Chilean Mediterranean Diet Index (Chilean-MDI, range from 0-14 points), physical activity using IPAQ, and current smoking.

**Results:** In this study sample, 44% of Chilean adults displayed high wellbeing measured by MHC, and higher MHC scores were found among older than younger people. MHC correlated with optimism, but not subjective vitality. Regarding lifestyle, only 21% of the sample exhibited a healthy eating behavior based in high adherence to MD (Chilean-MDI ≥9 points), 27% reported low physical activity and 32% were smokers. Healthy eating -defined as a high Mediterranean diet score- was significantly associated with all wellbeing measures. In addition, people with higher wellbeing showed a healthier overall lifestyle.

**Conclusions:** Our findings support a link between wellbeing and different components of a healthy lifestyle behavior in Chile. Interventions aimed to increase wellbeing may lead to a better lifestyle as well as reduced risk of chronic diseases. Supported by Fundación Banmédica.

**Keywords:** Mediterranean diet, healthy lifestyle, Psychological wellbeing, Mental health continuum, chronic diseases prevention

**Background and objectives:** Edorexy is a recent term, and refers to episodes of appetite produced by various forms: “addiction” to food, stress or by anxious / depressive episodes. Eating disorders often occur in athletes, and can affect the performance of players. Therefore, we determine the frequency of edorexy, nutritional status and body composition in soccer players.

**Methods:** We conducted a cross-sectional study of 36 male players from the Intermediate Division, who play soccer at Club Tacuary during May and July 2016. We evaluated edorexia using the self-administered questionnaire of López Morales (2013). We used the ISAK procedure for anthropometric measurements.

**Results:** We found that median age was of 22 years. The average of fat mass percentage (% FM) was 24.3 ± 4.0% (High) and fat-free mass (% FFM) was 38.1 ± 2.6% (Adequate). Mesomorphic and meso-endomorphic component was the mostly frecuent, not suitable for the type of sport practiced. The psychological data of the Edorexy Inventory showed an overall score of 50.2 ± 7.0pts. Risk of having edorexy syndrome was present in 19/36 of the players surveyed and 8/36 players were diagnosis with edorexy syndrome. The players with edorexy have lower % FFM (difference 2.80%, p = 0.021) and higher % FM (difference 4.40%, p=0.033).

**Conclusions:** We find that in soccer players the % FM is above the recommendations for this sport.

**Keywords:** Eating disorder, soccer, somatotype, body composition

**Background and objectives:** This study aimed to characterize the customers of a self-service commercial restaurant concerning the consumption beverages.

**Methods:** We investigated individuals of both sexes who have eaten lunch at a self-service restaurant located on a university campus in Rio de Janeiro-RJ. Participants fulfilled a personal data form and semi-quantitative questionnaire on beverage consumption, which was evaluated according to its validity and reproducibility. The consumption of beverages was classified as: did not consume beverages (no-beverage), consumed water, sugar sweetened beverages (SSB), low-calorie beverages. Data were stratified for sex, age, position related to the university, and physical activity. Statistical analyzes were performed using the chi-square test considering the statistical significance p-value <0.05.

**Results:** 143 individuals were investigated (mean age = 32 years, standard deviation = 11), 59% were men, 44% practiced physical activity regularly, 57% were university students, 26%, university staff or faculty, and 17%, external workers. It was observed that 36% of the participants did not consume any drink at lunch, 28% consumed SSB, 27% consumed water, and 9%, low-calorie beverages. Compared to men, a higher proportion of women did not consume any beverage on the day investigated (45% vs. 30%). The consumption of SSB was more frequent in men than in women (36% vs. 15%, p = 0.04). Individuals over 45 years old had higher consumption of SSB (35%) when compared to those younger than 25 years old (29%). Those who reported regular physical activity practice had higher proportion (49%) of no-beverage at lunch than those who were not active (20%). Conversely, those who did not perform physical activity regularly reported consuming SSB (48%) more frequently than their counterparts (21%). Among the external workers, there was higher frequency of no-beverages

<footnote>(1)Aguilar Rabito, Ana Carolina; (2)Casaccia Torres, Gustavo Gabriel;</footnote>

<footnote>(2)Méndez Molas, Silvia Lorena; (3)Morínigo Martínez, Macarena.</footnote>

<footnote>(1)Nutritionist, MSc. Department of Nutrition Research. Faculty of Chemical Sciences. National University of Asuncion. Paraguay;</footnote>

<footnote>(2)Nutritionist. Faculty of Chemical Sciences. National University of Asuncion. Paraguay; (3)Nutritionist. Department of Nutrition Research. Faculty of Chemical Sciences. National University of Asuncion. Paraguay.</footnote>

<footnote>(1)Reino, Alice; (2)Cnop, Mara; (3)Oliveira, Aline; (4)Santos, Vitória;</footnote>

<footnote>(4)Alves, Iuna; (4)Silva, Merilin; (3)Paula, Nilma; (3)Pereira, Rosangela A;</footnote>

<footnote>(3)Marins, Vania.</footnote>

<footnote>(1)Bsc. Instituto Josué de Castro. Universidade Federal do Rio de Janeiro. Brazil; (2)MSc. Nutricionist. Instituto de Nutrição Josué de Castro. Universidade Federal do Rio de Janeiro. Brazil; (3)PHd. Nutricionist. Instituto de Nutrição Josué de Castro. Universidade Federal do Rio de Janeiro. Brazil; (4)BSc. Nutricionist. Instituto de Nutrição Josué de Castro. Universidade Federal do Rio de Janeiro. Brazil.</footnote>
(46%) when compared to students (33%) and university staff and faculty (35%).

