking system helped data collector and investigators to locate the respondent's households, reducing the barrier of distance. Any mismatch in data could be easily detected and traced using unique identifiers, and accordingly respondent specific corrections were made. A back-
up copy of the entre database were stored in a separate server in a different physical location to ensure data protection.

**Conclusions:** We have developed an application for Symbian, Android operating system and web platform to assist research activities. Quality, complete and timely data collection from a large community based trial is unprecedented in rural Bangladesh. This innovation ensured quality data capturing by reasonably educated workforce at point of contact in an integrated manner.

**Keywords:** operating system, data capturing, paperless, digital technology

144/2500

HIGH-FAT DIET DISRUPTS PERIPHERAL CIRCADIAN CLOCKS IN WHITE AND BROWN ADIPOSE TISSUES

(1)Li, Dongyang; (2)Yamazaki, Tomomi.

(1)MD. Graduate School of Humanities and Sciences and Program for Leading Graduate Schools. Ochanomizu University. Japan.;

(2)PhD. Department of Nutritional Science. National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition. Japan.

**Background and objectives:** Due to the periodic changes of 12h-light and 12h-dark in the environment, circadian clock rhythmic exists in almost all living creatures. The circadian oscillation system is generated by a transcriptional feedback loop that consists of clock genes. It has been reported that clock genes regulate metabolic and physiological process in peripheral tissues. However, the relationship between dysfunction of circadian mechanism and obesity has not been revealed clearly. The aim of this study is to examine the change of circadian oscillation of clock genes in white adipose tissue (WAT) and brown adipose tissue (BAT) in high-fat diet-induced obese mice.

**Methods:** Six-week-old male ddY mice, after one week feeding of a normal laboratory diet, were divided into a low-fat diet (LFD, 10 energy%), or a high-fat diet (HFD, 60 energy%) for 8 weeks under strict 12h-light and 12h-dark cycle. Mice were sacrificed every 4h over continuous 24h, and WAT and BAT were isolated. The circadian expression of clock genes was examined by quantitative real-time PCR.

**Results:** Without difference in the quantity of energy intake between feeding groups, after 8 weeks on a HFD, mice displayed obese metabolic features. In LFD group, a similar oscillatory pattern of the clock genes was revealed in WAT and BAT. Additionally, HFD feeding affected the circadian expression of clock genes by altering phase, amplitude or oscillatory pattern, but the effects varied from WAT to BAT. In WAT, the oscillations of Bmal1, Clock, Per(1-3), Cry(1-2), Rev-erb(α,β) and Rora were affected by HFD feeding significantly. However, in BAT, the oscillations of Npas2, Bmal1, Cry(1-2), Ror(α,β,γ) were changed significantly by HFD feeding.

**Conclusions:** Clock genes displayed robust cyclic expression both in WAT and BAT. The oscillatory pattern of the clock genes were disrupted in HFD induced obese mice, but the effects of HFD on peripheral circadian clocks are different between WAT

and BAT. This indicates an intrinsic correlation between circadian oscillation and metabolic function in adipose tissues, and the difference in circadian regulation between WAT and BAT. Further study is needed to reveal the mechanisms.

**Keywords:** circadian oscillation, obesity, disruption, brown adipose tissue, white adipose tissue

144/2520

COMPARISON BETWEEN EQUATIONS TO ESTIMATE ENERGY REQUIREMENT FOR WOMEN FROM ANTIOQUIA WITH EXCESS WEIGHT (COLOMBIA)

(1)Deossa Restrepo, Gloria Cecilia; (2)Gómez Maquet, Sandro;

(3)Velasquez, John Edinson; (4)Restrepo, Luis Fernando; (5)Rodríguez, Daniela.

(1)Nutritionist dietitian. Specialist and master in food science and human nutrition. Professor, school of nutrition and dietetics, University of Antioquia, Medellin Colombia.; (2)Medical nutritionist. Medellin, Colombia; (3)Nutritionist dietitian school of nutrition and dietetics, University of Antioquia, Medellin Colombia; (4)Statistician, Specialist in statistic and Biomathematics, associate professor. Colombia.

**Background and objectives:** Energy is the ability of bodies to perform work and produce changes in themselves or in other bodies. The energy balance occurs when the daily energy needs are equal to the expenditure, in this way the weight is conserved. **Objective:** To compare the energy expenditure by indirect calorimetry vs diverse equations to estimate the energy expenditure at rest, in women with overweight

**Methods:** Materials and methods: population and sample: 1500 female patients, aged between 18 and 73 years, with overweight, who attended for 9 years (2006-2015) to private medical consultation and performed indirect calorimetry, of the total of calorimetry, was made a selection of a sample corresponding to 1178 calorimetry for this study. Statistical analysis: we performed a comparative descriptive analysis of multidimensional type of cross-section. To the statistical analysis we used multivariate analysis of variance (MANOVA) with canonical orthogonal type contrast, the analysis was complemented by the Spearman correlation technique, additionally was one-dimensional type descriptive statistics. We used SAS University 2015 statistical packet

**Results:** The present investigation it showed that as the age increases, it diminishes the stature, increases the average weight and increases the body mass index (BMI). When performing the analysis of variance (MANOVA), we did not detect significant differences in energy expenditure, determined by indirect calorimetry (IC) in the analyzed groups (p>0.05); we detected a significant difference (p<0.05) in energy expenditure according to the Harris and Benedict equation (HB).

**Conclusions:** An overestimation or underestimation of energy requirements in individuals can lead to a deficit or excess in caloric intake, which will be reflected in their nutritional status.

**Keywords:** Energy requirement, indirect calorimetry, energy expenditure
APPLICATION OF A NEW CHALLENGE METH-
OD: IMPROVING METABOLIC RESILIENCE WITH
WHOLEGRAIN WHEAT PRODUCTS

(1)Stroeve, Johanna H.M.; (1)Hoevenaars, Femke P.M.; (1)de Hoogh, Iris;

(2)Esser, Diederik; (3)Schutte, Sophie; (4)Priebe, Marion G.; (5)Vonk, Roel;

(6)van der Kamp, Jan-Willem; (7)Afman, Lydia; (1)Wopereis, Suzan.

(1)PhD. Research Group Microbiology & Systems Biology. TNO, Netherlands Organization for Applied Scientific Research. The Netherlands.; (2)PhD. Division of Human Nutrition. Wageningen University. The Netherlands.; (3)MSc. Division of Human Nutrition. Wageningen University. The Netherlands.; (4)PhD. Center for Medical Biomics. University Medical Center Groningen. The Netherlands; (5)Prof. Center for Medical Biomics. University Medical Center Groningen. The Netherlands; (6)MSc. Research Group Functional ingredients. TNO, Netherlands Organization for Applied Scientific Research. The Netherlands.; (7)Asst. Prof. Division of Human Nutrition. Wageningen University. The Netherlands.

**Background and objectives:** Whole grain wheat (WGW) consumption has been associated with beneficial health effects in observational studies. However, intervention studies show mixed effects upon traditional measurements under overnight fasting conditions. The aim of the study was to show that quantification of resilience can be used to substantiate health effects of WGW in a healthy population. For this purpose we used a standardized mixed meal challenge test called PhenFlex test (PFT).

**Methods:** A randomized controlled double blind trial was performed with 50 male and female participants with mildly elevated plasma total cholesterol levels. After 4 weeks run-in with refined wheat (RW) participants were assigned to either 12 weeks WGW (98 g per day) or RW. Before and after 12 weeks intervention PFT was performed. Blood samples were taken at overnight fasting (t=0) and 30, 60, 120, and 240min postprandial. During the 4 hour response time course, 31 biomarkers were quantified focusing on cardio-metabolic health.

**Results:** At fasting only 2 out of 31 biomarkers were significantly different between RW and WGW, in contrast to the PFT response with 12 out of 31 biomarkers. Among these were ALAT and ASAT, TG and HDL, CRP, IL8, SAA, IL10, IL6, IL1b and TNFα. PFT response showed little or no significant differences in NEFA, TG, cholesterol, glucose and insulin responses between the two interventions, but when combining these into a health space model a clear WGW metabolic health effect in the direction of subjects from younger age was observed.

**Conclusions:** Here we show for the first time in a RCT that WGW improved metabolic health, liver health and inflammatory status as measured by a set of biomarkers to a nutritional challenge test. This confirms the associated beneficial health effects from epidemiology, while traditional overnight fasting blood measurements showed little or no health effect of WGW.

**Keywords:** whole grain wheat, phenotypic flexibility, biomarkers, challenge test, metabolic health

**Further collaborators:** This research was supported by the public private partnership entitled "Combining innovation with

tradition: improving resilience with essential nutrients and whole
wheat bread", financed by Topsector Agri & Food (TKI-AF 12083).
This project was sponsored by TNO roadmap Nutrition and
Health and co-funded by Cereal Partners Worldwide, the Dutch
Bakery Center, and GoodMills Innovation GmbH.

IN OBESE WOMEN, INCREASED BLOOD VOLUME
AND REDUCED SERUM IRON PARTIALLY EX-
PLAIN THE HIGHER RISK FOR IRON DEFICIENCY

(1)Cepeda Lopez, Ana Carla; (2)Melse-Boonstra, Alida; (3)Mettler-Naef, Nicole; (4)Mueller, Sandro Manuel; (5)Toigo, Marco; (6)Zimmermann, Michael Bruce; (7)Herter-Aeberli, Isabelle.

(1)PhD. MSc. MD. Ciencias de la Salud. Universidad de Monterrey. México.; (2)Nutritionist. Division of Human Nutrition. Wageningen University. The Netherlands.; (3)Balgrist Move>Med. Universitätsklinik Balgrist; (4)PhD. Exercise physiologist. Department of Neurology. University Hospital and University Zurich. Switzerland.; (5)PhD. Muscle Physiologist. Laboratory for Muscle Plasticity. University Hospital Balgrist. University of Zurich.; (6)PhD. MD. Laboratory of Human Nutrition, ETH Zürich, Switzerland; (7)PhD. MSc. Nutritionist. Laboratory of Human Nutrition, ETH Zürich, Switzerland.

**Background and objectives:** Obesity has been shown to be a risk factor for low serum iron status in different settings. The hypoferremia of obesity might be explained by a combination of biological factors such as inflammation, hemodilution and increased iron requirements. Excess body mass has been suggested to lead to increased blood volume, which may explain lower serum iron concentrations observed in obese individuals.

This observational study compares blood volume in nor-
mal-weight versus overweight and obese, healthy, non-anemic
women (n=62) (BMI 18.5-39.9 kg/m2). We examined if differenc-
es in blood volume might explain the reduced serum iron in over-
weight/obese women. Additionally we developed an equation to
calculate blood volume in overweight/obese women.

**Methods:** We assessed body composition by dual energy X-ray absorptiometry (DXA), iron status, inflammation, and blood volume using the carbon monoxide (CO)-rebreathing method.

**Results:** Overweight/obese women presented higher absolute blood volume, plasma volume and red blood cells, and lower serum iron compared to in normal-weight (P<0.05). There were no significant differences in body iron stores comparing in normal-weight, overweight and obese women. Body mass (r=0.74), lean mass (r=0.82) and fat mass (r=0.56) were correlated with blood volume (p<0.05). Blood volume (r2=0.22, β=-0.29, P=0.02) was a negative predictor for serum iron when adjusted for body iron stores. Equations utilizing combined height-body mass and lean mass were the most accurate for predicting blood volume in all BMI groups.

**Conclusions:** Due to the dilutional effect of blood volume, 'true' hypoferremia may be overestimated in populations with a
high prevalence of obesity when using serum iron as an indicator. Nevertheless, our results indicate that the iron requirements of obese women are actually increased.

**Keywords:** hypoferremia; overweight; plasma volume; iron status

**Further collaborators:**

We especially thank Sophia Wussler for her assistance with the administration of the study, data collection, and preliminary data analyses within her Master's thesis. We acknowledge Christophe Zeder, Adam Krzystek and Timo Christ who assisted with the stable-isotope administration and analyses.

# Track 2: Nutrition Through Life Course

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## LIPID PROFILE AND FUNCTIONAL ACTIVITY OF BIOACTIVE PEPTIDES IN HUMAN MILK

(1)Baena García, Laura; (2)Sánchez López, Antonio Manuel;

(3)Giménez Martínez, Rafael; (3)Sánchez Hernández, Silvia; (4)Noack

Segovia, Jessica Pamela; (4)Levet Hernández, María Cristina; (5)Menor

Rodríguez, Maria Jose; (2)Cobo Viedma, Laura; (5)Guisado Barrilao,

Rafael; (2)Aguilar Cordero, María José.

(1)Grupo de Investigación CTS 367. Plan Andaluz de Investigación. Junta de Andalucía. Spain. Programa de Doctorado Medicina y salud Pública. Universidad de Granada.

Spain.; (2)Grupo de Investigación CTS 367. Plan Andaluz de Investigación. Junta de Andalucía. Spain. Departamento de Enfermería. Universidad de Granada. Spain.; (3)Departamento Nutrición y Bromatología. Universidad de Granada. Spain.;

(4)Universidad de Santo Tomás de Talca (Chile); (5)Departamento de Enfermería. Universidad de Granada. Spain.

**Background and objectives:** Human milk is a fluid of extreme chemical complexity that provides the required nutrients for the suitable development of the newborn and a series of compounds with biological activity essential for adaptation to extrauterine life. Last years, the presence of polyunsaturated long chain fatty acids in breast milk and infant feeding has become very important. They are obtained by the mother's diet during pregnancy and lactation. The purpose of the study is to determine the nutritional status of pregnant women and their influence on the markers of fatty compound synthesis in breast milk.

**Methods:** A prospective cohort study will be conducted in women during pregnancy and lactation. The sample is 112 healthy women and 112 women with risk pregnancies (diabetic, obese and hypertensive).

The anthropometric evaluation will be performed obtaining the following parameters: weight, size, folds, perimeters, diameters.

The nutritional assessment will be done using 3 types of validated questionnaires: food register, 24-hour reminder questionnaire and food consumption frequency questionnaire. The lactogenesis is evaluated through the collection of 3 samples: colostrum, transition milk and mature milk. Each of the above samples will be determined as follows: short chain fatty acids, total fatty acid quantification. The following complementary parameters will also be determined: triglycerides, cholesterol, and glucose. As well as, bioactive peptides: study of in vitro digestibility of milk protein and identification of functional peptides, identification of peptides, study of antioxidant activity, antibacterial and probiotic, bioavailability of minerals.

**Results:** The fat composition of the milk will be different depending on the nutrition of the woman during gestation, her anthropometric measurements and the presence or absence of risk pathologies during the course of gestation.

**Keywords:** Bioactive peptides, breastfeeding, pregnancy, nutrition
# EXPLORING THE POTENTIAL ROLE OF BREASTFEEDING IN THE RECOVERY OF ACUTE MALNUTRITION AMONG INFANTS AGED BELOW 6 MONTHS

(1)Mwangome, Martha; (2)Berkley, James; (3)Jones, Caroline;

(4)Moloney, Grainne.

(1)PhD. Nutritional Epidemiologist. Clinical Department. Kenya Medical Research Institute. Kilifi. Kenya; (2)FRCPCH. Clinician Paediatrician. Kenya Medical Research Institute. Kenya; (3)PhD. Social scientist. Kenya Medical Research Institute. Kenya; (4)MSc. Public Health Nutritionist. UNICEF Kenya. Nairobi. Kenya.

**Background and objectives:** Globally, 4.7 million infants under 6 months (U6M) suffer from severe acute malnutrition (SAM). Recent data suggests that survival of these infants during and after admission is very poor. In a clinical trial, mortality among SAM infants u6m followed up for 1 year after discharge from treatment was 31 per 100 child years and weight gain was poor. Re-establishing exclusive breastfeeding is the main thrust of the WHO updated treatment guidelines, however no studies have tested if successful re-establishing exclusive breastfeeding during inpatient treatment would result in maintained exclusive breastfeeding after discharge and result in nutritional recovery (catch-up growth) and survival.

**Methods:** We are conducting a prospective cohort study involving 90 infants aged 4 weeks to 4 months admitted with acute malnutrition (WFLZ<-2 or WFAZ<-2) at the Kilifi County Hospital (KCH), Kenya. Study participants are nutritionally managed as per the WHO treatment guidelines emphasizing on re-establishing exclusive breastfeeding and followed up at 2nd, 4th and 6th weeks after discharge to assess growth (anthropometry), breastfeeding status, morbidity and mortality. Views on challenges and drivers of breastfeeding retention are also be collected using interviews.

**Results:** We anticipate the following outcomes from the study; i) the proportion of malnourished infants under 6 months effectively re-establishing exclusive breastfeeding (attaining weight velocity of >5g/kg/day on breast milk only for 3 consecutive days before discharge); ii) proportion of infants retaining exclusively breastfeeding 4 weeks after discharge; iii) post-discharge weight gain in relation to breastfeeding status; iv) challenges and motivators to retaining exclusive breastfeeding among recovering infants.

**Conclusions:** The results of this study which will be presented in the conference will demonstrate if exclusive breastfeeding can be attained and retained after discharge; and if breast milk alone is sufficient for recovery of acutely malnourished infants.