**Conclusions:** There was high consumption of sugar-sweetened beverages and the results point out to the need of interventions aiming to healthy beverages consumption in commercial restaurants.

**Keywords:** beverages, sugar sweetened beverages, university, healthy eating promotion, food consumption.

obese. An increased risk of BC of 42% was observed for each unit of increased in the inflammatory diet score in this group (Odds Ratio: 1.42; Confidence Interval: 1.1-1.84).

**Conclusions:** Obese women with an inflammatory diet have a greater risk of BC in Córdoba (Argentina).

**Keywords:** Inflammatory diet index - Obesity - Breast cancer - Argentina - case-control study.

## ASSOCIATION BETWEEN INFLAMMATORY DIET SCORE, OBESITY AND BREAST CANCER IN CÓRDOBA, ARGENTINA

(1)Becaria Coquet, Julia; (2) González, María Florencia; (2) Caballero, Víctor Ramón; (2) Camisasso, María Cecilia; (3) Tumas, Natalia; (4) Niclis, Camila; (4) Román, María Dolores; (5) Díaz, María del Pilar; (4) Muñoz, Sonia Edith; (6) Aballay, Laura.

(1)BSc. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba (UNC). Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Argentina.; (2) BSc. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba . Argentina.; (3) 3PhD. Centro de Investigaciones y Estudio sobre Cultura y Sociedad (CIECS). Universidad Nacional de Córdoba. CONICET. Argentina.; (4) PhD. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Argentina.; (5) PhD. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba . Argentina.; (6) PhD. Escuela de Nutrición. Facultad de Ciencias Médicas.Universidad Nacional de Córdoba . Argentina.

**Background and objectives:** Breast cancer (BC) is a multifactorial disease; several environmental factors have been linked to this pathology. Specifically, obesity and inflammatory diet have been associated with an increased risk of BC in women. Endocrine changes related to these factors trigger an inflammatory response, which favors the occurrence of BC. The aim of this research was to assess the association between the consumption of an inflammatory diet and BC risk, taking into account nutritional status, in Córdoba province (Argentina).

**Methods:** A case-control study was conducted during 2008-2016 period (346 cases of BC and 566 controls). An inflammatory diet score was developed including 15 dietary variables (nutrients and food groups consumption), obtained through a validated FFQ. A score (0, 0.5 or 1) was assigned for each variable included in the score depending on the compliance of dietary recommendations. A higher score indicated a higher degree of adherence to an inflammatory diet. For each woman an inflammatory score was calculated. A multiple logistic regression model was performed to assess the association between BC occurrence and inflammatory diet, stratifying by nutritional status.

**Results:** The inflammatory diet score mean was 6.7 (0.9) in all women included in the study. 20% of the women studied were

## EVALUATION OF HYDRATION STATUS OF A BRAZILIAN FLAG FOOTBALL TEAM

(1) Parise Polo, Gabriela; (1) Lekevicius Consolin, Brunna; (2) Marques Rossi, Luciana; (3) Rodrigues, Tânia; (2) Barrella, Ana Beatriz.

(1) Nutrition Student. Centro Universitário São Camilo. Brazil.;

(2) PhD. Department of Food Science and Experimental Nutrition. Faculty of Pharmaceutical Sciences. University of São Paulo. Brazil.; (3) BSc. Nutritionist. RGNutri Consultoria em Nutrição. Brazil.

**Background and objectives:** The Flag Football holds many similarities to rugby, but with less contact and with the difference that the play has to stop when a flag is withdraw from the side of the players' bodies. For being an outdoor sport, the body temperature can rise significantly, dissipating more heat to the environment and therefore requiring a greater hydration control. According to the percentage of body dehydration in relation to the weight variation, the physiological effects can lead to compromised performance. Thus, this study aimed to identify the status of hydration after Flag Football training.

**Methods:** We evaluate 17 female athletes from a Brazilian Flag Football team, aged 26,24 ± 3.8 years. This work was approved by the Ethics and Research Committee of Centro Universitário São Camilo, Brazil. A bioelectrical impedance was used to obtain body mass before and after training. To evaluate the hydration status, it was calculated the percentage of weight variation (%WV). Variables such as self-reported height (m) and percentage of body fat (%BF), calculated by body density (BD) through the sum of three skinfolds, were also collected. The hydration during the training was performed with water ad libitum and the amount ingested was accounted in the %WV.

**Results:** The average high and body fat was 1,65 ± 0,03 m and 23,23 ± 6,87%. Regarding the weight variation, at the end of training eight athletes has gained weight (0,72 ± 0,51%) and eight has lost (0,50 ± 0,36%). Only one player neither gained nor lost weight. As a weight variation was between ±1%, the athletes finished training normohydrated.