**Keywords:** Severe Acute Malnutrition; infants under 6 months; Breastfeeding; weight gain; Kenya

**Further collaborators:**

Amina Abubakar. PhD. Developmental Psychologist. Kenya Medical Research Institute. Kenya

# AN ANALYSIS OF THE RELATIONSHIP BETWEEN 25-HYDROXY VITAMIN D LEVELS AND MUSCULOSKELETAL HEALTH: A POPULATION-BASED STUDY OF CHINA'S ELDERLY

(1)Zhao, Wenzhi; (2)Zhao, Ai; (3)Szeto, Ignatius Man Yau; (4)Zheng, Wei;

(5)Zhang, Yumei.

(1)PhD candidate. Department of Nutrition and Food Hygiene, School of Public Health. Peking University. China.; (2)PhD. Department of Social Medicine and Health Education, School of Public Health. Peking University. China; (3)PhD. Yili Innovation Center. Inner Mongolia Yili Industrial Group Co., Ltd. China.; (4)PhD. Department of Social Medicine and Health Education. School of Public Health. Peking University. China; (5)Professor. Department of Nutrition and Food Hygiene. School of Public Health. Peking University. China.

**Background and objectives:** background and Objectives Vitamin D deficiency is a public health problem worldwide, in spite that vitamin D plays an important role in musculoskeletal health, immunity system, chronic non-communicable diseases and other diseases. Vitamin D is essential in the regulation of calcium and phosphate homeostasis, which affect bone development and preservation. More and more evidence has shown that vitamin D plays an important role in skeletal muscle, affecting falls or sarcopenia in the elderly. This study was to analyze the reasons behind the prevalence of vitamin D deficiency in Chinese community-dwelling elder people, and furthermore explore the relationship between vitamin D levels and indicators of bone health and muscle health.

**Methods:** Subjects were part of a cross-section survey, in which questionnaires contained social demographic information, lifestyle information, diseases history, dietary survey and other questions. Physical examinations included somatometry, bone density, body composition and blood test.

**Results:** The prevalence of vitamin D deficiency and vitamin D insufficiency among the respondents was 74.1% and 20.9%, and there was significant difference among respondents from different regions. The percentage of respondents diagnosed with osteopenia or osteoporosis was about 69.5% and there was significant difference between genders in terms of prevalence of osteoporosis. The prevalence of sarcopenia was 5.7%, and there was no significant difference between genders and residential places. In the final regression models, vitamin D conditions failed to show significant difference on the probability of leading to osteopenia and sarcopenia, though vitamin D conditions were retained in the final model of sarcopenia, while age and residential place were on the contrary.

**Conclusions:** Vitamin D deficiency is severe in our respondents, and so as the prevalence of osteopenia. Age and gender do affect the prevalence of osteopenia, and for that of sarcopenia the factors are age and region. We should pay more attention on vitamin D deficiency and musculoskeletal health in the elderly.

**Keywords:** Serum vitamin D; Osteopenia; Osteoporosis; Sarcopenia; The elderly
144/483

SUGARY DRINKS CONSUMPTION AND ABDOMINAL OBESITY IN ADOLESCENTS: A BRAZILIAN COHORT STUDY

**Background and objectives:** Introduction. Adolescence is marked by changes in body composition due to growth and development, which may be influenced by many factors as food and beverage intake. Several studies show that high consumption of sugary drinks is associated with risk factors for noncommunicable diseases, for example, abdominal obesity. However, especially among teenagers, it is observed an increasing trend in the consumption of these drinks.

Objective. To assess the relationship between consumption of sugary drinks and abdominal obesity among adolescents from public schools of João Pessoa/Brazil.

**Methods:** Design. This is an analysis of the baseline study Longcaafs cohort - "Longitudinal Study Sedentary Behavior, Physical Activity, Food and Health of Adolescents", conducted with 1009 adolescents between 10-14 years. Abdominal obesity was evaluated by the waist circumference measures; and the sugary drinks consumption by 24-hour recall. Sugary drinks consumption above 10% of daily total energy intake was considered excessive.

**Results:** The daily average energy intake of the adolescents was 2357.5kcal, of which 11.0% (254.5kcal), on average, were arising from sugary drinks. The prevalence of excessive consumption of sugary drinks among adolescents was 46.6% (n=470), while the prevalence of abdominal obesity was 40.2% (n=404). Although the relationship between this two variables was not statistically significant (p=0.40), the high prevalence of abdominal obesity and sugary drinks intake are worrying.

**Conclusions:** Monitoring and health promotion actions targeting adolescents are necessary to change not only the quality of food and beverage intake, but also the anthropometric measurements of this population, improving the quality of life of a whole generation.

**Keywords:** Sugary drinks; Abdominal obesity; Teenage School

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ASSESSMENT OF ANEMIA CONTROL AND PREVENTION SERVICE PROVISION DURING ANTENATAL CARE IN NORTHERN GHANA

**Background and objectives:** Anemia is a severe public health problem in Ghana, particularly among women of reproductive age (42 percent), and children under five (66 percent), the most common causes being diets deficient in absorbable iron, malaria, and intestinal parasites. Anemia shows regional disparities as in the Northern Region (48 and 82 percent, respectively). The USAID-funded Resiliency in Northern Ghana (RING) Project seeks to reduce anemia and has trained health workers on anemia prevention and control, including on the use of HemoCue Hb 301 devices to measure hemoglobin during antenatal care (ANC) visits.

The objectives of the assessment were to:

1. Assess gaps in anemia prevention and control during ANC visits, including provision of nutrition counseling, anemia testing, iron folic acid (IFA) supplementation, treatment, and referral;

2. Identify the origin of the gaps in the supply chain of medicines provided.

**Methods:** We used the Expanded Programme on Immunization cluster survey methodology with the primary sampling unit being the districts, the secondary sampling being the level of health facility, and the tertiary the health facilities. The sample was based on two groups: the Interventions Districts (IDs) (where HemoCue devices have been supplied for anemia testing) and the non-IDs (where devices have not been provided). Thirty health facilities were randomly selected across each group in which seven interactions between health workers and pregnant women were observed, and information was collected with Android-based tablets. In addition, in each health facility, interviews and review of documents were conducted in order to assess the supply of IFA and others anemia related medicines at the facility, district, and regional stores.

**Results:** We will present the results in the two targeted groups, in particular the main bottlenecks in regarding to service delivered during ANC visits. In addition we will provide a comprehensive diagnostic of the supply chains of the essential commodities needed in the control and prevention of anemia. **Results:** **Conclusions:** We will discuss how bottlenecks in service delivery as well as in access to essential medicines were addressed following the survey.

**Keywords:** anemia - antenatal care - service delivery - supply chain

<footnote>(1)Costa Pereira De Arruda Neta, Adélia; (2)Francisca Rodrigues, Iara;</footnote>

<footnote>(3)Araújo Teixeira, Juliana; (4)Gorgulho, Bartira; (5)Cazuza F. Júnior,</footnote>

<footnote>José; (2)Emília Lima, Flávia; (6)Marchioni, Dirce.</footnote>

<footnote>(1)PhD. Department of Nutrition. School of Public Health.
University of Sao Paulo. Av. Dr. Arnaldo, 715. Postal code:
01246-904. Sao Paulo. Brazil.; (2)Department of Nutrition. Federal
University of Paraíba. University City. Postal code: 58059-900.</footnote>

<footnote>João Pessoa, Brazil; (3)PhD. Department of Nutrition. School
of Public Health. University of Sao Paulo. Av. Dr. Arnaldo, 715.</footnote>

<footnote>Postal code: 01246-904. Sao Paulo, Brazil.; (4)PostDoc Position.</footnote>

<footnote>Department of Nutrition. School of Public Health. University
of Sao Paulo. Av. Dr. Arnaldo, 715. Postal code: 01246-904. Sao</footnote>

<footnote>Paulo, Brazil.; (5)Department of Physical Education. Federal
University of Paraíba. University City. Postal code: 58059-900.</footnote>

<footnote>João Pessoa, Brazil; (6)Department of Nutrition. School of Public
Health. University of Sao Paulo. Av. Dr. Arnaldo, 715. Postal code:
01246-904. Sao Paulo, Brazil.</footnote>

<footnote>(1)Guyon, Agnes; (2)Kappos, Kristen; (3)Osman, Mohammed Shaibu.</footnote>

<footnote>(1)John Snow Inc. (JSI). Ghana.; (2)MPH. John Snow Inc (JSI).Ghana.;</footnote>

<footnote>(3)PHD. John Snow Inc (JSI). Ghana.</footnote>
# MATERNAL ALPHA-LINOLENIC ACID INTAKE IS ASSOCIATED WITH OFFSPRING BIRTHWEIGHT

(¹)Phang, Melinda Phang; (²)Dissanayake, Hasthi; (³)McMullan, Rowena; (⁴)Celemajer, David; (⁵)Hyett, Jon; (⁶)Gordon, Adrienne; (⁷)Skilton, Michael.

(¹)B.Sc. PhD. Research Fellow. Boden Institute. Sydney Medical School. University of Sydney. Australia.; (²)BSc. MPhil. Scientist. Boden Institute. Sydney Medical School. University of Sydney. Australia.; (³)MBChB. Neonatal Fellow. Mothers and Babies. Royal Prince Alfred Hospital. Australia.; (⁴)MBBSc. MSc. PhD. D.Sc. Cardiologist. Cardiology. Royal Prince Alfred Hospital. Australia.; (⁵)MBBSc. MD. obstetrician. Obstetrics. Royal Prince Alfred Hospital. Australia.; (⁶)MBChB. MRCP. MPH. PhD. Neonatologist. Mothers and Babies. Royal Prince Alfred Hospital. Australia.; (⁷)BSc. PhD. Future Leader Fellow. Boden Institute. Sydney Medical School. University of Sydney. Australia.

**Background and objectives:** Epidemiological evidence indicates that birthweight is inversely associated with adult ischemic heart disease, with a 10–20% lower risk per 1 kg higher birthweight. Imbalanced maternal fatty acid intakes have been reported to be associated with impairments in fetal growth. Accordingly, we sought to determine the association of maternal fatty acid intake during pregnancy with offspring birthweight in healthy mother-child dyads in an Australian tertiary hospital.

**Methods:** Newborn infants (n=223) were recruited at birth from the Royal Prince Alfred Hospital, Australia. Maternal diet during pregnancy was assessed using a validated Food Frequency Questionnaire. Individual fatty acids were expressed as a percentage of total fatty acid intake (%TFA). Birthweight percentiles were obtained using the most recent Australian national birthweight percentiles. All analyses were adjusted for gestational age and sex and total energy intake.

**Results:** Neither maternal total fat nor polyunsaturated fat intake were associated with offspring birthweight. Higher maternal intake of omega-3 alpha-linolenic acid (ALA) as percentage of total fatty acid intake (%TFA) was associated with higher offspring birthweight [201g per 1% higher of total fatty acids (95% CI: 21, 380); P=.03]. Categorical analysis of dietary ALA intake by tertiles showed an increasing trend in birthweight across the lowest to highest tertiles (P ANOVA =.05) and significant differences in birthweight between the lowest and highest groups of dietary ALA intake [mean difference:-221g, (95%CI:-429,-12); P=.04]. Subgroup analyses by birthweight percentiles for gestational age and gender reported that mothers of infants born small-for-gestational age (SGA; birth weight <10th percentile for gestational age and sex; n=32) had the lowest ALA intake compared to those born normal birthweight (<25th to ≤75th percentile; n=109) or large for gestational age [(LGA; >90th percentile; n=21); P ANOVA =.05]. No statistically significant associations were observed for the longer chain omega-3 polyunsaturated fatty acids or omega-6 polyunsaturated fatty acids.

**Conclusions:** In otherwise healthy women giving birth at a major tertiary hospital in Australia, intake of ALA, a plant-derived omega-3 fatty acid, is associated with higher birthweight. This may have implications

for prevention strategies aimed at improving fetal growth via modification of maternal diet, and warrants further study.

**Keywords:** birthweight, maternal diet, fatty acids, alpha-linolenic acid

# A HIGHER-CARBOHYDRATE, LOWER-FAT DIET DURING PREGNANCY IS ASSOCIATED WITH GREATER GESTATIONAL WEIGHT GAIN: THE GUSTO STUDY

(¹)Chong, Mary; (²)Lai, Jun Shi; (³)Soh, Shu E; (⁴)Loy, See Ling; (⁵)Kramer, Michael S; (⁶)Shek, Lynette PC; (⁷)Yap, Fabian; (⁸)Tan, Kok Hian; (⁹)Godfrey, Keith M.; (¹⁰)Chong, Yap Seng.

(¹)PhD. Assistant Professor. Saw Swee Hock School of Public Health, National University of Singapore, Singapore; (²)PhD. Research Fellow. Singapore Institute for Clinical Sciences. Agency of Science, Technology and Research. Singapore.; (³)PhD. Research Scientist. Singapore Institute of Clinical Sciences. Agency of Science, Technology and Research. Singapore.; (⁴)PhD. Research Fellow. Department of Reproductive Medicine. KK Women's and Children's Hospital. Singapore.; (⁵)PhD. Professor. Departments of Pediatrics and of Epidemiology. McGill University. Canada.; (⁶)MBBS. Principal Investigator. Singapore Institute of Clinical Sciences. Agency of Science, Technology and Research. Singapore.; (⁷)FRCPCH. Head and Senior Consultant. Department of Paediatrics. KK Women's and Children's Hospital. Singapore.; (⁸)MBBS. Head. Department of Maternal Fetal Medicine. KK Women's and Children's Hospital. Singapore.; (⁹)PhD. Professor. MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre. University of Southampton & University Hospital Southampton NHS Foundation Trust. UK.; (¹⁰)MD. Associate Professor. Departments of Obstetrics and Gynaecology. National University of Singapore. Singapore.

**Background and objectives:** Diet during pregnancy can influence gestational weight gain (GWG), but evidence relating dietary macronutrient composition and food groups to GWG is inconclusive. Hence, we aim to examine the associations of maternal energy, macronutrient and food intakes with GWG in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort.

**Methods:** Dietary intake of pregnant women was assessed at 26–28 weeks’ gestation mainly using the 24-hour recall, with a subgroup completing the 3-day food diaries. GWG z-scores were calculated from weights measured at first antenatal appointment and before delivery. Inadequate and excessive GWG were defined using the Institute of Medicine recommendations based on weights at 15 and 35 weeks’ gestation. Associations were examined using substitution models for macronutrient composition, with linear or multinomial logistic regressions.

**Results:** Mean (SD) daily energy intake, and percentage energy intakes from carbohydrate, protein and fat of 960 pregnant women were 1868 (598) kcal, 51.4% (8.7), 15.7% (3.7), and 32.8% (7.6),
children are more vulnerable than normal children of same aged
group. There is urgent need to improve the diet quality for im-
proving their nutritional status. To the authors' knowledge, food
intake pattern of the autistic children has not been described yet in
Bangladesh. So, our objective was to assess the food intake pattern
of autistic children and compare with that of normal children.

**Methods:** A cross-sectional study was conducted during April to December, 2016 among children aged 3-5 years with autism (n=53) and normal children (n=53), were selected from four schools in urban Dhaka city, Bangladesh. Data on food intake pattern was collected by food frequency questionnaire (with a reference period of 7 days) from the children's parents using a structured questionnaire. Statistical analysis was done by IBM SPSS software (version 20) and comparison between autistic and normal children were made by using Mann-Whitney-U test for non-normal distribution.

**Results:** Children with and without autism consumed 39 foods from six food groups (Cereals, Pulses, Egg, Meat & Fish, Organ Meat, Vegetables & Fruits, Dairy Products). The result revealed that five out of six food groups had significant difference in terms of food consumption (p<0.05). The food consumption was lower by autistic children than normal children. The food consumption were (autistic vs. normal children): unleavened bread (81.7% vs. 98.8, p=0.00); egg (53.2% vs. 98.8, p=0.00); chicken (93.1% vs. 100, p=0.002); beef (32.3% vs. 76%, p=0.004); pui leaf (72.2% vs. 81.7%, p=0.002); carrot (62.7% vs. 85.5%, p=0.00); tomato (66.7% vs. 83.6%, p=0.001); malta (30.4% vs. 70.3%, p=0.009); milk (95% vs. 98.8%, p=0.00).

**Conclusions:** Food from five out of six food groups was less eaten by autistic children than normal children. Autistic children had chewing problem, carbohydrate intolerance, sensitivity to some food items like gluten, casein, sugar, chocolate etc. and they were medically restricted for food.

**Keywords:** Food intake pattern, autistic children, normal children, food frequency questionnaire.

we aimed to investigate the potential effect of prenatal exposure to
the 1959-1961 Chinese famine on adult cognitive impairment.

**Methods:** We obtained data from the second National Sample Survey on Disability implemented in 31 provinces in 2006, representing 1.9 per 1000 non-institutionalized inhabitants of China, and restricted our analysis to 387,093 people born from 1956 to 1965. The definition of disabilities was based on the WHO International Classification of Functioning, Disability, and Health (WHO-ICF). Cognitive impairment was defined as intelligence quotient (IQ<70) and adaptive behavior, and IQ for adults was evaluated by the Wechsler Adult Intelligence Scale-Revised by China (WAIS-RC). Famine severity was defined as cohort size shrinkage index, which has been widely used in previous Chinese studies. The famine impact on adult cognitive impairment was estimated by difference-in-difference models, which were established by the variations of famine exposure across birth cohorts.

**Results:** Compared with adults born in 1963, those who exposed to Chinese famine during gestation (born in 1959-1962) did not experience more risk of cognitive impairment in adulthood in the total sample. However, when excluding concurrent impairments (i.e. hearing, visual, speech, physical and mental disorders), we found individuals born in 1961 had more than two-fold (OR=2.18, CI: 1.15, 4.15) risk of cognitive impairment than their 1963-born peers even though adjusting for multiple demographic and socioeconomic variables. Stratified analyses showed that long-term impact of prenatal famine on cognitive impairment was evident in both male and female sample, but only in rural, not in urban area.

**Conclusions:** Prenatal exposure to Chinese famine had enduring deleterious effect on the risk of cognitive impairment and concurrent disorder of cognitive impairment may be one of important confounders in this long-term impact. Further studies need to explore the difference between Chinese and Dutch famine and the corresponding mechanism on this issue.

**Keywords:** Chinese famine, Cognitive impairment, Prenatal malnutrition

**Background and objectives:** A growing number of studies have focused on long-term impact of Dutch and Chinese famine on adult health during past decades. The current measures of cognitive functioning in adulthood do not indicate a long-run association with prenatal exposure to Dutch famine. However, whether such association emerges in China is still poorly understood. In this study,

<footnote>(1)He, Ping; (2)Chen, Gong; (3)Song, Xinming; (4)Zheng, Xiaoying.</footnote>

<footnote>(1)PhD. Candidate. Institute of Population Research. Peking University. China; (2)PhD. Demographer. Institute of Population Research. Peking University. China; (3)PhD. Epidemiologist. Institute of Population Research. Peking University. China; (4)PhD. Demographer and Health Economist. Institute of Population Research. Peking University. China.</footnote>
# FEASIBILITY AND IMPACTS OF INTEGRATING NUTRITION INTERVENTIONS INTO AN EXISTING MATERNAL, NEONATAL, AND CHILD HEALTH PLATFORM IN BANGLADESH

(1)Nguyen, Phuong; (2)Kim, Sunny; (3)Sanghvi, Tina; (4)Mahmud, Zeba;

(5)Tran Mai, Lan; (6)Aktar, Bachera; (7)Afsana, Kaosar; (8)Frongillo, Edward; (9)Ruel, Marie; (10)Menon, Purmina.

(1)International Food Policy Research Institute; (2)PhD. Research Fellow. Poverty, Health, and Nutrition Division. International Food Policy Research Institute. Washington. D.C. USA; (3)PhD. Country Programs Director. Alive & Thrive. FHI 360. Washington. D.C. USA; (4)MD. Country Manager. Alive & Thrive. FHI 360. Dhaka. Bangladesh; (5)BS. Research Analyst. Alive & Thrive. FHI 360. Hanoi. Vietnam; (6)MD. Program Manager. Health, Nutrition and Population Program. BRAC. Dhaka. Bangladesh; (7)MD, PhD. Director. Health, Nutrition and Population Program. BRAC. Dhaka. Bangladesh; (8)PhD. Professor and Director. Global Health Initiatives. Health Promotion, Education, and Behavior. Arnold School of Public Health. University of South Carolina. Columbia. SC. USA; (9)PhD. Division Director. Poverty, Health, and Nutrition Division. International Food Policy Research Institute. Washington, D.C. USA; (10)PhD. Senior Research Fellow. Poverty, Health, and Nutrition Division. International Food Policy Research Institute. New Delhi. India.

**Background and objectives:** Maternal undernutrition contributes to poor child growth and development. Limited evidence exists on effective nutrition intervention packages and delivery platforms to improve maternal nutrition. We evaluated the feasibility and impact of a nutrition-focused Maternal, Neonatal and Child Health (MNCH) package compared with the standard MNCH package in Bangladesh. The standard MNCH package provides essential health services and sales of iron and folic acid (IFA) by frontline health workers [FHWs] through home visits. The nutrition-focused Alive & Thrive MNCH package was integrated into the MNCH platform, providing additional inter-personal counseling (IPC), community mobilization (CM), distribution of free IFA and calcium supplements, and weight-gain monitoring, with additional time from FHWs in home visits to discuss maternal and child nutrition.

**Methods:** We used a cluster-randomized design with cross-sectional surveys in 2015 and 2016 with FHWs and pregnant and recently delivered women (n~700, 600 and 2,000, respectively, per survey round). We examined operational feasibility, including FHWs' capacity, training, supervision, and service coverage. We derived difference-in-difference estimates (DDE) on maternal dietary diversity, micronutrient supplement intake, and breastfeeding practices.

**Results:** FHWs were committed and well-supervised, and covered a small catchment area. There were no major shifts in time in either group. FHWs in both groups had high knowledge about micronutrients, but FHWs in nutrition-focused MNCH improved knowledge about maternal dietary diversity compared to those in the MNCH group. Coverage of IPC and CM was higher in the nutrition-focused MNCH group than the MNCH group (97%

vs. 70% and 50% vs 30%, respectively). Improvements were significantly greater in the nutrition-focused MNCH, compared to MNCH group for consumption of IFA (DDE: 9.8 percentage point [pp], 46 tablets), and calcium supplements (DDE: 12.8 pp, 50 tablets), maternal dietary diversity (DDE: 30.0 pp, 1.6 food groups), daily intakes of several micronutrients during pregnancy, and exclusive breastfeeding (DDE: 31 pp), but not for early initiation of breastfeeding.

**Conclusions:** Integrating intensified IPC and CM interventions addressing nutrition during pregnancy into an existing MNCH platform was feasible and effective, leading to improvements in multiple maternal nutrition outcomes. This effective model could be adapted into other health systems in similar contexts.

**Keywords:** Bangladesh, dietary diversity, interpersonal counseling, maternal undernutrition, micronutrient intake.

**Conflict of Interest Disclosure:** All authors declare no conflicts of interest. TS, ZM, BA, SS and KA were members of the program implementation team that designed and implemented the interventions studied and reported on in this manuscript. They reviewed the manuscript and provided interpretation of the results, but final decisions for manuscript content lay with the primary authors from the evaluation team (PHN, SSK, EAF, MTR and PM).

**Further collaborators:**

Sadia Shabnam, MD. Program Manager. Health, Nutrition and Population Program. BRAC. Dhaka. Bangladesh.

# A PROGRAM IMPACT PATHWAYS MEDIATION ANALYSIS OF A MULTI-SECTORAL NUTRITION PROGRAM IN NEPAL

(1)Choufani, Jowel; (2)Kennedy, Andrew; (3)Cunningham, Kenda.

(1)MSc. Nutritionist/Senior Research Assistant. Environment and Production Technology Division. International Food Policy Research Institute. USA.; (2)PhD candidate. Department of Epidemiology and Population Health. London School of Hygiene & Tropical Medicine. United Kingdom.; (3)PhD. Senior Technical Advisor. Suaahara II. Helen Keller International. Nepal.

**Background and objectives:** As the importance of simultaneously addressing the diverse determinants of malnutrition grows, the complexity of nutrition programming increases. Evaluation of complex programs requires researchers to carefully unpack potential pathways to impact. This can be done using program impact pathways (PIPs), which map out program phases to assess each step in the intended pathways to impact. A PIP analysis was conducted to understand whether program inputs of Suaahara, a complex nutrition program in Nepal targeting the first 1,000 days, translated into intended outcomes and to identify gaps along theorised pathways to impact.

**Methods:** Regression analysis, using data from a cross-sectional household-level survey for a process evaluation (n=472) split evenly throughout 4 Suaahara and comparison districts, was used to test associations between residing in a Suaahara intervention area and six
ideal household health and nutrition behaviours. For positive, significant associations, structural equation modelling was used to empirically test hypothesized mediators along the pathways to impact.

**Results:** Belonging to the intervention arm was positively associated with optimal household WASH facilities and practices (b=0.69, p<0.001) and maternal diet during pregnancy (b=0.41, p<0.001). Exposure to specific WASH messages was found to be a positive mediator for how belonging to the intervention arm translated into ideal household WASH facilities and practices (b=0.18, p<0.001). Although being in the intervention arm influenced both maternal knowledge and practices related to diet during pregnancy, there was no association between knowledge and practices.

**Conclusions:** PIP analyses are useful for monitoring and evaluating the impacts pathways of complex nutrition programs. Evidence for a link between the intervention and WASH facilities and practices through direct and indirect pathways is encouraging and can be used to support the continuation of related intervention components. Further investigation into the reasons for a lack of translation of knowledge from exposure to Suahara integrated messages to diet during pregnancy should be considered.

**Keywords:** Diet during pregnancy; Nutrition-sensitive; Program Impact Pathway; WASH behaviours; Nepal

144/696

THE ROLE OF DAIRY FOR THE MANAGEMENT OF MUSCLE MASS AND FUNCTION IN PEOPLE AGED 50+ YEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS

(1)Wycherley, Tom; (2)Riley, Malcolm; (2)Stonehouse, Welma; (2)Taylor, Pennie; (2)Brinkworth, Grant; (2)Luscombe-Marsh, Natalie.

(1)School of Health Sciences. University of South Australia. Adelaide. South Australia. 5000. Australia; (2)Commonwealth Scientific Industrial Research Organisation. Adelaide. South Australia. 5000. Australia.

**Background and objectives:** A meta-analysis of randomised controlled trials (RCT's) was performed to investigate the effects of whole dairy foods and supplements containing dairy ingredients, with and without resistance training (RT), on lean mass, strength, muscle size, muscle protein synthesis and physical function in people aged 50+ years.

**Methods:** RCT's published to March 1 2015 were identified by a comprehensive systematic search of scientific databases. Eligible reports were critically appraised in duplicate. Data were pooled using random-effects meta-analyses.

**Results:** 34 RCT's were eligible for inclusion. Dairy consumed in combination with RT resulted in a small increase in lean mass (weighted mean difference [95% CI]; 0.5 [0.02, 0.98]kg; P=0.04; I²=68%) but had no effect on muscle size (P=0.80), leg press strength (P=0.40) or grip strength (P=0.29). Dairy consumed in the absence of RT had no effect on lean mass (P=0.58). There were insufficient data to analyse gait speed. Dairy protein supplements of different dosages (i.e. 20 vs. 40g/day) increased fractional synthetic rate of myofibrillar protein both in the context of RT (0.03

[0.0, 0.06]%/hr; P=0.02; I²=87%) and without RT (0.02 [0.01, 0.02]%/hr; P<0.001; I²=0%).

**Conclusions:** Increased dairy intake (at least 20 g per day - particularly in the form of dairy protein supplements) when combined with RT, is an effective nutritional strategy to augment lean body mass in people aged 50+ years. While dairy protein acutely up-regulates muscle protein synthesis in this age group irrespective of RT, this effect does not directly translate into increases in regional muscle size, muscle strength or function.

**Keywords:** dairy. dairy supplements. muscle mass. body composition. ageing

**Conflict of Interest Disclosure:** The authors declare no conflict of interest. The research was sponsored by the Dairy Health and Nutrition Consortium through a grant that was awarded in a competitive tender process.

144/706

DRIVERS OF NEPAL'S SUCCESS IN REDUCING THE PREVALENCE OF UNDERNUTRITION SINCE THE MID-1990S: VARIATION BY AGRO-ECOLOGICAL ZONE

(1)Cunningham, Kenda; (2)Singh, Akriti; (3)Pandey Rana, Pooja;

(4)Karmacharya, Chandni; (5)Headey, Derek.

(1)DrPH. Helen Keller International. Nepal.; (2)PhD Candidate. Tufts University. USA.; (3)MSc. Helen Keller International. Nepal.; (4)MSc. Independent. Canada.; (5)PhD. International Food Policy Research Institute. USA.

**Background and objectives:** Nepal's rapid reductions in child undernutrition and the drivers of this progress have been well-documented. However, Nepal's three agro-ecological zones' (AEZ) - terai (plains), hills, and mountains - drastic differences (e.g. ethnic composition, population density, remoteness) may influence nutrition-related indicators. This study assesses commonalities and differences in drivers of Nepal's success in reducing child nutrition in Nepal's three AEZs.

**Methods:** Analyzing data from Nepal's 1996, 2001, 2006 and 2011 DHS, we used multivariate regression analysis and decomposition techniques to identify drivers of reductions in LAZ and WHZ. Explanatory variables included: household assets; material and paternal education; access to healthcare; WASH facilities/ practices; household demography and non-time-varying factors (e.g. child age, residency, caste, maternal age and survey year).

**Results:** Since 1996, child (<2y) stunting and wasting (<5y) declined rapidly. The terai experienced the fastest reductions in stunting, whereas wasting reductions were concentrated in the mountains and terai. During this time, asset ownership, education, and access to health and sanitation services improved, but with sub-national variation in magnitude and speed. Our linear decomposition approach showed the changes in LAZ and WHZ that were predicted by changes in the explanatory variables over time in each AEZ. Health services were the single largest contributor to change in LAZ in all three AEZs. Increased toilet use was moderately important in the hills and terai. For WHZ, toilet use
was very important: the single largest factor in the terai. Health services were a key driver in all three sub-samples. Asset accumulation was important in the hills and mountains only, whereas maternal education was only important in the terai.

**Conclusions:** Nepal's success in reducing undernutrition and the drivers differ across the strikingly diverse AEZs. Our findings of variation in the factors that best predict changes in outcomes over time by AEZ, suggest that some sub-national level policies and programs targeting location-specific obstacles may be necessary. There are indications that WASH investments may yield especially large returns in the humid and densely populated terai. Our findings highlight that a one-size-fits-all approach may not address persistent under-nutrition and targeted approaches may be more effective.

**Keywords:** Nepal, undernutrition

144/725

MATERNAL COTTON-PICKING DURING PREGNANCY IS ASSOCIATED WITH MATERNAL AND EARLY INFANCY NUTRITIONAL STATUS IN RURAL PAKISTAN

**Background and objectives:** In rural Pakistan, the nutritional status of women of reproductive age and infants is poor. The agricultural workforce is becoming increasingly feminised, with 75% of women employed in agricultural labour. The impact of women's agricultural work, conducted during pregnancy, on maternal and early infancy nutritional status is not well documented. Thus, this study aimed to examine the relationship between cotton-picking during pregnancy, maternal body mass index (BMI) and infant growth. Cotton-picking involves long hours of intensive agricultural work.

**Methods:** A cross-sectional survey of a representative sample of rural mother-infant dyads was conducted in Sindh province in January to February 2016. Infants were 2-12 weeks of age. Interviewer-administered questionnaires and maternal and infant anthropometric measurements (weight and height/length) were collected. The primary outcomes were maternal BMI measured post-pregnancy (BMI; n=1146) and infant length-for-age zscore (LAZ; n=1143).

Associations between cotton-picking during pregnancy and maternal BMI and infant LAZ were examined using multivariable linear regression analysis; adjusting for potential confounders (i.e. household wealth index and education). Structural-equation based modelling was used to test whether maternal BMI mediated the association between cotton-picking and infant LAZ.

**Results:** Overall, 21.6% of women were underweight and 45.3% of the infants were stunted. Among the women, 29% were involved in cotton-picking during pregnancy. In the multivariable analysis, cotton-picking during pregnancy was negatively associated with both post-partum maternal BMI (β=-0.87 [-1.33; -0.45]) and infant LAZ (β=-0.34 [-0.54; -0.13]). The structural-equation based modelling results showed that cotton picking had a total negative effect (β=-0.35 [-0.53; -0.16]) on infant LAZ. 14% (-0.05/-0.35) of the relationship between cotton-picking and infant LAZ was mediated via maternal BMI.

**Conclusions:** This study has generated new evidence for link between maternal agricultural workload and maternal and infant nutrition in a sample of mother-infant dyads living in rural Pakistan. Maternal cotton-picking during pregnancy was negatively associated with both maternal BMI and their offspring's size at 2-12 weeks of age. The results of this study underscore the need to reduce agricultural workload demands during pregnancy to reduce the risk of negative energy balance and improve the nutritional status of mothers and new born infants.