**Conclusions:** The post training hydration status showed that the fluid replacements strategies were adequate. Given the importance of being adequately hydrated, nutritional counseling and follow-up become essential to avoid detriment to athlete's health and performance.

**Keywords:** Hydration. Dehydration. Football. Physical Activity.
NUTRITIONAL PROFILE OF PRE-SCHOOL CHILDREN, SCHOOLCHILDREN AND TEENAGERS FROM PUBLIC SCHOOLS IN THE GUARULHOS CITY. BRAZIL

(1)Nuzzo dos Santos, Letizia; (2)Korukian Freiberg, Clara; (2)Pelliciari, Maria Christina; (2)Toscano Ferreira, Rosana; (2)Araujo, Mariangela; (2)Gomes Fiore, Elaine; (2)Paulino Machado, Adriana.

(1)MSc. Nutricionist. Guarulhos University. Nutrition Department. Guarulhos. São Paulo. Brazil; (2)MSc. Nutricionist. Nutrition Department. Guarulhos University. Guarulhos. SP. Brazil.

**Background and objectives:** Front of the epidemiological scenario of Brazil indicating increased obesity in all age groups including children and adolescents, to diagnose the health and nutritional status of schoolchildren in the city of Guarulhos to guide the municipal departments of health and Education in educational programmes and to intervene in possible deviations found. Such a problem is alarming and affects several countries, necessitating effective interventions to minimize the above panorama. The main objective of this study was to identify the health and nutritional status of pre-school children, schoolchildren and teenagers, that attend public schools in Guarulhos City, aged 5 to 12 years.

**Methods:** Cross-sectional study, approved by the Committee of ethics in research. The study was carried out in 09 schools, located in central and peripheral region of the city, with 3612 students with anthropometric measurements assessment of weight and stature. The nutritional evaluation was based on indicators stature/age and BMI/age, expressed as z-score, and being adopted as the standard reference WHO (2007).

**Results:** The IMC showed that among the Group of children named preschoolers and schoolchildren, 1.27% are with low weight, while 16.33% and 13.02% showed overweight and obesity respectively. As for teenagers, 1.97% presented low weight, while 18.34% and 12.98% showed overweight and obesity respectively. There were no statistically significant differences between boys and girls in both of groups: children and teens. The data of obesity were more consistent in the schools located at the central region of the city where social conditions are more favorable. Height for age, with 95% confidence, was about 97.76% of children and 97.18% of the adolescents.

**Conclusions:** The data confirm the decline in child malnutrition and the increasing prevalence of overweight and obesity. The stature of the almost whole population was adequate. The study was presented to the Health and Education Departments of the municipality to corroborate with the public policies of intervention and health promotion, showing the importance of this partnership so that intervention programmes are actually implemented.

**Keywords:** Nutritional status. Child obesity.

SCHOOL-FOOD ENVIRONMENT REVIEW AND SUPPORT TOOL (SCHOOL-FERST): A NATIONAL SURVEY OF POLICY AND PRACTICE IN NEW ZEALAND SCHOOLS

(1)D'Souza, Erica; (2)Vandevijvere, Stefanie; (3)Swinburn, Boyd.

(1)MCS. PhD candidate. The School of Population Health. The University of Auckland. New Zealand.; (2)Phd. Research Fellow. The School of Population Health. The University of Auckland. New Zealand.; (3)MD. Professor. The School of Population Health. The University of Auckland. New Zealand.

**Background and objectives:** Research consistently demonstrates the positive links between healthy school environments, educational outcomes and student well-being. Yet New Zealand (NZ) school food and nutrition environments are not consistently monitored and evaluated. A valid, efficient and valuable monitoring and feedback system is needed to show trends in the healthiness of NZ school food environments and to stimulate action.

**Methods:** Participants from 819 (Response Rate = 33%) primary, intermediate, secondary and composite schools completed a cross-sectional, validated school food survey (School-FERST). Policies were analysed using an adapted version of the Well-SAT tool. Canteen menus were analysed using the national Food and Beverage Classification System for NZ schools, and a sample of menus from Auckland, Taupo, Christchurch and Timaru schools (n=54) were validated using fieldworker observations. Key informant interviews (n=18) were conducted to ascertain the best ways in which to give feedback to schools.

**Results:** Forty percent of schools stated they had a food and nutrition policy. Most of these policies (n = 146) were vague, lacked comprehensiveness and contained weak statements. Seventy one percent of schools sold food and beverages to students during the school day, with 58% offering only milk and water as beverage options. The average menu score was 2 out of 5, indicating only 20-40% of items on canteen menus were 'healthy'. A large proportion of schools (81%) used food and beverages for fundraising with 90% of these schools using 'unhealthy' items. Most schools had fruit orchards and/or vegetable gardens (80%), included nutrition education in curriculum (90%), are not sponsored by food and beverage companies (94%), and do not have commercial advertising on school grounds (97%). Key informant interviews revealed that schools engaged with comparative, visual feedback with minimal text. They also noted the usefulness of recommendations and positive stories from other schools.