**Keywords:** agricultural workload, nutritional status, women, infant, Pakistan

144/914

CONSUMPTION OF FOOD, FOOD DISORDERS AND PHYSICAL ACTIVITY IN ADOLESCENTS OF URBAN AND RURAL AREAS OF THE SIERRA REGION OF ECUADOR

**Background and objectives:** In Ecuador, adolescents represent 19.3% of the population INEC-Ecuador (2010). This period is characterized by a stage of physical, psychological and psychological changes in which a child becomes an adult. This transition

<footnote>(1)Pradeilles, Rebecca; (2)Allen, Elizabeth; (3)Gazdar, Haris;</footnote>

<footnote>(4)Mysorewala, Ayesha; (5)Mazhar, Sidra; (6)Dangour, Alan;</footnote>

<footnote>(7)Ferguson, Elaine.</footnote>

<footnote>(1)BSc, MSc, PhD. Research Fellow in Global Health Nutrition. Department of Population Health. London School of Hygiene and Tropical Medicine. London. UK.; (2)MA, MSc, PhD. Professor in Medical Statistics. Department of Medical Statistics. London School of Hygiene and Tropical Medicine. London. UK.; (3)Senior Researcher. Collective for Social Science Research. Karachi. Pakistan.; (4)BSc. Research officer. Collective for Social Science Research. Karachi. Pakistan; (5)BSc, MSc. Research officer. Collective for Social Science Research. Karachi. Pakistan; (6)MSc, PhD. Professor in Food and Nutrition for Global Health. Department of Population Health. London School of Hygiene and Tropical Medicine. London. UK.; (7)BSc, PhD. Associate professor in Nutrition for Global Health. Department of Population Health. London School of Hygiene and Tropical Medicine. London. UK.</footnote>

<footnote>(1)Carpio Arias, Tannia Valeria; (2)Ramos Padilla, Patricio;</footnote>

<footnote>(2)Villavicencio Barriga, Veronica; (2)Delgado López, Verónica;</footnote>

<footnote>(3)Andrade, Carlos; (4)Valencia Peñaloza, Valeria; (5)Carpio Salas, José Gabriel; (6)Morejon Teran, Yadira Alejandra.</footnote>

<footnote>(1)PhD student. MCs. Nutritionist. Department of Nutrition, Food Science and Gastronomy School of Pharmacy. University of Barcelona. Barcelona. Spain; (2)MCs. Nutritionist. Research Group on Food and Human Nutrition. Superior Polytechnic School of Chimborazo. Riobamba. Ecuador.; (3)MCs. Engineer. Research Group on Food and Human Nutrition. Superior Polytechnic School of Chimborazo. Riobamba. Ecuador.; (4)MCs. Nutritionist. Specialist in school feeding. Quito, Ecuador.; (5)Bachelor of Languages. Department of Languages, Superior Polytechnic School of Chimborazo. Riobamba. Ecuador.; (6)MCs. Nutritionist. Institute of Collective Health. Federal University of Bahia. Campus Canela. Salvador. Brazil.</footnote>
requires an adaptation of the factors that allow the adolescent to develop all the normal functions with normality. Aims: To evaluate the dietary intake, eating disorders and physical activity of adolescents from a population of the Andean region of Ecuador and their difference between urban and rural areas.

**Methods:** Cross-sectional study (n = 131). It was applied: a 24-hour reminder and food consumption frequency questionnaire; It was evaluated anthropometry, physical activity and risk of eating disorder.

**Results:** 19.1% of the population presented short stature by age and 17.6% risk of overweight according to BMI//Age. Macro-nutrient adequacy percentages throughout the population were low (66.5% carbohydrate, 60.5% protein and 79.8% fat).

Statistically significant differences were found between protein (p = 0.012), fats (p <0.001) carbohydrates (p = 0.013) and energy (p <0.001) according to the zones; (Urban areas showed higher consumption compared to rural areas).

Statistically significant differences were found between the levels of physical activity of adolescents in urban areas (less activity) compared to adolescents in rural areas (greater activity). According to the Scoff questionnaire, 32.3% of adolescents were classified as having an Eating Disorder Risk, clinical differences were found by sex being greater in women than in men. However differences between sex and area were not statistically significant.

**Conclusions:** The adolescents' diet differs according to the geographical area, showing worse consumption in the rural area.

**Keywords:** Diet, Teens, Ecuador, Urban, Rural

**Further collaborators:** High schools "Chap. Edmundo Chiriboga "and" San Andres " High School for the facilities and opening for data collection and the" Vicente Anda Aguirre " High School for the facilities for the pilot study.

egy to prevent malnutrition among children 0-24 months through adequate infant and young child (IYC) feeding practices, including home-fortification with SQ-LNS. The SPOON SBCC strategy will build on extensive formative research in Colombia, as well as Guatemala and Mexico. We present an investigation of attributes and beliefs caregivers in Colombia associate with complementary foods in order to identify potential messages and actions for promotion of SQ-LNS.

**Methods:** Pile sorting, a cognitive mapping technique, was used to evaluate caregivers' knowledge and beliefs about selected foods and caregiving actions. A convenience sample of mothers (n=28) of children aged 0-24 months living in poor communities in Pasto, Colombia were presented with 25 cards with pictures of foods (n=18), and caregiving actions (n=7). Each respondent was asked to put the cards into piles based on what she felt 'go together'. The piles were then used for discussion to explore the rationale for the groupings.

**Results:** Caregivers made a distinction between food and non-food items, although there were overlaps between these categories, as well as inter-category variability. Foods were often grouped because they: i) relate to complementary feeding and timing of introduction of specific foods (theme used by 81% of mothers), ii) are seen as similar food types (71%), iii) are considered beneficial for child's health (50%), or iv) contain vitamins and minerals (38%). Caregiving actions cards were most commonly grouped into the following categories: i) childcare (42%), ii) affection (27%) and iii) illness prevention (31%).

**Conclusions:** The pile sorting demonstrates that mothers view foods and caregiving actions from multiple dimensions, with an emphasis on advantages for child's health. Mothers in Pasto are concerned with the health and wellbeing of their children, and are cognizant of topics including complementary feeding, illness prevention, affectionate care, growth and development, and vitamins. However, there are intragroup variations in how respondents interpret each topic. This exercise provides insights for the design of messaging and behavior change components for an SQ-LNS intervention.

**Keywords:** infant and young child feeding practices, formative research, cognitive mapping techniques, Colombia

**Conflict of Interest Disclosure:** The authors declare no conflicts of interest. SPOON was financed by the Inter-American Development Bank.

<footnote>(1)Gust Duque, Tiffany; (2)Bernal, Ines Jennifer; (3)Gonzalez, Wendy;</footnote>

<footnote>(4)Vossenaar, Marieke; (5)Bonvecchio, Anabelle; (6)Pelto, Gretel;</footnote>

<footnote>(3)Tumilowicz, Alison.</footnote>

<footnote>(1)MPH RDN. Global Nutrition Consultant. Global Alliance for Improved Nutrition. Switzerland.; (2)PhD. Global Nutrition Consultant. Global Alliance for Improved Nutrition (GAIN). Switzerland; (3)PhD. Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland;
(4)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM); (5)PhD. Directora. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México; (6)PhD. Division of Nutritional Sciences. Cornell University. USA.</footnote>
## FOOD ACCESS AND DIETARY INDICATORS ASSOCIATED WITH DEPRESSION IN WOMEN OF REPRODUCTIVE AGE IN SYLHET, BANGLADESH

(1)Sparling, Thalia; (2)Waid, Jillian; (3)Wendt, Amanda; (4)Gabrysch, Sabine.

(1)MPH. Doctoral candidate and researcher. Unit of Epidemiology and Biostatistics. Institute of Public Health. University of Heidelberg; (2)MSW. Research, Learning and Evaluation. Helen Keller International. Bangladesh.; (3)PhD. Unit of Epidemiology and Biostatistics. Institute of Public Health. Germany; (4)PD Dr. Dr. med. PhD. Unit of Epidemiology and Biostatistics. Institute of Public Health. Germany.

**Background and objectives:** Depression is common among women of reproductive age, especially in LMICs. Increased nutritional needs during pregnancy and lactation may deplete nutrients essential to neurotransmission and increase the risk of depression. Depression may conversely lead to poor self- and child care and reduce household food access and dietary diversity. We aim to examine the association between depressive symptoms and several indicators of food access and nutritional status in non-peripartum (NPW) and peripartum women (PW) in rural Bangladesh.

**Methods:** The Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized field trial evaluates the impact of Helen Keller International's homestead food production program on undernutrition, including around 2700 young women in Sylhet, Bangladesh. We used cross-sectional FAARM baseline data to study the association of food access and nutritional status with depression in NPW and PW women using multivariable logistic regression.

**Results:** Of 2,599 women in the study, 1018 (39%) were pregnant or one year postpartum, while 1,581 (61%) were NPW. Overall, 20% of women screened positive for major depression (Edinburgh Postpartum Depression Scale ≥12). Both food insecurity (HFIAS) and poor household food consumption (FCS) were strongly associated with depression in fully adjusted models (NPW HFIAS: OR 2.59, 95% CI 2.02-3.30 and PW OR 3.60, 95% CI 2.46-5.27; NPW FCS: OR 2.63, 95% CI 1.80-3.86 and PW FCS: 2.67, 95% CI 1.58-4.53). Low dietary diversity (<5 food groups) was also associated with depression (NPW OR: 1.78, 95% CI 1.30-2.44 and PW OR: 2.11, 95% CI 1.32-3.39), and several distinct food groups lowered the odds of depression in women (dairy, eggs, fish, vitamin A-rich foods and vitamin C-rich foods). Anemia was not associated with depression. Chronic energy deficiency (BMI <18.5) was positively associated with depression in NPW (OR: 1.38, 95% CI 1.04-1.84).

**Conclusions:** In this large study from Bangladesh, depression was associated with household food insecurity, poor household food consumption, women's dietary diversity, and low BMI. Further studies should investigate the causal links of food access and nutrition with depression, and interventions to reduce poor diets and depression among women in LMICs should be considered.

**Keywords:** depression, peripartum, food, nutrition, Bangladesh

## HIGH-PROTEIN EXPOSURE DURING GESTATION - CONSEQUENCES ON FOOD PREFERENCES AND HEALTH IN ADULT RAT OFFSPRING IN SELF-SELECTION MODELS

(1)Carlin, Gabrielle; (2)Chaumontet, Catherine; (3)Darcel, Nicolas;

(3)Blachier, François; (4)Kodde, Andrea; (5)Oosting, Annemarie; (6)Tomé, Daniel; (3)Davila, Anne-Marie.

(1)MSc. Lab. Nutrition Physiology and Ingestive Behavior. AgroParisTech INRA University Paris-Saclay. Paris. France; (2)MSc. Research Engeneer. Lab. Nutrition Physiology and Ingestive Behavior. AgroParisTech INRA University Paris-Saclay. Paris. France; (3)PhD. Lab. Nutrition Physiology and Ingestive Behavior. AgroParisTech INRA University Paris-Saclay. Paris. France;

(4)BSc. Nutricia Research. Utrecht. Netherlands; (5)PhD. Nutricia Research. Utrecht. Netherlands; (6)PhD. Professor physiologist. Lab. Nutrition Physiology and Ingestive Behavior. AgroParisTech INRA University Paris-Saclay. Paris. France.

**Background and objectives:** Perinatal exposure via mother's diet induces imprinting that impacts longer term phenotype and health of the offspring. This study evaluates the consequences of a maternal high protein diet during gestation on food preference and health markers in rat pups exposed to two self-selection models (SSM).

**Methods:** Two groups of Wistar rat dams were fed a high-protein (HP; 55% protein) or a normal protein (NP; control; 20% protein) isocaloric diet during gestation and then switched to a NP diet during lactation. At 3 wk, female pups from the 2 dam groups were weaned and subdivided into 3 diet groups (i.e. six groups each n=8 pups). Each group was subjected to either the control NP diet, a C1 choice diet, or a C2 choice diet, respectively. C1 and C2 groups were exposed to a choice between 2 cups with either proteins (P) or a mix of carbohydrate (C) (88%) and lipid (L) (12%), or a choice between 3 cups, with either protein (P), carbohydrates (C) or lipids (L), respectively.

**Results:** Compared to the NP group and independent of maternal diet, C1 and C2 groups consumed 10% more energy as P and decreased C intake (P<0.0001). C2 groups compared to control NP group, increased L consumption up to 22% and energy intake (P<0.0001). C1 groups gained less weight than control NP groups (P<0.0001). In contrast, pups from dams fed HP diet during gestation (HP-C2) and subjected to C2 choice had a higher weight gain compared to NP-C2 group (P<0.0001). At 15 wk, HP-C2 group gained 13.5% more weight than NP-C2 group (NP-C2, 183.3+7.7 g; HP-C2, 208.1+11.5 g, P<0.06). In HP-C2 group, total and visceral adipose tissues weight were increased 41.2% (NP-C2, 44.2+2.8 g; HP-C2, 62.4+6.8 g, P<0.03) and 52.1% (NP-C2, 25.9+1.9 g; HP-C2, 39.4+4.5 g, P<0.01), respectively, compared to NP-C2 group.

**Conclusions:** The present study showed that programming by maternal HP diet during gestation does not affect food choice. But the consequence of a higher P and L intake in the C2 groups is emphasized in pups from dams subjected to a HP diet during gestation, causing increased adiposity. Metabolic pathways are currently explored.
**Keywords:** fetal exposure, protein, preferences, overweight

**Conflict of Interest Disclosure:** This thesis work is partly paid by Danone Nutricia Research.

**Further collaborators:** Corine Delteil (PNCA. Paris. France).

144/1198

RELATION BETWEEN DIET, NUTRITIONAL STATUS, AND STIMULATION AND CHILD DEVELOPMENT: A PATH ANALYSIS

(1)Larson, Leila; (2)Bauer, Patricia; (3)Martorell, Reynaldo.

(1)MPH. PhD Candidate. Nutrition and Health Sciences Doctoral Program. Emory University. USA.; (2)PhD. Asa Griggs Candler Professor of Psychology. Department of Psychology. Emory University. USA.; (3)PhD. Robert W. Woodruff Professor of International Nutrition. The Hubert Department of Global Health & Nutrition and Health Sciences program. Emory University. USA.

**Background and objectives:** Malnutrition is an important public health problem with implications for child development. We examined the direct and indirect effects of diet on memory and overall mental development in young children in rural Bihar India.

**Methods:** A cross-sectional survey of 4292 children 6 to 18 months of age in 70 health sub-centers of West Champaran, Bihar was conducted in February-March 2016 as part of an endline to a randomized cluster multiple micronutrient trial. Motor and mental development was assessed using the Developmental Milestones Checklist-II, a 75-item parental report. In a subsample of 1179 children 12 to 18 months, memory was assessed using four Elicited Imitation tasks (measured as correctly imitated sequences of actions). Path analyses investigated the pathways through which diet, nutritional status, hemoglobin, stimulation, and motor skills are associated with memory or mental abilities. Standardized coefficients are reported.

**Results:** Mean motor and mental development scores were 18.6 (SD 6.5) out of 32 and 25.8 (SD 7.5) out of 50; mean number of pairs of actions complete in the correct order was 1.7 (SD 1.2). Fit indices for path models were acceptable. Motor development was significantly (p<0.05) directly associated with memory (standardized β=0.13) and mental development (β=0.53), and indirectly associated with mental development through stimulation in the home (β=0.01). Length-for-age z-score (LAZ) and weight-for-length z-score (WLZ) were indirectly associated, through motor development, with memory (β=0.03 for LAZ, β=0.01 for WLZ) and mental development (β=0.14 for LAZ, β=0.04 for WLZ). Hemoglobin was directly associated with memory (β=0.07), but not mental development. Dietary diversity (score out of 7) was not significantly associated with either outcome.

**Conclusions:** Nutritional status, stimulation, motor development and hemoglobin status in early life may have important implications for foundational mental and memory abilities.

**Keywords:** child development, cognition, nutritional status, diet, path analysis

144/1238

APPLICATION OF A COMMON FORMATIVE RESEARCH PROTOCOL TO DEVELOP STRATEGIES FOR BEHAVIOR CHANGE: THE SPOON PROJECT IN COLOMBIA, GUATEMALA AND MEXICO

(1)Bonvecchio, Anabelle; (2)Gonzalez, Wendy; (3)Duque, Tiffany;

(4)Bernal, Ines Jennifer; (5)Garcia-Meza, Rosario; (6)Alvarado, Rocio;

(7)Vossenaar, Marieke; (8)Neufeld, Lynnette M.; (9)Pelto, Gretel;

(9)Tumilowicz, Alison.

(1)PhD. Nutritionist. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México;

(2)PhD. Nutritionist. Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland; (3)MPH. RD. Consultant for Global Alliance for Improved Nutrition (GAIN). Switzerland;

(4)PhD.Nutritionist. Consultant for Global Alliance for Improved Nutrition (GAIN). Switzerland; (5)MA. Nutritionist. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala; (6)MPH. Nutritionist.

Centro de Investigación en Nutrición (CINyS). Instituto Nacional de Salud Pública de México (INSP). México; (7)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM).; (8)PhD. Nutritionist. Division of Nutritional Sciences. Cornell University. USA; (9)PhD. Nutritionist. Consultant for Global Alliance for Improved Nutrition (GAIN). Switzerland.

**Background and objectives:** Recent evidence suggests that point-of-use fortification using small quantity - lipid-based nutrient supplements (SQ-LNS) improves the nutrient adequacy of infant and young child (IYC) diets in resource-constrained settings. In the context of the nutrition transition in Latin America, and evidence linking IYC feeding to future risk of overweight and obesity, the Inter-American Development Bank initiated a project ("SPOON") in Mexico, Colombia, and Guatemala to evaluate the effectiveness of point-of-use fortification of complementary foods using unsweetened SQ-LNS and promotion of WHO recommended IYC feeding practices for children aged 0-23 months. We describe the methods used by a multi-cultural team of researchers trained in anthropology and communication to conduct formative research with the aim of developing a social and behavior change communication (SBCC) strategy to promote exclusive breastfeeding (EBF), appropriate complementary feeding practices and the use of unsweetened SQ-LNS.