**Conclusions:** School food and nutrition policies remain weak, and canteen and fundraising menus remain largely unhealthy. Students remain exposed to inconsistent messages and practices across the school that contribute to unhealthy food choices. Therefore a sustainable monitoring and feedback system is required to initiate change and improve outcomes over time.

**Keywords:** school food, food environment, obesity prevention, food policy
# SYSTEMS MAPPING OF UNHEALTHY FOOD ENVIRONMENTS IN AUCKLAND SCHOOLS: A CASE STUDY

(1)D'Souza, Erica; (2)Swinburn, Boyd; (3)Vandevijvere, Stefanie.

(1)MCS. PhD candidate. The School of Population Health. The University of Auckland. New Zealand.; (2)MD. Professor. The School of Population Health. The University of Auckland. New Zealand.; (3)PhD. Senior Research Fellow. The School of Population Health. The University of Auckland. New Zealand.

**Background and objectives:** Group model building (GMB), a method of systems science, is a systematic process of involving key stakeholders in a structured process to create mental maps of their relevant food systems and combining these into one overall causal loop diagram (CLD). By having multiple stakeholders around the table, this process fosters mutual understanding, shared insights, consensus, motivation for implementing the results and catalyses change. Systems science was used to build a CLD to understand the complexity of school food systems, and identify sustainable, low-burden intervention points that can be easily embedded into an already existing system. This is the first time systems science was used to understand unhealthy food environments in Auckland schools.

**Methods:** GMB sessions were conducted in two schools. Each session consisted of three workshops spread over 6-8 weeks. Schools nominated a group of representatives (staff, students, parents, canteen providers, etc.) to participate in building a CLD to identify the causes and effects of an unhealthy food environment. Using a set of engagement activities, scripts and software participants created a visual map of their school food environment to build shared understanding, allowing them to better able to identify leverage points for a healthier environment.

**Results:** Participants developed a CLD that represented their own perceptions of the contributors and causes of unhealthy food environments at their school. Several themes were identified, each unique to the individual school but transferrable to other schools in their community, due to their shared lived environments. Schools identified intervention points, as the dynamic CLD allowed them to envision the possible outcomes of such interventions.

**Conclusions:** This participatory process empowered schools to take ownership while motivating them to act as agents of change. It allowed them to visualize, process and plan a prevention response that engages with multiple levels of their school food system, allowing for the best possible chance at achieving sustainable positive outcomes.

**Keywords:** schools, food environment, systems dynamics, participatory research, obesity prevention

# AVAILABILITY OF ADEQUATELY IODIZED SALT IN PARAGUAYAN HOUSEHOLDS DURING 2011-2015

(1)Ledesma Solís, Erik Marcelo; (2)Sánchez Bernal, Susana.; (3)Masi, Celia.

(1)Medical Doctor, MD, MSc. Faculty of Medical Sciences. National University of Asuncion. Paraguay; (2)MD, MSc. Institute of Food and Nutrition. Ministries of Public Health and Social Welfare. Paraguay; (3)Nutritionist. MSc. Institute of Food and Nutrition. Ministries of Public Health and Social Welfare. Paraguay.

**Background and objectives:** Iodine Deficiency Disorders (DDY) has been an endemic problem in Paraguay due to the low Iodine content in its land considering that it's a Mediterranean country. The main strategy for the sustained elimination of IDD has been the universal salt iodization. Determine the availability of adequately iodized salt in Paraguayan households during 2011-2015.

**Methods:** Descriptive cross-sectional study with secondary data.

**Results:** 12.126 salt samples distributed in the five year period were included. The fine salt was the most frequently consumed; most samples came from urban areas and the origin was mainly national. Adequate iodine values remained above 52% during the study periods, showing a value of 57, 9% in 2015. During the five year period, iodine deficiency was higher in rural areas and in unregistered salt samples ($\chi^2p<0,05$). According to the geographical area, iodine deficiency was variable across the five year period. Deficiency levels have shown a tendency to increase (4,7% en 2011 vs. 34,3% en 2015, $\chi^2 p=0,0001$), while excessive levels have declined (35,6% en 2011 vs. 7,7% en 2015, $\chi^2 p=0,0001$). Mean values of salt iodine content have decreased showing a median of 23 ppm in 2015, significantly lower than previous years (Kruskal Wallis $p=0,0001$).

**Conclusions:** 6 of each 10 households have an adequately iodized salt consumption. Iodine deficiency in salt is mainly concentrated in rural areas and in unregistered samples. This represents a public health problem that needs to be addressed.

**Keywords:** salt, iodine, iodine deficiency, households

**Further collaborators:**

Johana Meza Paredes
Patricia Velazquez Comelli
INFANT AND YOUNG CHILD FEEDING PRACTICES AND NUTRITIONAL STATUS OF 6-24 MONTHS-OLD IN GREATER ACCRA REGION, GHANA

(1)Berko Nartey, Eunice; (1)Koryo-Dabrah, Alice; (2)Adedia, David.

(1)MPhil. Registered Dietitian. Department of Nutrition and Dietetics. University of Health and Allied Sciences. Ho. Ghana;

(2)MPhil. Mathematician. Department of Nutrition and Dietetics. University of Health and Allied Sciences. Ho. Ghana.

**Background and objectives:** Good nutrition is the basis for child survival, physical growth, mental development, performance, productivity, health and general well-being throughout human life (WHO, 2016). The research assessed the caregivers' infant feeding practices and nutritional status of their 6-24-month-old children.

**Methods:** Cross-sectional survey using stratified random sampling technique was used to select 408 children from eight health facilities in the Greater Accra Region of Ghana. Dietary data was collected using the 24-hour recall and analysed using the Esha Fpro for nutrient analysis. The WHO Anthro software (version 3.2.2) was used to generate indices of nutrition (stunting, wasting, underweight, and obesity) from weight (kg) and length/height measurements (cm).

**Results:** The study showed that caregivers' age (p=0.058), education (p=0.00), employment status (p=0.00), spouse's financial support (p=0.00), alternative means of care (p=0.00), hygiene (p=0.026; p<0.05), and source of knowledge of infant feeding (p=0.017), as well as age of their child (p=0.005), significantly influenced nutritional status. Infant feeding practices that was found to significantly influence nutritional status included, duration of exclusive breastfeeding (p=0.01), safe preparation and storage of food (p=0.00). In comparison to the Dietary Reference Intakes, only children from Osu recorded above the RDA for calories (963.6kcal), fat (48.6g), and Ridge for protein (27.9g). However, about 63% of the infants and young children who participated in the research did not meet their iron and zinc requirements. Food items that significantly contribute to the nutritional status, include cereals (p=0.014), animal protein (p=0.020), vegetables (p=0.004), fruits (p=0.034), and fats & oils (p=0.048). In total, 12.5% of IYC were found to be underweight, 9.4% wasted, and 41.5% stunted, whilst 17% of the infants were overweight. Highest incidences for stunting, wasting and overweight were recorded by children in Adabraka (38.6%), Osu (21.6%), and Tema (33.3%).

**Conclusions:** Malnutrition is still prevalent in Greater Accra, showing a worrying increase in the double burden of stunting and obesity. The findings of the study will contribute to having targeted interventions to improve IYCF practices in especially the Greater Accra region of Ghana. When malnutrition is minimized through improved infant feeding practices it may lead to better socio-economic development for sustainable quality life.

**Keywords:** Child Feeding Practices, Nutritional status, Dietary Reference Intakes

KNOWLEDGE, INTERPRETATION AND USE OF FRONT OF PACK LABELLING OF FOODS AND BEVERAGES IN COLLEGE STUDENTS FROM MEXICO CITY

Morales-Zárate, Maricruz; Bahena, Liliana; Tolentino Mayo, María Lizbeth.

Instituto Nacional de Salud Pública. Mexico.

**Background and objectives:** Several international organizations recognize the Front of Pack Labelling of Foods and Beverages (FoPL) as a Public Health strategy to fight overweight (OW) and obesity (OB), a regulatory measure that has already been implemented in several countries. The objective of this study was to explore and identify the degree of knowledge, interpretation and use of FoPL, mainly from the Guideline Daily Amounts (GDA's) system, in college students.

**Methods:** Data was obtained from 97 college students from Mexico City who answered a questionnaire. This included previously validated questions divided into four sections: 1) general knowledge of FoPL, 2) interpretation of GDA's, 3) use of GDA's for purchase decision and 4) interpretation and preference of GDA's (Mexican) vs. octagonal labeling (Chilean). In addition, information on height and weight was collected by self-report and the body mass index (BMI) was calculated as kg/m2.

**Results:** The prevalence of OW or OB in the overall sample was 30.2%. From the total population, 39% answered correctly the amount of daily average calories that should be eaten (2500 kcal). 94% reported consumption of products with FoPL, predominantly of dairy products (73.1%), sweet snacks (72%) and salty snacks (63%); 31.9% reported buying products with FoPL due to nutritional information and 17.5% for claims. The GDA's was familiar mainly to women (65.5%) and subjects with OW (64.9%) and OB (33.3%). However, 86.9% of the women and 85.9% of the men did not interpret correctly the GDA's, and the same happened with 70.4% of the people with OW and OB. The highest GDA's interpretation score was in the age group of >24 years (25%). It was found that 11.4% of the women and 8.3% of the men purchase based on the GDA's. None of the obese respondents uses GDA's to buy their products. Finally, 71% of the respondents preferred octagonal labeling.

**Conclusions:** Including the FoPL in the Mexican legislation is a good first step. However, it's necessary a full impact assessment of the labeling regulation, with the intention of developing a tool that supports consumers on having a comprehensible, complete and reliable source of dietary information.

**Keywords:** Front-of-Pack Labelling, Food-packaged, regulation, GDA's.
# EATING OUT AND THE CONSUMPTION OF ULTRA-PROCESSED FOOD AMONG BRAZILIAN ADOLESCENTS AND ADULTS

(1)Andrade, Giovanna; (2)Gombi-Vaca, Maria Fernanda; (3)Levy, Renata.