**Methods:** The main research questions included:

1. How can SQ-LNS be integrated into existing complementary foods and feeding practices?

2. What are the positive attributes that caregivers associate with complementary foods and feeding that could be used to promote SQ-LNS?

3. What instructions and messages can be communicated to promote utilization of SQ-LNS?

4. What are the most effective communication strategies?

We created a common protocol which consisted of two streams of inquiry: (a) focused ethnographic study (FES) to obtain localized knowledge related to IYC feeding, and (b) 14-day home feeding trial to explore the acceptability and use of unsweetened SQ-LNS.

**Results:** A common protocol ensured consistency in research questions, approach and data collected across settings. However,
adaptations were necessary due to variations in the characteristics of the study populations, setting-specific SPOON project designs and methodological preferences of country-level researchers. In Mexico, the FES sampling design was changed to account for multiple ethno-linguistic groups. In Colombia, more emphasis was given to collect data on EBF, a priority for SPOON project in this setting. In Guatemala, focus group discussion was added to FES data collection.

**Conclusions:** Multi-country research studies benefit from a common protocol. However, some local adaptations are necessary to ensure that methods and results reflect differences across contexts.

**Keywords:** small quantity - lipid-based nutrient supplement (SQ-LNS), formative research, Colombia, Guatemala, Mexico

**Conflict of Interest Disclosure:** The authors declare no conflicts of interest. SPOON was financed by the Inter-American Development Bank.

**Further collaborators:** Gabriela Montenegro-Bethancourt PhD. Nutritionist. Research Institute and Higher Education on Health Sciences (IECIS). Rafael Landívar University. Guatemala Leah Cabrera. (MFA). SOMOS. Design Thinking. USA

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## PRE-AND POST-NATAL LIPID-BASED NUTRIENT SUPPLEMENTS AND COGNITIVE, SOCIOEMOTIONAL AND MOTOR FUNCTION IN PRE-SCHOOL-AGED CHILDREN IN GHANA

(1)Ocansey, Maku Eugenia; (2)Prado, Elizabeth; (3)Young, Rebecca R.; (4)Adu-Afarwuah, Seth; (5)Kumordzie, Sika; (6)Okronipa, Harriet; (7)Oaks, Brietta; (8)Dewey, Kathryn G.

(1)Mphil. Nutrition. University of California, Davis. USA.; (2)PhD. Assistant Project Scientist. Department of Nutrition. University of California, Davis.; (3)MSc. Statistician. Department of Nutrition. University of California, Davis.; (4)PhD. Lecturer. Department of Nutrition and Food Science. University of Ghana, Legon. Ghana.; (5)MPhil. Nutritionist. Department of Nutrition. University of California, Davis.; (6)MSc.Nutritionist. Department of Nutrition. University of California, Davis.; (7)PhD. Nutritionist. Department of Nutrition. University of California, Davis.; (8)PhD. Distinguished Professor. Department of Nutrition. University of California, Davis.

**Background and objectives:** Adequate nutrition is necessary for brain development during pregnancy and infancy. There is a dearth of evidence from randomized controlled trials of combined supplementation during both pre- and postnatal periods on developmental outcomes in later life. We aimed to investigate the effects of provision of pre- and postnatal lipid-based nutrient supplements (LNS) on cognitive, motor and socio-emotional function at preschool age.

**Methods:** We performed a follow-up study of children aged 4-6 years in 2016, born to women who participated in the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD trial (n=1320) conducted in Ghana in 2010-2014. Women had been randomized to daily LNS or multiple micronutrient (MMN) tab-

lets during pregnancy through 6 months postpartum or iron and folic acid (IFA) during pregnancy and calcium placebo through 6 months postpartum. Children in the LNS group received LNS from 6 to 18 months.

Primary outcomes were (1) a cognitive factor score based on a test battery adapted from sub-tests of the Developmental Neuropsychological Assessment, Parent's Evaluation of Developmental Status, and other sources, (2) motor score from the NIH Toolbox 9-hole pegboard test, and (3) socioemotional difficulties based on the Strengths and Difficulties Questionnaire (SDQ). Eight secondary outcomes were calculated in specific cognitive and other domains (e.g., language, SDQ prosocial). Analysis was by intention to treat and a 2-group comparison (LNS vs non-LNS (MMN+IFA)).

**Results:** Developmental results represent 76% of live births from the main trial (n=965). Preliminary analyses in the 2-group comparison show that children in the LNS group had a significantly lower socioemotional difficulties score than children in the non-LNS groups after adjusting for child age, factors at baseline (e.g., maternal BMI, age, education) and factors at follow-up (e.g., maternal cognition). Adjusted and unadjusted differences in mean z-score (95% CI) were: -0.15 (-0.27, -0.02), p = 0.026; and -0.12 (0.21, 0.02) p = 0.084 respectively. Cognitive, motor and secondary outcomes did not significantly differ by intervention group in either 3- or 2-group comparisons (ps > 0.1).

**Conclusions:** Provision of LNS during the first 1000 days of development may improve behavioral function but did not affect cognition at preschool age in this setting.

**Keywords:** Cognitive development, Preschool development, lipid-based nutrient supplementation, multiple micronutrients, maternal nutrition

144/1666

## THE EFFECT OF IODINE SUPPLEMENTATION IN MILDLY IODINE-DEFICIENT PREGNANT WOMEN ON CHILD DEVELOPMENT: A RANDOMIZED CONTROLLED TRIAL

(1)Gowachirapant, Sueppong; (2)Jaiswal, Nidhi; (3)Melse-Boonstra, Alida; (4)Galetti, Valeria; (4)Stinca, Sara; (1)Winichagoon, Pattanee; (5)Srinivasan, Krishnamachari; (6)Zimmermann, Michael Bruce.

(1)PhD. Institute of Nutrition. Mahidol University Bangkok. Thailand.; (2)PhD. St. John's Research Institute Bangalore. India.; (3)PhD. Division of Human Nutrition. Wageningen University and Research. The Netherlands.; (4)PhD. Laboratory of Human Nutrition. Institute of Food, Nutrition and Health. ETH Zurich. Switzerland.; (5)MD. St. John's Research Institute Bangalore. India.; (6)MD. Laboratory of Human Nutrition. Institute of Food, Nutrition and Health. ETH Zurich. Switzerland.

**Background and objectives:** Iodine deficiency during pregnancy may be associated with lower IQ in offspring. It is unknown whether iodine supplementation in mildly iodine-deficient pregnant women improves cognitive function in their children.
**Methods:** We randomized Indian and Thai pregnant women to receive daily 200 µg oral iodine or placebo until term. Primary outcomes were child development assessed at 1 and 2 years using the Bayley Scales of Infant Development (BSID)-III and at 5-6 years using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI)-III. Secondary outcomes were maternal and infant thyroid function, pregnancy outcomes and child hearing performance. The trial was double-masked and analysis was by intention-to-treat using mixed effects models.

**Results:** Pregnant women (n=832) entered the trial at a mean±SD gestational age of 10.7±2.7 weeks; their median (IQR) urinary iodine concentration (mUIC) was 131 (81, 213) µg/L, indicating mild iodine deficiency. Compliance with supplementation was 87%; mUICs in the 2nd and 3rd trimester were higher in the iodine group (p<0.001). There were no significant group differences in the cognitive and the combined motor and language BSID-III scores at 1 or 2 years. At 5.4 years, mean differences (95% CI) between iodine and placebo for WPPSI-III scores were: -0.7 (-2.9,1.4), p=0.87 for verbal IQ; -1.6 (-4.5,1.3), p=0.60 for performance IQ; -1.7 (-4.3,0.9), p=0.39 for processing speed; and -1.3 (-3.6,1.1), p=0.63 for full scale IQ.

**Conclusions:** Daily supplementation with 200 µg iodine in mildly iodine deficient pregnant women increased iodine intakes into the sufficient range but had no effect on child neurodevelopment.

**Keywords:** iodine, pregnancy, cognition, children, supplementation

**Further collaborators:** Ian Mackenzie, MD. Hearing Impairment Research Group. Liverpool School of Tropical Medicine. UK. Susan Thomas, PhD. St. John's Research Institute Bangalore. India. Tinku Thomas, PhD. St. John's Research Institute Bangalore. India.

**Methods:** This study was performed among 3,564 children participating in a population-based cohort study in the Netherlands. Dietary intake was assessed with food-frequency questionnaires at age 1 year. We calculated intakes of total protein and protein from different sources; of total carbohydrates, fiber, polysaccharides, monosaccharides and disaccharides; and of total, saturated, monounsaturated and polyunsaturated fat. Height and weight were repeatedly measured during childhood. Fat and fat-free mass were measured at 6 and 10 years using dual X-ray absorptiometry. We calculated body mass index (BMI), fat mass index (FMI), and fat-free mass index (FFMI). Macronutrient intakes were expressed in energy percentages and entered in multivariable linear mixed models in which we examined different macronutrient replacement effects independent of total energy intake. Models were adjusted for several parental and child sociodemographic and lifestyle factors.

**Results:** Results from multivariable models showed that higher intake of total and animal protein (both dairy and non-dairy) was associated with a higher height, weight and BMI up to the age of 10 years, irrespective of whether it was replacing carbohydrates or fats in the diet. Further analyses showed that the positive association with BMI was completely explained by a higher FMI and not FFMI and that this was irrespective of later diet. No significant associations were observed for the other macronutrients.

**Conclusions:** Our results suggest that high protein intake, particularly animal protein, in early childhood is associated with higher body fat mass, but not fat-free mass. Future studies are needed to examine the optimal range of protein intake for infants and young children.

**Keywords:** children, obesity, protein, epidemiology, cohort

## MACRONUTRIENT COMPOSITION OF EARLY CHILDHOOD DIET IS RELATED TO GROWTH AND ADIPOSITY DURING CHILDHOOD

(1)Voortman, Trudy; (2)Jaddoe, Vincent; (3)Franco, Oscar.

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

(2)Professor of Pediatric Epidemiology. Department of Pediatrics. Erasmus University Medical Center. Rotterdam. The Netherlands; (3)Professor of Preventive Medicine. Department of Epidemiology. Erasmus University Medical Center. Rotterdam. The Netherlands.

**Background and objectives:** Previous studies suggest that high protein intake in infancy leads to a higher body mass index. However, it is not clear whether this reflects a higher fat mass and hence more adiposity, or a difference in lean mass, as observed in adults. Furthermore, it is not clear what the role is of other macronutrients and whether effects are independent of diet in later childhood. We examined associations of macronutrient composition of the diet in early childhood with growth and detailed measures of body composition up to the age of 10 years.

## FEEDING PRACTICES AND NUTRITIONAL STATUS OF 6-23 MONTHS OLD CHILDREN AT DEMBA GOFA AND GEZE GOFA WOREDAS, GAMO GOFA ZONE, ETHIOPIA

(1)Borko, Tafese Bosha; (2)Markos, Tigist; (3)Kuche, Desalegn; (4)Assefa, Tsehai; (5)Fikre, Tadese; (6)Hailu, Tesfaye; (7)Zegeye, Menen.

(1)Tafese Bosha Borko. MSc. Nutritionist. School of Nutrition, Food Science and Technology. Hawassa University. Ethiopia.; (2)Tigist Fekadu Markos. MSc. Nutritionist. School of Nutrition, Food Science and Technology. Hawassa University. Ethiopia.; (3)Desalegn Kuche. Nutritionist. Ethiopian Public Health Institute. Ethiopia.;

(4)Tsehai Assefa. Nutritionist. Ethiopian Public Health Institute. Ethiopia.; (5)Tadese Fikre. Food Engineer. School of Nutrition, Food Science and Technology. Hawassa University. Ethiopia.; (6)Tesfaye Hailu. Nutritionist. Ethiopian Public Health Institute. Ethiopia.;

(7)Menen Zegeye. Nutritionist. School of Nutrition, Food Science and Technology. Hawassa University. Ethiopia.

**Background and objectives:** Prevalence of stunting in Southern Ethiopia is equal to the national average, 44%. Poor infant and young child feeding practices, household food insecurity, poor maternal and child caring practices, poor water and sanitation practices.
itation, etc were causes of child malnutrition in Ethiopia (CSA, 2014). The objective of the study was to assess under-2 children feeding practices and nutritional status at Demba Gofa and Geze Gofa Woredas of Gamo Gofa Zone, Ethiopia.

**Methods:** Community-based cross sectional survey was conducted to collect data on 520 samples. Multistage cluster sampling technique was employed. A pretested structured questionnaire was used to collect data on household socio-demographic and economic characteristics, food security level and infant and young child feeding practices. Child weight, height and MUAC were taken following standard procedure. Data were analyzed using WHO Anthro version 3.2.2 and SPSS Version 16.0. Binary logistic regression was used to identify predictors of stunting, underweight and wasting among study participants. Cut off point for significance test was p-value < 0.05.

**Results:** It was found that majority, 91%, of mothers initiate breast feeding immediately after delivery. Majority of children, 93.8%, ever breast feed. Only 37.9% of children received minimum diet diversity required. The stunting, underweight and wasting prevalence was 18.5%, 9.1% and 3.9% respectively. As age increases, chance for a child to be stunted increases [AOR (95% CI) = 2.69 (1.27, 5.67). Father's educational status predicted stunting [AOR (95% CI) =0.28 (0.11, 0.73). Breast feeding was also a predictor of stunting in the study area with 2.92 (95% CI, 1.25, 6.85) less likely to be stunted than none breast fed one. Compared with male children, females were less likely to be underweight [AOR (95% CI) = 0.44 (0.23, 0.85). Underweight prevalence increased with the age of children [AOR (95% CI) = 25.53 (1.16, 8.04).

**Conclusions:** Stunting, underweight and wasting prevalence among under-2 years is relatively better in study areas compared with the criteria of WHO for assessing severity of malnutrition.

**Keywords:** Feeding practice, stunting, underweight, wasting.

144/1822

A NOVEL APPROACH TO ANALYSE THE RELATIONSHIP BETWEEN PHYSICAL FITNESS AND BIOMARKERS IN OLDER ADULTS

(1)Aparicio Ugarriza, Raquel; (1)López Torres, Olga; (2)Díaz, Ángel Enrique; (3)Bibiloni, María del Mar; (4)Julibert, Alicia; (5)Palacios, Gonzalo; (3)Tur, Josep Antoni; (5)Gonzalez Gross, Maria Marcela.

(1)MSc. ImFINE Research Group. Department of Health and Human Performance. Universidad Politécnica de Madrid. Spain;

(2)MSc. Clinical Laboratory Unit. Department of Sport and Health. Spanish Agency for Health Protection in Sport (AEPSAD). Madrid. Spain.; (3)PhD. NUCOX Research Group. Fundamental Biology and Health Science. University of the Balearic Islands. Spain.;

(4)MSc. NUCOX Research Group. Fundamental Biology and Health Science. University of the Balearic Islands. Spain.; (5)PhD. ImFINE Research Group. Department of Health and Human Performance. Universidad Politécnica de Madrid. Spain.

**Background and objectives:** Physical fitness (PF) is an independent predictor of all-cause mortality. Biomarkers are the main key to evaluate the influence of PF on the human body. The aim of

this study was to investigate the association between PF levels and biomarkers in older adults.

**Methods:** 429 non-institutionalized Spanish older adults (57% females), aged over 55 years were included in this multicenter study. Each participant performed a battery of validated PF tests (EXERNET). The score for each test ranged from 0 (worst) to 3 (best) points. The maximum score was 12 points. Scores of PF tests were added together to create a cluster. After that, participants were divided into 3 groups (low, medium and high). Fasted blood samples were collected and concentrations of routine biochemistry, vitamins, and homocysteine were analysed. Biomarkers were coded as 0 (out of reference range) and coded as 1 (within reference range). Dietary intake was assessed by two non-consecutive 24h recalls and nutrient intake was calculated using a computer program (ALIMENTA;NUCOX,Spain). Data was analysed using generalized linear model.

**Results:** A total of 68% and 59% of the participants showed vitamin 25(OH)D deficiency and excessive total cholesterol (TC), respectively. A total of 38.3%, 32.3%, 27.7% and 24.3% of the participants presented high glucose, uric acid, LDL-cholesterol (LDL-c) and total homocysteine (tHcy) concentrations, respectively. More subjects from the low PF group were significantly out of the reference range for tHcy, TC, HDL-cholesterol and creatinine than those in the high PF group (p<0.05). However, less subjects from the low PF group presented vitamin B12 levels out of range (p<0.05). Subjects in the low PF group presented greater LDL-c and triglycerides risk taking into account lipid intake.

**Conclusions:** Participants included in the high PF group had a better blood markers profile than those included in the other PF groups. PF can have an impact on biomarkers concentrations. Only lipid blood markers seem to be influenced by nutrient intake. Thus, PF has an essential role in the studied population.

**Keywords:** physical fitness, nutrition, dietary habits, biomarkers, aging

**Further collaborators:** Supported by Instituto Salud Carlos III (PI11/01791 & CB12/03/30038). ImFINE and NUCOX are members of the EXERNET network.
# VEGETARIAN AND VEGAN DIETS IN PRE-PUBERTAL POLISH CHILDREN: ELUCIDATING BENEFITS AND COSTS IN GROWTH, METABOLISM AND CARDIOVASCULAR RISK

(¹)Malgorzata, Desmond; (²)Sobiecki, Jakub; (³)Jaworski, Maciej;

(⁴)Ksiazyk, Janusz; (⁵)Fewtrell, Mary; (⁶)Wells, Jonathan.