(1)Nutritionist. Departamento de Medicina Preventiva. Universidade de São Paulo. Brazil.; (2)MPh. Departamento de Medicina Preventiva. Universidade de São Paulo. Brazil.; (3)PhD. Departamento de Medicina Preventiva. Universidade de São Paulo. Brazil.

**Background and objectives:** Background: Eating out has been related to higher consumption of food characterized by high degree of processing, such as soft drinks, sweets and fast foods.

Objectives: To describe food consumption away from home and at home, according to the purpose and extension of industrial food processing. Evaluate the association between eating out and consumption of ultra-processed food.

**Methods:** Cross-sectional study using the 2008-2009 Brazilian Dietary Survey, carried out with 34,003 individuals aged 10 years or older. Food items were classified in food groups using the NOVA classification. Eating out was evaluated through two indicators: percentage of calories eaten out and frequency of days each individual reported eating out. Both indicators were described according to sociodemographic characteristics. Percentage of food calories per food group was estimated according to location of consumption. Multilevel model was used to evaluate the association between eating out and the participation of ultra-processed food in the diet.

**Results:** Although most of the calories consumed away from home in Brazil come from the culinary preparations food group, there were a higher contribution of calories from ultra-processed food when away from home, especially from items such as soft drinks and ready-to-eat meals. Compared to consumption at home, eating out increased the consumption of ultra-processed food by 51%.

**Conclusions:** In Brazil, eating out was associated with ultra-processed food consumption. In order to discourage consumption of ultra-processed food away from home, public policies such as food taxation and limitation of sales outlets should be considered.

**Keywords:** Eating out; Ultra-processed food; Multilevel analysis.

# FORMULATION AND NUTRITIONAL EVALUATION OF COMPLEMENTARY FOODS PREPARED FROM MAIZE, SORGHUM, GROUNDNUT, CRAYFISH, AND BEANS

(1)Abisola, Akano; (2)Olusoga, Olusanya; (3)Adegoke, Odusina;

(4)Adebukola, Catherine; (5)Opeyemi, Wahab.

(1)Phd Human Nutriton. Tai Solarin University Of Education Ogun. Nigeria; (2)Phd Human Nutrition. Tai Solarin University Of Education. Nigeria; (3)Phd Agric Economics. Tai Solarin University Of Education. Nigeria; (4)Phd Human Nutrition. Federal University Of Agriculture Abeokuta. Nigeria; (5)Msc Chemistry. Tai Solarin University Of Education Ogun. Nigeria.

**Background and objectives:** Undernutrition among infants has risen to such an extent that it has become a major public health problems especially in the developing countries. In many developing countries, the traditional complementary foods are the gruels prepared from cereals. The gruels from these cereals had been found to be of poor nutritional value, this is majorly responsible for high prevalence of undernutrition, notably protein-energy malnutrition (PEM) in Nigeria. The objective of this study was to formulate and prepare cheap and nutritious local complementary foods that can be used by Nigerian mothers

**Methods:** The study was an experimental study. Sorghum (Sorghum bicolor), maize, cowpea and (Vigna unguiculata), groundnut and crayfish were obtained from a local market in Ijebu-ode, Nigeria. The sorghum and maize were manually cleaned and were processed into flour using standardized fermentation and germination methods as described by (Ariahu, et al 2009), beans was processed using boiling method, groundnut, roasting method and crayfish drying method. The dried form of the items were dry milled into flour and packed into hermetically sealed container, eighteen samples were derived from the flour and thereafter, proximate and sensory analyses were conducted and results were presented in tables.

**Results:** The results of the proximate analysis of the complementary foods (CFs) showed that the moisture content of the CFs ranged from 4.00±1.79% for samples 1 to 9.12% for sample 10. The crude protein content ranged from 17.84±1.12% for samples 16 to 25.63v±0.89% for sample 6. The crude fibre content ranged from 1.64±0.36% to 4.63±2.89%. The antinutrient content of the complementary foods (phytate, oxalate and trypsin inhibitor) were determined. The phytate content ranged from 0.09±0.00mg/100g in sample 13 to 4.95±0.41mg/100g in sample 10. The results of the sensory evaluation of the best six complementary foods with the highest protein contents were conducted. In terms of colour and overall acceptability, sample 4 was most acceptable (7.76 and 7.67 respectively) and was more significantly different from others.

**Conclusions:** The protein content of the complementary foods increased as the content of both legumes increased since the content of the crayfish was constant.

**Keywords:** Complementary food, Malnutrition, Proximate analyses, Sensory Analyses
DETERMINANTS OF UNDERNUTRITION AMONG
YOUNG CHILDREN IN SOTNIKUM OPERATION
DISTRICT, SIEM REAP, CAMBODIA

(1)Blaney, Sonia; (2)Main, Barbara; (3)Chhorvann, Chhea; (4)Vong, Lenin; (5)Hun, Vannary; (6)Menasria, Lylia; (7)Leblanc, Caroline.