(¹)PhD candidate. Dietitian. 1. UCL Great Ormond Street Institute of Child Health. University College London. United Kingdom. 2. Department of Paediatrics, Nutrition and Metabolic Diseases. Children's Memorial Health Institute. Poland.; (²)MSc. 1. Department of Epidemiology and Biostatistics. Imperial College London. United Kingdom. 2. Department of Paediatrics, Nutrition and Metabolic Diseases. Children's Memorial Health Institute. Poland.; (³)PhD. Department of Biochemistry, Radioimmunology and Experimental Medicine. Children's Memorial Health Institute. Poland.; (⁴)MD. PhD. Department of Paediatrics, Nutrition and Metabolic Diseases. Children's Memorial Health Institute. Poland.; (⁵)MD. UCL Great Ormond Street Institute of Child Health. University College London. United Kingdom.; (⁶)PhD. UCL Great Ormond Street Institute of Child Health. University College London. United Kingdom.

**Background and objectives:** In adults, the health effects and safety of appropriately planned vegetarian and vegan diets have been evaluated, and some benefits, mainly cardio-metabolic, have been established. However, equivalent evidence in children is sparse, and relates mainly to anthropometric outcomes and nutrient intakes. More detailed information on cardio-metabolic outcomes, growth parameters and micronutrient status are lacking.

We aimed to assess the associations of vegetarian and vegan diets in children with a range of anthropometric, nutritional and cardio-metabolic outcomes.

**Methods:** We conducted a cross-sectional study in 188 healthy prepubertal Polish children aged 5 - 10 years: 52 vegans, 64 vegetarians, and 72 omnivores matched for socio-economic status (SES). We ascertained SES using electronic questionnaires, dietary intakes by food records and dietary screener questionnaires. We analysed fasting blood for lipids, vitamin B12, homocysteine and complete blood count (including haemoglobin and mean corpuscular volume (MCV)); and measured bone mineral density by DXA, anthropometry, blood pressure (BP).

We calculated internal z-scores – adjusting for age and sex – for height, skinfold thicknesses and bone mineral content (BMC); BMC was additionally adjusted for bone area. We used external reference data for BMI and systolic BP. ANOVA was used to compare group means of all outcomes except vitamin B12, where the Kruskall - Wallis test was used to compare medians.

**Results:** Omnivores were significantly taller than vegetarians (0.41 SDS, 95%CI 0.01, 0.82) and vegans (0.55 SDS, 95%CI 0.13, 0.98). Vegans had significantly lower BMC (-0.61 SDS, 95%CI -1.02, -0.19), haemoglobin (-0.39 g/dl, 95%CI -0.73, -0.05), vitamin B12, LDL-cholesterol (-23.4 mg/dl, 95%CI -33.0, -13.6), mean of 4 skinfolds, BMI, and significantly higher homocysteine

and MCV compared to omnivores. Vegetarian values were in between those of vegans and omnivores. Vegans had non-significantly lower systolic BP than the other two groups.

**Conclusions:** Vegan diets in childhood are associated with increased risk of deficiencies in B12 and iron, and negatively affect linear growth and bone mineral accretion. The same diet is beneficial for cardio-metabolic health, by reducing blood lipids, body fat and blood pressure. Both these costs and benefits are of smaller magnitude in vegetarian children.

**Keywords:** vegetarian diet, children, growth, cardiovascular risk, nutrient deficiency

# DOCOHEXAENOIC ACID IMPROVES THE REDUCED UMBILICAL VEIN RELAXATION OBSERVED IN THE OFFSPRING OF PREGNANCIES WITH MATERNAL OBESITY

(¹)Farias, Marcelo; (²)Villalobos-Labra, Roberto; (³)Solari, Sandra;

(⁴)Aguirre, Carolina; (⁵)SAMITH, BARBARA; (⁶)Rojas, María José.

(¹)MD. PhD. Division of Obstetrics and Gynaecology. School of Medicine. Faculty of Medicine, Pontificia Universidad Católica de Chile. Chile.; (²)BSc. PhD (c). Division of Obstetrics and Gynaecology. School of Medicine. Faculty of Medicine, Pontificia Universidad Católica de Chile. Chile.; (³)MD. Department of Clinical Laboratories. School of Medicine. Faculty of Medicine. Pontificia Universidad Católica de Chile. Chile.; (⁴)Nutritionist. PhD. Faculty of Medicine. Pontificia Universidad Católica de Chile. Chile.; (⁵)Nutritionist. MSc. Faculty of Medicine. Pontificia Universidad Católica de Chile. Chile.; (⁶)Nutritionist. Division of Obstetrics and Gynaecology. School of Medicine. Faculty of Medicine. Pontificia Universidad Católica de Chile. Chile.

**Background and objectives:** Maternal obesity (MO) is associated with increased risk of long term metabolic risk in the offspring (REF), probably involving mechanisms such as early programming of insulin resistance in fetal and neonatal tissues. On the other hand, exposure to the polyunsaturated acid Docohexaenoic acid (DHA) has been related with increased insulin response in multiple cell types. The aims of our study were to evaluate the in vitro effect of DHA on vascular response of umbilical vein to insulin, and the role of the intracellular inhibitory phosphorylation of the insulin receptor substrate-1.

**Methods:** Umbilical cords from normal and MO pregnant woman attending to obstetrics service at the Clinical Hospital of Pontificia Universidad Catolica de Chile were obtained after informed consent. Isolated rings of umbilical vein were used to evaluate vasodilatation capacity by wire-myography, in absence or presence of insulin (10-10 to 10-6 uM, 0-20 min) and DHA (100 uM, 12 h). Primary cultures of human umbilical vein endothelial cells (HUVEC) were used to evaluated phosphorylated and total protein levels of IRS-1 in cells exposed or not to insulin (1 nM, 30 min), in absence or presence of DHA (100 uM, 12 h).
**Results:** Insulin produces a significant vasodilation (20%) in umbilical vein rings from normal pregnancies, an effect that was absent in MO-derived umbilical rings. This vasodilator effect of insulin was recovered in umbilical vein rings from MO pregnancies pre-incubated with DHA. In addition, HUVEC from MO pregnancies showed increased levels of IRS-1 phosphorylated in serine307, compared with normal cells, a difference that was reduced by DHA, even in presence of insulin.

**Conclusions:** In vitro addition of DHA recovers the reduced vascular response to insulin in umbilical vein from MO pregnancies, involving a reduction of the inhibitory phosphorylation of IRS in serine307.

**Keywords:** Early programming, Insulin resistance, Maternal obesity, Docohexaenoic acid, human umbilical vein

vs 56.3±1.7; P=0.024), IFG2 (51.2±5.1 vs 48.9±4.4; P=0.021) and BDNF (3.1±0.8 vs 2.7±0.7; P=0.003). The effect of folic acid on IGF2 methylation was however significant only in female offspring (52.1±5.5 vs 48.5±5.3; P=0.028) but not in males (50.2±4.6 vs 49.3±3.4; P=0.201). In contrast, for the BDNF gene, folic acid treatment had a significant effect in male (3.2±0.8 vs 2.7±0.7; P=0.012) but not female (2.9±0.7 vs 2.6±0.7; P=0.212) offspring.

**Conclusions:** These results indicate that folic acid supplementation (400 µg/d) in trimesters 2 and 3 of pregnancy exerts significant changes in DNA methylation of genes related to offspring brain function and growth, which appear to be sex-specific. These findings require further investigation using genome-wide approaches.

**Keywords:** Folic Acid. Cord Blood. DNA methylation. Pregnancy. Epigenetics.

144/1993

OFFSPRING DNA METHYLATION CHANGES IN RESPONSE TO MATERNAL FOLIC ACID SUPPLEMENTATION IN THE SECOND AND THIRD TRIMESTERS: EVIDENCE FROM A RANDOMIZED CONTROLLED TRIAL

(1)Caffrey, Aoife; (2)Irwin, Rachelle; (3)McNulty, Helene; (2)Walsh, Colum;

(2)Lees-Murdock, Diane; (3)Strain, Sean JJ; (3)Pentieva, Kristina.

(1)MSc. NICHE. Biomedical Sciences Research Institute. Ulster University. Northern Ireland.; (2)PhD. Genomic Medicine Group. Biomedical Sciences Research Institute. Ulster University. Northern Ireland.; (3)PhD. NICHE. Biomedical Sciences Research Institute. Ulster University. Northern Ireland.

**Background and objectives:** Folic acid is widely recognised for its role in the prevention of neural tube defects and other congenital malformations. There is also emerging evidence that maternal folate status during pregnancy is associated with cognitive development in childhood. Folate dependent DNA methylation may provide a potential biological mechanism to link folate status during pregnancy with cognition in the offspring but this remains to be confirmed. Observational studies using candidate-gene or genome-wide analysis have linked maternal folate status with offspring DNA methylation of specific genes, including those related to neurodevelopmental pathways. This study aimed to investigate the effect of maternal folic acid supplementation on cord blood DNA methylation of genes related to brain function.

**Methods:** Samples for the current study were obtained from a randomized controlled trial in pregnancy which investigated the effect of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT). Cord blood (n 86) taken at the time of delivery was assessed for DNA methylation of the retrotransposon LINE-1 (indicative of global DNA methylation) and the following genes associated with brain function and growth: RBM46, PEG3, IGF2, GRB10, BDNF, GRIN3B, OPCML and APC2.

**Results:** The results showed that compared with placebo, the newborns of mothers who received folic acid during pregnancy had significantly lower DNA methylation (%) of LINE-1 (57.2±2.1

144/1997

EFFECT OF MULTIPLE MICRONUTRIENT SUPPLEMENTATION IN LACTATING WOMEN ON INFANT GROWTH AND MORBIDITY: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL IN RURAL BURKINA FASO

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

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

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

**Methods:** In a randomized controlled trial in rural Burkina Faso, 1426 pregnancies were allocated to daily supplementation with either UNIMMAP (intervention) or IFA (control) for three months after delivery. In total, 1296 mothers with live births were enrolled in the study. Daily tablet intake was directly observed by trained community workers. Anthropometry, morbidity and he-
moglobin concentration of infants were measured monthly until
the first birthday.

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

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

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

144/2116

PRENATAL SUPPLEMENTATION WITH
SMALL-QUANTITY LIPID-BASED NUTRIENT
SUPPLEMENTS OR MULTIPLE MICRONUTRIENTS
INCREASES URINARY IODINE CONCENTRATION
IN SEMI-URBAN GHANA: A RANDOMIZED CON-
TROLLED TRIAL

(1)Adu-Afarwuah, Seth; (2)Lartey, Anna; (3)Okronipa, Harriet; (4)Ashorn, Per; (5)Arimond, Mary; (6)Dewey, Kathryn G.

(1)PhD. Senior Lecturer. Dept. of Nutrition and Food Science.
University of Ghana. Legon. Accra. Ghana; (2)President, IUNS
2013-2017; (3)MSc. Department of Nutrition and Food Science.
University of Ghana. Ghana; (4)MD. Center for Child Health
Research. University of Tampere School of Medicine and
Tampere University Hospital. Finland; (5)MSc. Department of
Nutrition. University of California, Davis. USA; (6)PhD. Department
of Nutrition. University of California, Davis. USA.

**Background and objectives:** In many developing countries, the iodine intakes of pregnant women may be low. Consumption of small-quantity lipid-based nutrient supplements (SQ-LNS) providing macro- and micronutrients including iodine may impact iodine status. We examined urinary iodine concentration (UIC) as a secondary outcome among 3 groups of pregnant women enrolled in the iLiNS (International Lipid-based Nutrient Supplements)-DYAD Ghana trial.

**Methods:** Women (n = 1320, <20 weeks of gestation) were randomized to consume during pregnancy 60 mg iron and 400 µg fol- ic acid/d (IFA); or multiple micronutrient supplements containing

18 vitamins and minerals including 250 µg iodine/d (MMN); or
20 g/d SQ-LNS with 22 vitamins and minerals including the same
iodine content as MMN (LNS). In a sub-sample (IFA, 92; MMN,
102; LNS, 101), we measured UIC in spot urine samples at enrol-
ment and 36 weeks of gestation, compared UIC among groups at
36 weeks gestation by using the Kruskal-Wallis test, and assessed
adequacy of iodine intakes by using WHO cut-off levels: median
UIC <150 µg/L representing inadequate iodine intakes, median
UIC 150-249 µg/L representing adequate iodine intakes, and UIC
≥500 µg/L representing excessive iodine intakes.

**Results:** In this subsample of women, mean ± SD age was 26 ± 5 years, and 37% were first-time mothers. At baseline, the overall median (interquartile range) UIC was 137 µg/L (78 – 221 µg/L). At 36 weeks of gestation, median (interquartile range) UIC was lower (overall P = 0.011) in the IFA group [120 µg/L (95 – 258 µg/L)] than in the MMN group [172 µg/L (97 – 266 µg/L)] or LNS group [151 µg/L (95 – 258 µg/L)]. This suggests insufficient iodine intakes in the IFA group, and adequate intakes in the MMN and LNS groups.

**Conclusions:** We conclude that on the basis of UIC, the iodine intakes of pregnant women in this semi-urban setting in Ghana appear to be inadequate despite a national salt iodization program, and that the consumption of SQ-LNS or multiple micronutrient supplements providing iodine at the WHO-recommended daily dose increases the likelihood of adequate iodine status. This trial was registered at clinicaltrials.gov as NCT00970866.

**Keywords:** iLiNS Project; iLiNS DYAD Ghana; small-quantity lipid-based nutrient supplements; urinary iodine concentration; iodine intakes

**Further collaborators:**

Supported by a grant to the University of California, Davis,
from the Bill & Melinda Gates Foundation.
# EFFECT OF INFECTION ON NUTRITIONAL STATUS OF INFANTS IN A COHORT STUDY OF VITAMIN A IN WESTERN KENYA

(1)Grant, Frederick; (2)Wanjala, Rose; (3)Low, Jan; (4)Levin, Carol; (5)Cole, Donald; (6)Okuku, Haile Selassie; (7)Ackatia-Armah, Robert; (8)Varela, María Cristina.

(1)PhD. Nutritionist. International Potato Center. Dar-es-Salaam. Tanzania.; (2)MPH. Epidemiologist. International Potato Center. Nairobi. Kenya.; (3)PhD. Agriculture Economist. International Potato Center. Nairobi. Kenya.; (4)PhD. Agriculture Economist. University of Washington. Seattle. WA. USA.; (5)MD. Epidemiologist. Dalla Lana School of Public Health. University of Toronto. Toronto. Canada.; (6)MSc. Epidemiologist. International Potato Center. Dar-es-Salaam. Tanzania.; (7)PhD. Nutritionist. International Potato Center. Kigali. Rwanda.; (8)PhD. Nutritionist. Rollins School of Public Health. Emory University. Atlanta. GA. USA.

**Background and objectives:** Infection is associated with impaired nutritional status especially of infants under 5 years old. We assessed the impact of infection indicated by both acute phase proteins (APP), C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), and as reported by maternal recall, on the nutritional status of infants.

**Methods:** 505 pregnant women were enrolled into a nested longitudinal cohort study of vitamin A. Data analysis was restricted to infant data at 4-months (n=400 mother-infant-dyads) and 9-months (n=385 mother-infant-dyads) postpartum. Incidence and severity of respiratory infection and diarrhea over the previous 14 days were assessed by maternal recall; information on infant/child feeding practices were also collected. Infant weight, recumbent length and heel-prick capillary blood collection were taken at 4- and 9-months postpartum. Indicators of VA status [(retinol binding protein (RBP)], iron status (Hb, ferritin) and subclinical inflammation APP, CRP and AGP were determined. Subclinical inflammation was defined as CRP >5mg/L and/or AGP >1g/L. Impacts of infection on infant nutritional status were estimated with random effect logistic models adjusted for clustering and differences at enrollment.

**Results:** Infection prevalence, based on elevated CRP and AGP levels, was 36.7%. For diarrhea reported symptoms, 67.4% at 4-months and 42.4% at 9-months had no indication of infection as indicated by CRP and AGP; whilst for acute respiratory reported symptoms, 54.5% at 4-month and 42.6% at the 9-month visit had no indication of infection. There was significant positive association with infection among VA deficient infants based on maternal reported symptoms. The odds of having infection in underweight infants was 3.7 times higher (OR: 3.7; P=0.019); this attenuated after adjusting for inflammation. Infants with iron deficiency were less likely to have infection (OR: 0.40; P=0.001); after adjusting for inflammation, this effect disappeared (OR: 1.11; P=0.607). Infants with VA deficiency were 5 times more likely (OR: 5.06; P=0.0001) to have infection, but after adjusting for inflammation they were less likely to have infection (OR: 0.55; P=0.002).

**Conclusions:** Acute phase proteins are more useful in defining infection in a population compared to reported symptoms of illness. Not controlling for inflammation in a population while assessing nutritional status might result in over reporting or underreporting prevalence.