(1)Professor or nutrition. Moncton University. Canada; (2)Senior Health advisor. World Vision Canada. Mississauga. Ontario. Canada; (3)Director of National Institute of Public Health of Cambodia. Cambodia; (4)Consultant. World Vision Cambodia. Cambodia; (5)Technical health and nutrition specialiste. World Vision Cambodia. Cambodia; (6)Graduate student enrolled in the programme of Master in Nutrition. Moncton University. Canada; (7)Professor of nutrition. Moncton University. Canada.

**Background and objectives:** According to the UNICEF framework on the determinants of malnutrition, immediate causes of poor child nutritional status are inadequate dietary intake and poor health status which are, in turn, determined by access to food, to care to health (underlying determinants). To help at improving impact of nutrition programme, a better understanding of causes of malnutrition is essential especially in areas where malnutrition affects a significant proportion of young children. In Cambodia, stunting and wasting affect 32% and 10% of children below five years of age respectively. In Siem Reap province, these proportions are at 36% and 10%. The objective of this study is to assess the relationship between child nutritional status and its immediate and underlying determinants among a population of Cambodian young children.

**Methods:** Data of a current clinical trial investigating the impact of consumption and promotion of local foods on child nutritional status will be further analysed to respond to the aforementioned objective. The clinical study is a cluster-randomized controlled tri- al among children 6-23 months old (n=360) living in 14 randomly selected villages. Data on nutritional (anthropometry, haemoglobin, ferritin) and health status (c-reactive protein, intestinal parasites in faeces, occurrence of illnesses), dietary intake (24-hour recalls), food and health practices, household food security, access to health and socioeconomics have been collected at baseline and will be collected at endline. Anthropometry data were analysed using WHO Anthro. Dietary intake are currently assessed using Nutrific software. House- hold food security (HFI) will be assessed using the HFI Scale. The adequacy of dietary practices will be estimated using WHO indica- tors. Scores will be developed to assess health practices and health and responsive feeding. Descriptive analyses will be used to assess differences in nutritional status and correlations will be performed to test for association between nutrition status and its determinants. Regressions will be used to identify predictors of nutritional status.

**Results:** Data are currently analysed since baseline study has been finalized in February. Preliminary results on nutritional status reveal lower rates of undernutrition than expected: 19,5% stunting and 7,9% wasting. Moreover 7 out of 10 children (n=375) had a haemoglobin value below 11g/dl.

**Conclusions:** To come.

**Keywords:** young children, undernutrition, determinants, Cambodia

LIVESTOCK OWNERSHIP IS ASSOCIATED WITH
INCREASED ODDS OF ANEMIA AMONG PRE-
SCHOOL-AGED CHILDREN, BUT NOT WOMEN
OF REPRODUCTIVE AGE IN GHANA

(1)Jones, Andrew; (2)Colecraft, Esi; (3)Awuah, Raphael; (4)Boatemaa, Sandra; (5)Lambrecht, Nathalie J.; (6)Adjorlolo, Leonard Kofi; (7)Wilson, Mark L.

(1)PhD. Department of Nutritional Sciences. School of Public Health. University of Michigan.; (2)DrPH. Nutrition and Food Science Department. University of Ghana. Ghana.; (3)PhD. Regional Institute for Population Studies. University of Ghana. Ghana.; (4)MPhil. Regional Institute for Population Studies. University of Ghana. Ghana.; (5)BS. Department of Nutritional Sciences. School of Public Health. University of Michigan. USA.; (6)PhD. Livestock and Poultry Research Center. University of Ghana. Ghana.; (7)ScD. Department of Epidemiology. School of Public Health. University of Michigan. USA.

**Background and objectives:** Animal agriculture may help to mitigate anemia by providing access to nutrient-dense animal-source foods, but may also increase exposure to infections that increase the risk of anemia. The objective of this study was to determine the association between livestock ownership and anemia among women and children in Ghana.

**Methods:** We analyzed data from the 2014 Ghana Demographic and Health Survey (GDHS) using information on household livestock ownership that was collected through a quantitative survey. Capillary blood samples from women of reproductive age (15-49 years) (n = 4,798) and preschool-aged children (6-59 months) (n = 2,736) were analyzed using HemoCue photometer systems to assess hemoglobin (Hb) concentrations. Anemia was defined among non-pregnant women of reproductive age as Hb < 120 g/L, and among preschool-aged children as Hb < 110 g/L. In separate multiple logistic regression analyses for women and children we examined the association of household livestock ownership with anemia adjusting for the complex survey design of the GDHS and potential confounding covariates including socioeconomic status and infection indicators.

**Results:** In unadjusted analyses, household ownership of any livestock was positively associated with the prevalence of anemia among both women of reproductive age (44.3% of women from households with livestock were anemic vs. 40.3% without livestock; $\bar{2} = 7.8$; P=0.005), and preschool-aged children (74.0% of children from households with livestock were anemic vs. 62.4% without livestock; $\bar{2} = 42.5$; P<0.001). In multiple logistic regression analysis, household livestock ownership was not associated with anemia among women (OR (95% CI): 1.1 (0.88, 1.3)), but was associated with anemia among children (1.5 (1.1, 2.1)). Household ownership of chickens was associated with anemia in children (1.7 (1.3, 2.4), but ownership of no other animal species was independently associated with anemia risk in children.