**Keywords:** Inflammation, Infection, Vitamin A deficiency, Iron deficiency, Infants.

**Conflict of Interest Disclosure:** Frederick Grant, Rose Wanjala, Jan Low, Carol Levin, Donald Cole, Haile Selassie Okuku, Robert Ackatia-Armah, Amy Webb Girard, no conflicts of interest.

# INFANT BREASTMILK INTAKES AND MOTHERS' BODY COMPOSITION AND ENERGY EXPENDITURE: A COMPARATIVE STUDY

(1)Matsiko, Eric; (2)Hulshof, Paul; (2)Van der Velde, Laura; (2)Kenkhuis, Marlou Floor; (3)Tuyisenge, Lisine; (4)Melse-Boonstra, Alida.

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

**Background and objectives:** The WHO recommends exclusive breastfeeding during the first six months of life. Data from developing countries on breast milk adequacy and its association with body composition and energy expenditure of lactating mothers are scarce. We aimed to compare the breast milk output of lactating mothers in Rwanda and the Netherlands.

**Methods:** We used a convenience sample of 8 Rwandan and 5 Dutch mother-infants pairs (child's age 2-4 months) who fed their infants exclusively with breast milk. Rwandan mothers were recruited from a deprived rural area with a high level of childhood stunting, whereas Dutch mothers were all affluent. The dose-to-mother technique with doubly labelled water was used to assess child's breast milk intake, body composition and energy expenditure. After dosing, saliva samples from mothers and infants were collected over a 14-day period and analyzed for deuterium (2H) and 18-oxygen (18O) abundance by Isotope Ratio Mass Spectrometry. Data were fitted to model water turnover using the multi-point protocol in the mother and infant by using the solver function in Microsoft Excel.

**Results:** The estimated mean (±SD) daily breast milk output was 902±261 g/d among Rwandan mothers and 848±205 g/d among Dutch mothers (P= 0.706). The percentage of body fat was not significantly different between Rwandan and Dutch mothers (33% vs. 32%, P=0.759), but the total daily energy expenditure was much higher in Rwandan mothers compared to Dutch mothers (3214 kcal vs. 2338 kcal, P=0.004).

**Conclusions:** Despite their very high total energy expenditure, Rwandan mothers had similar breast milk output compared to Dutch mothers.
**Keywords:** Breast milk intake, Doubly labelled water, Rwanda, Dutch, the Netherlands.

**Conflict of Interest Disclosure:** Authors declare that there is no conflict of interest whatsoever in this submission be it with any staff of the organizing body or any affiliate. It is merely submitted for academic research purposes as the contribution to the research subject area.

144/2908

IODINE STATUS IN BREAST MILK DURING THE
FIRST 12 WEEKS POSTPARTUM IN TIANJIN, CHINA

(1)Wang, Wei; (2)Zhang, Wanqi; (3)Sun, Yu; (1)Chen, Wen; (1)Zhang, Yixin;

(4)Tan, Long; (5)Shen, Jun; (6)Zhao, Zhuo.

(1)PhD. School of Public Health. Tianjin Medical University.
China.; (2)PhD. Professor. School of Public Health. Tianjin Medical
University. China.; (3)MSc. School of Public Health. Tianjin Medical
University. China.; (4)PhD. Lecturer. School of Public Health.
Tianjin Medical University. China.; (5)MD. Associate Professor.
School of Public Health. Tianjin Medical University. China.; (6)PhD.
Entry-Exit Inspection and Quarantine. China.

**Background and objectives:** The present study investigated the iodine status of breast milk and breastfed infants during the first 12 weeks postpartum in Tianjin, China.

**Methods:** A total of 175 pregnant women were recruited before delivery. Their breast milk and 24-h urine samples were collected at 4, 8, and 12 weeks postpartum; spot urine samples were simultaneously collected from their infants. The iodine content of the samples was measured.

**Results:** The mean breast milk iodine concentrations (BMICs) at 4, 8, and 12 weeks were 221.7 ± 103.5 µg/L, 175.2 ± 76.2 µg/L, and 148.1 ± 66.2 µg/L, respectively. Significant differences existed between the mean BMICs of the three sampling times (F = 12.449, p < 0.001). The BMIC showed a decreasing trend during the first 12 weeks postpartum. The median urinary iodine concentrations (UICs) of the mothers were 152, 112, and 109 µg/L at the different sampling times. The BMIC and UIC were not correlated in the mothers. The median UICs in the infants were 251, 183, and 164 µg/L. The infant UICs were statistically different at the three sampling times (p = 0.001). Moreover, the infant UICs correlated with the BMICs (Rs = 0.205, p = 0.010) but not with the maternal UICs (Rs = 0.131, p = 0.067).

**Conclusions:** The BMIC in and infant iodine intake from breast milk decreased in the first 12 weeks. Breastfed infants could receive adequate iodine from breast milk in Tianjin City.

**Keywords:** Iodine Status, Breast Milk, Lactating Women, Infant, Urine

**Further collaborators:** Shuhai Lan, Bodi Hospital, Tianjin, China. 1587228250@qq.com

144/2971

10-YEAR RISK ESTIMATION FOR TYPE 2 DIABETES MELLITUS IN UNIVERSITY STUDENTS IN ASUNCIÓN, PARAGUAY

Gonzalez Cañete, Natalia Elizabeth.

MSc. Nutritionist. School of Medicine. Human Nutrition Career.
Universidad del Pacífico Privada. Paraguay.

**Background and objectives:** The beginning of university life implies an important change in the life of the individual. According to research, university life is characterized by limited time for meals and for the practice of physical activity, lack of main meals, excess weight, preference for junk food, and few hours of sleep, among other factors. Objectives: To estimate the risk of 10 years of type 2 diabetes in university students.

**Methods:** Observational, descriptive, cross-sectional study with non-probabilistic sampling for convenience, carried out in 106 students of Medicine, Dentistry, Nutrition, Accounting, Administration, Audiovisual Sciences and Graphic Design of the Universidad del Pacífico Privada, of Asunción, Paraguay, recruited from October to December 2015. All subjects underwent for weight and height measures for nutritional status assessment, and body fat was also determined; cardiovascular risk by abdominal circumference, daytime somnolence by Epworth sleepiness scale, and some dietary and physical activity (FA) habits described by survey. The 10-year risk of developing type 2 diabetes was assessed through the Findrisk survey. The protocol was approved by the Ethics Committee of the Universidad del Pacífico Privada.

**Results:** 69% of the population were women. 68% belonged to health careers, with 50% in their second year of university. The median age was 21 years. 59% were with normal weight, and 63% had normal abdominal circumference. 62% had body fat at a high acceptable level. "Low risk" of developing diabetes was found in 65% of cases, and a slightly elevated risk in 31% of the subjects. 73% presented normal daytime sleepiness, 50% reported sleeping 7 hours. 5% smoked and 55% performed AF; however, the median time spent on this was 25 minutes / week. Lunch was the most consumed meal (91%). 54% added additional sugar to their juices and infusions, while 74% reported consuming sugary beverages.

**Conclusions:** Interventions should be implemented at the university level, increasing the time spent on scheduled physical activity and improving the quality of beverages ingested by this population.

**Keywords:** Students, education, diabetes mellitus, habits, nutritional status.

**Further collaborators:** Nutritionist Galeano Clara.
# DEVELOPMENT OF MULTI-SECTORAL NUTRITION ACTION PLAN; TANZANIA EXPERIENCE

(1)Kaganda, Joyceline; (2)Kavish, Festo.

(1)PhD. Nutritionist. Tanzania Food and Nutrition Centre. Dar es salaam. Tanzania; (2)D.MSc,MSC,MD. Independent Human Development Consultant.

**Background and objectives:** Multisectoral actions is needed to elimination malnutrition in the world. However, developing the multi-sectoral nutrition action plan has been a challenge to most countries. Tanzania is ready to show an example on how to develop the National Multisectoral Nutrition Action Plan (NMNAP).

**Methods:** The process started by developing a road which provided for a “steering structure” for policy guidance, sectoral and partner coordination, strategic decisions and quality assurance.

Structurally, the NMNAP steering committee was chaired by the Scaling Up Nutrition (SUN) Country focal point. The steering committee established six task teams with the mandate to develop costed implementation plans for actions in the key result areas (KRA). In forming the task teams, the steering committee used the 2013 Lancet Conceptual Framework for addressing malnutrition and categorized the KRAs into three categories: nutrition specific, nutrition sensitive and enabling environment interventions.

A senior level nutrition expert was consulted as lead facilitator whose role was to provide technical harmonization, coordination, quality assurance and cross-theme conceptual standardization. Tanzania Food and Nutrition Centre (TFNC) facilitated all the technical meetings on key milestones.

Evidence was collected using desk reviews, and where appropriate new operational evidence was collected through bottleneck analysis. The process engaged all key actors in the multisectoral, multi-layer and multi-stakeholder nutrition system at all levels. Consultations were based on the SUN stakeholder platforms. In process, stakeholders did a working session to articulate the desired change and to understand how to relate in productive ways with different stakeholders through a common vision and action.

**Results:** The task teams consolidated their work in a workshop facilitated by the Lead Facilitator who then used the output from the workshop to develop draft-1 of the NMNAP. This draft was peer reviewed and validated in a second workshop. The Lead Facilitator incorporated inputs from the reviewers and the validation workshop into draft-2, which was then submitted to the High Level Steering Committee for Nutrition (HLSCN) for final inputs.

**Conclusions:** It took one year for the multi-sectoral plan to be developed and finally indorsed by the HLSC

**Keywords:** Development. Multisectoral. Nutrition. Plan

# Track 3: Public Health Nutrition and Environment

## EARLY-LIFE RISK FACTORS AND THEIR COMBINED EFFECTS AS PREDICTORS OF OVERWEIGHT IN SPANISH CHILDREN

(1)Iguacel Azorín, Isabel; (2)Escartín, Laura; (3)Fernández-Alvira, Juan Miguel; (4)Iglesia, Iris; (5)Layabén, Idoia; (6)Moreno, Luis A.; (7)Samper, María Pilar; (7)Rodríguez, Gerardo.

(1)MSc. Nurse. Psychologist. Economist. Department of Physiatry and Nursing. University of Zaragoza. Spain; (2)MD. Paediatrician. Institute of Aragonese Health Research. University of Zaragoza. Spain.; (3)PhD. Nutritionist. Psychologist. Spanish National Center for Cardiovascular Research. Spain.; (4)PhD. Nutritionist. Department of Physiatry and Nursing. University of Zaragoza. Spain.; (5)PhD. Biologist. Department of Nutrition and Bromatology. University of the Basque Country. Spain.; (6)PhD. Paediatrician. Nutritionist. Department of Physiatry and Nursing. University of Zaragoza. Spain.; (7)PhD. Paediatrician. Department of Paediatrics, Radiology and Physical Medicine. University of Zaragoza. Spain.

**Background and objectives:** Early-life risk factors have been associated with subsequent childhood obesity. However, most of the studies did not consider important confounders to disentangle the contribution of each factor and their cumulative effects. We aimed to explore pre-, peri- and postpartum risk factors on the risk of overweight/obesity at age 6y and to investigate the cumulative effect of early life risk factors on overweight/obesity at ages 2-,4- and 6y.

**Methods:** A total of 1,031 children were evaluated at birth and re-examined during a 6-year follow-up in a representative cohort of Aragon (Spain). Maternal smoking during pregnancy, gestational weight gain, gestational age, birth weight, caesarean section, breastfeeding practices and rapid infant weight gain from birth to 6 months of age were the factors studied. Parental body mass index (BMI), maternal education, parental/ethnicity origin were defined as main confounders. We used logistic mixed-effects models to assess the associations investigated.

**Results:** Parental BMI and parental ethnicity/origin were the strongest predictors and they confounded several associations. Rapid infant weight gain (OR=2.29; [1.54-3.42]99%CI) and smoking during pregnancy (OR=1.61; [1.01-2.59]99%CI) remained statistically significant after adjusting for confounders. A higher number of early-life risk factors was associated with higher odds of being overweight or obese at the age of 6, where the OR increased with the number of early-life risk factors: two early-life risk factors (OR=2.72; [1.54-3.42]99%CI); three early-life risk factors (OR=5.02; [2.28-11.04]99%CI) and four to six early-life risk factors (OR=7.33; [3.01-17.84]99%CI). No significant associations were found at the age of 2 or 4 years.
**Conclusions:** Rapid infant weight gain, parental BMI and origin/ethnicity are important determinants of childhood obesity. Those with a higher number of early risk factors had elevated odds for obesity at age 6 suggesting cumulative effects. Monitoring children with rapid infant weight gain is especially important for childhood obesity prevention.

**Keywords:** Overweight, children, early life risk factors; socio-economic status

for marketing to children. This method would be a useful way to determine whether food and beverage products can be marketed to US children.

**Keywords:** Food marketing; processed foods; public health nutrition; nutrient profiling.

**Conflict of Interest Disclosure:** ED, SWN and LST have no conflicts of interest.

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HOW DOES THE HEALTHINESS OF THE US FOOD SUPPLY COMPARE TO INTERNATIONAL GUIDELINES FOR MARKETING TO CHILDREN?

(1)Dunford, Elizabeth; (2)Ng, Shu Wen; (3)Taillie, Lindsey Smith.

(1)PhD. Research Fellow. The George Institute for Global Health. Australia.; (2)PhD. Research Associate Professor. The University of North Carolina at Chapel Hill. USA; (3)PhD. Research Assistant Professor. The University of North Carolina at Chapel Hill. USA.

**Background and objectives:** Background: Food marketing to children is pervasive and has been linked to increased preference and intake of unhealthy foods. The World Health Organization has developed the only multi-country nutrient criteria to identify foods that should not be marketed to children. However, it is unclear what proportion of the US food supply would be eligible/ineligible for marketing under these criteria.

**Objective:** To examine the proportion of US food and beverage products eligible for marketing to children under the WHO Europe Nutrient Profile Method (NPM).

**Methods:** Data for this study are from Label Insight's Open Access branded food database and were extracted in December 2016. Each product was assigned to one of the 21 NPM categories, and nutritional content of the food product cross-checked against the NPM criteria. As added sugars and non-sugar sweeteners are not declared in the Nutrition Facts Panel for US products, each item's ingredient list was checked for the presence of these ingredients. The number and proportion of US products meeting the NPM criteria for marketing to children was examined overall and by category.

**Results:** Out of 172,842 products, only 22% of US food and beverage products were eligible to be marketed to children. 100% of 'Fresh and frozen fruit, vegetables and legumes', and 0% of 'Chocolate and sugar confectionery, energy bars, and sweet toppings and desserts', 'Cakes, sweet biscuits and pastries', 'Edible ices', 'Juices' and 'Energy drinks' were eligible. Excluding those categories that the criteria specify are 100% eligible, 'Processed meat, poultry, fish' had the highest proportion of products eligible for marketing to children (56%) and 'Savory snacks' the lowest proportion.

**Conclusions:** The WHO Europe multi-country NPM does not allow the marketing of confectionery or sugar-sweetened beverages, and restricts less healthy non-discretionary items from being advertised, with only 22% of all packaged food products eligible

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WATCHING TV AND FOOD CONSUMPTION AMONG BRAZILIAN ADOLESCENTS: PENSE, 2015

(1)Enes, Carla Cristina; (2)Nucci, Luciana Bertoldi.

(1)PhD. School of Nutrition. Professor of postgraduate program in Health Sciences. Pontifical Catholic University of Campinas. Brazil.; (2)PhD. School of Medicine. Professor of postgraduate program in Health Sciences. Pontifical Catholic University of Campinas. Brazil.

**Background and objectives:** Evidence from cross-sectional studies has shown that excessive time in front of the TV has been associated with overweight and obesity in children and adolescents, since this practice has a negative influence on the dietary pattern of young people. The aim of this study was to investigate whether sedentary leisure time was associated with increased regular consumption of unhealthy foods, independently of socio-demographic indicators and family context.

**Methods:** We used data from the National School Health Survey (PeNSE 2015) conducted by a partnership between the Brazilian Institute of Geography and Statistics (IBGE) and the Brazilian Ministry of Health. The analysis included 101,807 students living in all regions of Brazil, including urban and rural areas and attending public and private schools. The outcome variable was sedentary leisure time, defined as watching more than two hours of TV daily. The target explanatory variables were regular consumption (≥5days/week) of sweets, soft drinks and processed meat. Odds ratios (OR) and 95% confidence interval (95%CI) were obtained by multiple logistic regression. Gender, participant's age, skin color, maternal education, administrative classification of the school and living with their mother and father were used as adjustment variables. All statistical analyses were performed using SAS® Studio, version 3.6 and commands were performed taking into account the complex sample design of PeNSE.

**Results:** Prevalence of sedentary leisure time was 59.8% (95% CI: 59.2-60.3). The regular consumption of sweets, soft drinks and processed meat was reported by 41.6% (95%CI: 41.1-42.2), 26.7% (95%CI: 26.2-27.2) and 31.3% (95%CI: 30.8-31.8) of adolescents, respectively. Regular consumption of unhealthy foods was statistically higher among adolescents who reported watching TV for more than two hours daily. The associations between the regular consumption of sweets, soft drinks and processed meat and watching more than two hours of TV daily were statistically significant be-
fore and after adjusting for sociodemographic characteristics and family composition.

**Conclusions:** The results highlight the need for integrated interventions to promote healthy leisure-time activities and healthy eating habits among adolescents to prevent negative health effects, particularly overweight and associated morbidities.

**Keywords:** Adolescent, food consumption, sedentary lifestyle

**Conclusions:** After multivariate adjustment, significant association was observed between IL-1β and UMFA. Although the vitamin is not metabolized, the presence of UMFA may indicate an adequate status because this form is only identified with saturation of the folate metabolism due to the excessive intake of this vitamin.

**Keywords:** Folic acid, unmetabolized folic acid, global DNA methylation, oxidative stress and inflammatory markers

144/893

## UNMETABOLIZED FOLIC ACID AND ITS ASSOCIATIONS WITH GLOBAL DNA METHYLATION, OXIDATIVE STRESS AND INFLAMMATORY MARKERS: ANALYSIS AFTER MANDATORY FORIFICATION OF FLOUR WITH FOLIC ACID

(1)Steluti, Josiane; (2)Carvalho, Aline M.; (2)Rogero, Marcelo M.;

(2)Fisberg, Regina; (2)Marchioni, Dirce.

(1)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (2)PhD. Department of Nutrition. School of Public Health. University of São Paulo. SP. Brazil.

**Background and objectives:** Folic acid fortification has increased dietary intake of folic acid and folate status, but it is also associated with the presence of unmetabolized folic acid (UMFA). Brazil has mandatory fortification of flours with folic acid since 2012 and recent study showed that 80% of population in São Paulo had presence of UMFA in plasma. Although the biological effects of UMFA are not well known, in the past several years, many researchers have reported potential adverse effects associated with high intake of folic acid. The present study aims to assess new associations with UMFA and health outcomes, considering oxidative stress (MDA and 8-oxo-dG), inflammatory markers (cytokines, CRP and adhesion molecules) and Global DNA methylation.

**Methods:** Data was from a cross-sectional population-based survey conducted in São Paulo, Brazil. UMFA was assayed by the affinity-HPLC method with electrochemical detection. Oxidative stress was estimated by malondialdehyde (MDA) concentration in the plasma using derivatisation with thiobarbituric acid and quantification by HPLC/diode array, and 8-OH-dG was assayed using ELISA kit. The CRP was determined by IMMAGE® system. We used the MILLIPLEX MAP 13-plex Cytokine Kit and Human CVD Magnetic Bead Panel 2 from Merck Millipore Corp to analyze the cytokines (IL-1β, IL-6, IL-8, IL-10, IL-12) and adhesion molecules (ICAM and VCAM), respectively. The global DNA methylation was estimated using hydrolysis of genomic DNA followed by specific detection and quantification of the 5-methylcytosine content. Analyses were performed using multivariate logistic regressions adjusted for smoking, sex, age and BMI.

**Results:** The odds ratios (95% CIs) in logistic regression were 1.02 (0.65;1.59) for MDA, 1.32(0.45;3.88) for 8-oxo-dG, 0.85 (0.54;1.33) for CRP, 1.79 (0.95;3.37) for ICAM, 0.95 (0.52;1.74) for VCAM, 0.44 (0.23;0.84) for IL-1β, 0.57 (0.31;1.07) for IL-6, 1.23 (0.66;2.26) for IL-8, 0.55 (0.29;1.02) for IL-10, 0.58 (0.31;1.07) for IL-12 and 0.65 (0.40;1.08) for Global DNA methylation.

144/1046

## QUANTITATIVE ASSESSMENT OF DIETARY SUPPLEMENT INTAKE IN 77 000 FRENCH ADULTS: IMPACT ON NUTRITIONAL INADEQUACY, EXCESSIVE INTAKE, AND EXTENT OF "AT RISK" PRACTICES

(1)Fassier, Philippine; (2)Egnell, Manon; (2)Srour, Bernard; (3)Vasson,

Marie-Paule; (4)Galan, Pilar; (2)Lécuyer, Lucie; (5)Latino-Martel, Paule;

(6)Hercberg, Serge; (5)Deschasaux, Mélanie; (7)Touvier, Mathilde.

(1)Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.;

(2)Ms. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.;

(3)PharmD. PhD. PU-PH. Clermont Université Auvergne. UFR Pharmacie. Inra, UMR 1019. CRNH Auvergne. Centre Jean-Perrin. CHU Gabriel-Montpied, Unité de Nutrition; (4)M.D. Ph.D. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (5)PhD. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (6)PhD. PU-PH. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.; (7)PhD. HDR. Nutritional Epidemiology Research Team (EREN). Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS) Inserm U1153 Inra U1125 Cnam Paris 13 University. France.

**Background and objectives:** Dietary supplements (DS) are largely consumed in occidental countries without having demonstrated their nutritional benefits and safety.

In a large population-based study of French adults: 1) to compare the prevalence of nutrient inadequacy and the proportion of individuals exceeding tolerable upper intake levels (UL) between DS users and non-users, and 2) to quantify the extent of potentially "at risk" DS use practices (e.g. DS/drugs contraindicated associations).

**Methods:** 76,925 participants to the NutriNet-Santé cohort completed a quantitative DS questionnaire and three 24h dietary records. A composition database including >8000 DS was developed. Variance reduction was applied to estimate usual intakes and analyses were weighted according to the French census data.
**Results:** DS highly contributed to total intakes among DS users of the specific nutrient (e.g. 52% for vitamin D, 21% for pyridoxine). Compared to dietary intakes only, their prevalence of inadequacy was reduced by 11% for vitamin C, 9% for magnesium, 6% for pyridoxine in men, and 19% for calcium, 12% for iron, 11% for magnesium in women (p<0.0001). The proportion of subjects exceeding UL reached 6% for iron and 5% for magnesium in men, and 9% for iron in women. 7% of DS users had potentially "at-risk" practices, such as DS-drugs contraindicated associations (e.g. niacin DS/anticoagulant drugs) or use of beta-carotene DS in current/past smokers.

**Conclusions:** While DS use contributed to decrease the prevalence of insufficient intakes for several nutrients, it also conveyed excessive intakes for iron and magnesium. Besides, a substantial proportion of potentially "at-risk" DS use practices was reported.

**Keywords:** Dietary supplements, nutrient inadequacy, tolerable upper intake levels, drug interactions

**Further collaborators:** Camille Pouchieu, Emmanuelle Kese-Guyot

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SCIENTIFIC PRODUCTION OF THE NATIONAL SCHOOL FOOD PROGRAM IN BRAZIL: A SYSTEMATIC REVIEW

(1)Canella, Daniela; (2)Quadros, Jhenifer; (3)Bandoni, Daniel.

(1)Department of Applied Nutrition. Rio de Janeiro State University. Rio de Janeiro. Brazil.; (2)Nutritionist, BSc. Department of Applied Nutrition. Rio de Janeiro State University. Rio de Janeiro. Brazil.; (3)Professor, PhD. Department of Health, Clinics and Institutions. Federal University of São Paulo. Santos. Brazil.

**Background and objectives:** The National School Food Program (Programa Nacional de Alimentação Escolar – PNAE) is one of the oldest nutrition programs in Brazil and is internationally recognized in the food and nutrition security area. The program offers meals free of charge to every student enrolled in public schools, as a strategy to guarantee the human right to adequate food. The objective of this study was to map, systematize and evaluate the scientific production about school food in Brazil.

**Methods:** A systematic review of literature was performed with the following guiding question: How is the scientific production on the National School Food Program in Brazil characterized?. The search for articles was made on Pubmed and Lilacs databases, using keywords related to school food and food and nutrition public policies. Studies made in Brazil were gathered, covering different aspects of PNAE. References of the selected articles were consulted in order to identify other relevant papers. The articles published until February 2016 were systematically reviewed and grouped in analytical categories. The results were described through relative frequency.

**Results:** From the articles found (2,839 non duplicated articles), 97 full articles were eligible and 16 were identified on references lists, adding up to 113 articles analyzed. The articles are

mostly originals (85,8%), quantitative (56,6%), conducted in the Southeast (31,8%) and the South (20,3%), and published from 2010 (67,2%). Six Brazilian public universities were responsible for 50,0% of the manuscripts analyzed. The objects studied were acceptability and adherence to school food (29.2%), evaluation of menu (27,4%), management and operation of the program (25,7%), professional training and action (14.2%), acquisition of products from family farmers (12.4%), sanitary aspects (8.8%) and others (8.0%).

**Conclusions:** The scientific production related to PNAE is growing, concentrated in some regions of the country, addresses several aspects even in different proportions, but is centered in quantitative approach.

**Keywords:** School feeding. School. National School Feeding Program. Nutrition programs and policies.

144/1104

IDENTIFYING SOURCES AND VARIABILITY OF IODINE IN COW'S MILK TO ENSURE ADEQUATE DIETARY IODINE INTAKES BY THE SWISS POPULATION

(1)Van der Reijden, Olivia; (2)Galetti, Valeria; (1)Hulmann, Marie;

(3)Haldimann, Max; (4)Schlegel, Patrick; (5)Kreuzer, Michael; (5)Bérard, Joël; (6)Manzocchi, Elisa; (7)Zimmermann, Michael Bruce; (2)Herter-Aeberli, Isabelle.

(1)MSc. Laboratory of Human Nutrition. Institute of Food, Nutrition and Health. ETH Zurich. Switzerland.; (2)PhD. Laboratory of Human Nutrition. Institute of Food, Nutrition and Health. ETH Zurich. Switzerland.; (3)MSc. Division of Risk Assessment. Federal Food Safety and Veterinary Office. Switzerland.; (4)PhD. Agroscope Posieux. Switzerland.; (5)PhD. Animal Nutrition. Institute of Agricultural Sciences. ETH Zurich. Switzerland.; (6)MSc. Animal Nutrition. Institute of Agricultural Sciences. ETH Zurich. Switzerland.; (7)MD. Laboratory of Human Nutrition. Institute of Food, Nutrition and Health. ETH Zurich. Switzerland.

**Background and objectives:** Like in many industrialized countries, the main dietary iodine sources in Switzerland are iodized salt and dairy products, with an estimated contribution of 54% and ≈30-40%, respectively. Current health policy calls for a reduction in per capita salt consumption from 9 to 5 g per day; thus, the dietary iodine contribution from dairy products will likely become more important. However, milk iodine concentration (MIC) varies widely, making milk an unpredictable source. Therefore, our research aim was twofold: 1) to survey the MIC from farms throughout Switzerland to determine the main factors determining MIC; and 2) to establish the dose-response relationship of iodine intake of cows and MIC at five different supplementation levels feeding a forage-based diet.

**Methods:** In study 1, we collected bulk milk samples from 32 farms (n=126) over a period of one year. From each farm, prior to the milk samplings, we sampled all diet components (n=305) including water and completed a questionnaire regarding feeding
and practices of disinfection with an iodine containing teat dip. In study 2, we supplemented 5×5 lactating cows with either 0 or 0.5, 0.7, 1 and 2 mg I/kg dietary dry matter (DM) for 21 days, and weekly collected milk (n=125) and feed samples (n=10).

**Results:** In study 1, the overall median (IQR) MIC was 87 (42-134) µg/L. Season had a significant effect on MIC, with the lowest and highest concentration found in September and March, respectively (p<0.001). Furthermore, MIC was elevated (p<0.01) by the use of iodine containing teat disinfectants. In study 2, dietary and milk iodine correlated strongly and positively on each sampling day (r^2>0.89, p<0.001). The milk iodine concentration was ≈150 µg/kg at a dietary iodine concentration of 1 mg I/kg dietary DM of the cow.

**Conclusions:** We will use these data with current estimated milk and dairy product intakes in target groups (young women and children) to model iodine intakes to set feeding recommendations for dairy cows and revise guidelines for milking to ensure milk and milk products remain reliable sources of dietary iodine.

**Keywords:** Milk iodine, Cow's milk, Swiss population, Recommendations, Dose-response.

COMPLEMENTARY FEEDING IN RURAL BANGLADESH: OUTCOMES FROM THE IMPROVING MATERNAL, NEONATAL AND CHILD SURVIVAL PROGRAMME

(1) Mohammed, Mahmood Kazi; (2) Hossain, Elora; (3) Khanam, Reshma; (4) Afsana, Kaosar.

(1) MBBS MPH. Senior Medical Officer. Health, Nutrition and Population Programme. BRAC. Bangladesh; (2) BDS MPH. Senior Sector Specialist. Health, Nutrition and Population Programme. BRAC. Bangladesh; (3) MBBS MPH. Manager. Health, Nutrition and Population Programme. BRAC. Bangladesh; (4) MBBS MPH PhD. Director. Health, Nutrition and Population Programme. BRAC. Bangladesh.

**Background and objectives:** Improving maternal, neonatal and child survival (IMNCS) programme of BRAC is a comprehensive community based health intervention focusing on preventive and curative care with a group of trained community health workers with the goal to reduce maternal, neonatal and child mortality, particularly among the poor and socially excluded populations in rural Bangladesh. The programme is reaching 25 million people living in 14 districts of Bangladesh with reproductive, maternal, neonatal child and adolescent health (RMNCAH) services.

This abstract intends to demonstrate the achievement of nutritional interventions of the programme of 2015. Principal nutritional interventions of the programme includes initiation of exclusive breast feeding, tracking of continuation of breast feeding, initiation of complementary feeding, tracking of consumption of adequate amount of food and consumption of animal protein by the community health workers.

**Methods:** The data indicated here are taken from the management and information system of the IMNCS programme.

**Results:** Data from January to December of 2015 reveals that, 501,834 (93%) of the neonates were successfully initiated breast feeding within one hour of their birth. However, 346,105 (83%) infants continued exclusive breast feeding.

The Shasthya Kormis (SKs) who are the community health workers of BRAC, counsel the mothers and her relatives about complementary feeding and consumption of different animal proteins for the development of the child through regular household visits. 404,166 (83%) children were successfully initiated complementary feeding in the catchment area of the programme. 290,135 (60%) children aging 6 months and above consumed appropriate amount of food. 325,558 (67%) children aging 6 months and above consumed animal protein which is a remarkable achievement despite prevailing superstitions in the community to feed different animal proteins to the children.

**Conclusions:** The impact of 9 years of the nutritional interventions of IMNCS programme on 25 million people shows clear evidence on improving the status of child nutrition which proves the interventions promising. Scaling up of the programme intervention to other regions will have a substantial effect in ensuring healthy lives for millions of children.

**Keywords:** Complementary feeding, public health nutrition, child health, paediatric nutrition

**Conflict of Interest Disclosure:** The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

NUTRITIONAL KNOWLEDGE SCALE FOR EUROPEAN ADOLESCENTS USING ITEM RESPONSE THEORY

(1) Sabrina Souza Santos, Thanise; (2) Julian Almarcegui, Cristina;

(3) Slater Villar, Betzabeth; (4) Widhalm, Kurt; (5) Gonzalez Gross, Maria Marcela; (6) Piccinelli, Raffaela; (7) Moreno, Luis A.

(1) MSc. Nutritionist.; (2) MSc. Nutritionist. Growth, Exercise, Nutrition and Development (GENUD) Research Group. University of Zaragoza. Spain.; (3) PhD. Nutritionist. Public Health Faculty. University of São Paulo. Brazil.; (4) PhD. President. Academic Institute for Clinical Nutritional. Austria.; (5) PhD. Teacher. Department of Health and Human Performance. Universidad Politécnica de Madrid. Spain.; (6) Council for Agricultural Research and Economics. Research Center on Food and Nutrition. Italy.; (7) PhD. Researcher. Growth, Exercise, Nutrition and Development (GENUD) Research Group. University of Zaragoza. Spain.

**Background and objectives:** The item response theory (IRT) has several advantages compared with classical test theory approaches and can be used to evaluate the precision of tests in Nutritional Sciences. The aim of the study was to develop a nutritional knowledge scale from a validated nutritional knowledge test (NKT) using the IRT.
**Methods:** 3215 adolescents of the HELENA study, 12.5-17.5 y, who completed >75% of the NKT and did not answer all the questions right or all the questions wrong were included in the analyses. The NKT consisted of twenty-three multiple-choice questions with four possible answers including the 'don't know' category. The dimensionality of the questionnaire was analyzed by the polychoric correlation matrix in factorial analysis with estimation by principal components analysis. The answers were analyzed by the three parameters logistic model. Discrimination, difficulty and guessing parameters and scores (measure of the construct) were estimated in scale (0,1). IRT parameters were estimated using Bilog-MG software. Other analyses were performed using Stata version 14.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(3)PhD. Department of Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany; (4)Department of Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany; (5)Department of Food Safety. Federal Institute for Risk Assessment. Berlin. Germany; (6)Prof. Department of Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany; (7)Prof. Department of Molecular Epidemiology. German Institute of Human Nutrition Potsdam-Rehbruecke. Nuthetal. Germany.

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

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

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

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

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

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

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

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

(4)Largaespada, Natalia.

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

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

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

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

**Results:** The overall prevalence of anemia (<12 g/dL) was 21.8% (95%CI 18.3, 25.8), ID (<15 µg/L) 12.0% (95%CI 9.0, 15.8);