**Conclusions:** Independent of socioeconomic status and infection indicators, livestock ownership in Ghana was associated with increased odds of anemia among young children, but not
among women. The association between livestock and anemia among children appears to be driven principally by ownership of poultry. Further research is needed to understand the potential nutrition- and/or infection-related mechanisms underlying these associations.

**Keywords:** livestock, anemia, poultry, malaria, Ghana

(1)Galván, Marcos; (2)Monroy-Campos, Alejandra; (3)López-Rodríguez, Guadalupe; (4)González-Unzaga, Marco; (4)Suárez-Dieguez, Teodoro;

(5)Guzmán-Saldaña, Rebeca; (2)Hernández-Cabrera, Jhazmín; (3)Olivo Ramírez, Diana Patricia; (6)Fernández Cortés, Trinidad Lorena;

(7)Amigo, Hugo.

(1)Phd. Leader of Academic Group of Nutritional and Molecular Epidemiology. School of Health Sciences. U Autonoma de Hidalgo. Mexico; (2)Nutritionist. PESOEH Project. School of Health Sciences. U Autonoma de Hidalgo. México.; (3)Phd. Professor. Academic Group of Nutritional and Molecular Epidemiology. School of Health Sciences. U Autonoma de Hidalgo. México.;

(4)MsC. Professor. Academic Group of Nutritional and Molecular Epidemiology. School of Health Sciences. U Autonoma de Hidalgo. México.; (5)PhD. Research Professor. Department of Psychology. School of Health Sciences. U Autonoma de Hidalgo. México.; (6)MsC. School of Health Sciences. U Autonoma de Hidalgo. México.; (7)PhD. Professor. Departamento de Nutrición. Facultad de Medicina. U de Chile. Santiago Chile.

**Background and objectives:** Considering the need to have information about the physical activity performed by school children in order to design interventions for the prevention of child hood obesity, the purpose of this study was to describe the phys ical performance, self-efficacy for physical activity and physical inactivity in Mexican urban schoolchildren by gender and type of school, as well as to determine the differences by nutritional status.

**Methods:** A cross-sectional study was conducted in 396 schoolchildren from two public and two private schools from ur ban municipalities in the state of Hidalgo, Mexico. Weight, height and waist circumference (WC) assessments were performed with standardized personnel and calibrated equipment; a six-min-ute walk test (TM6), physical activity self-efficacy questionnaire (PASQ), and physical activity and inactivity questionnaire for the Mexican population (CAINM) were applied. The nutritional sta tus was classified according to scores Z BMI (BMIZ) with WHO 2007 and school children with values> 90th percentile were diag nosed with abdominal obesity.

**Results:** In general, schoolchildren registered more than 50% of negative responses regarding the ability to perform physical ac tivity in the PASQ; and an average of 3.2 ± 1.9 hours in front of the screen, being higher in male schoolchildren than in women

(3.6 ± 2.1 vs 2.7 ± 1.6) (p <0.01). Students with abdominal obesity ran a lower total distance compared to non-obese schoolchildren both in public schools (509.3 ± 51.5 vs 541.4 ± 67.5 vs) and private schools (548.7 ± 70.8 vs 526.1 ± 54.3) (p <0.01), without detecting differences by nutritional status with BMIZ. A low correlation of hours of physical inactivity with the nutritional status was found (r≤0.17, p <0.05).

**Conclusions:** Schoolchildren with abdominal obesity showed a lower physical performance compared to normal weight chil dren. Self-efficacy for physical activity in schoolchildren was no toriously low, and the majority did not fulfill the recommendation of spending less than two hours watching TV or playing video games; the above is a challenge to overcome in public policies to promote physical activity in schoolchildren.

This study was supported by CONACYT project no. 216092 and PRODEP UAEH-CA-86.

**Keywords:** Physical performance, physical inactivity, child hood obesity, self-efficacy

**Further collaborators:**

Fernanda Ríos-Pérez, Gloria Camacho.

(1)Mogrovejo, Patricia; (2)Jimenez, Pablo.

(1)MD. MSc. PhD. Directora del Centro de Investigaciones en Enfermedades Crónicas No Transmisibles. Facultad de Ciencias de la Salud Eugenio Espejo. Universidad Tecnológica Equinoccial. Quito. Ecuador.; (2)MD, PhD (c). Profesor investigador de la Carrera de Medicina. Facultad de Ciencias de la Salud Eugenio Espejo. Universidad Tecnológica Equinoccial. Quito. Ecuador.

**Background and objectives:** Physical inactivity (PI) is a ma jor risk factor for morbidity and premature mortality. However, the prevalence of PI, physical activity's behavior, barriers and au to-efficacy are unknown in Ecuadorian workers. This study aimed to determine Body Mass Index (BMI), Physical Activity (PA) lev els, physical activity's behavior, PA barriers and auto-efficacy, and their relationship in Ecuadorian workers during 2006.

**Methods:** Through a medical story the following information was collected: 1. Sociodemographic information; 2. BMI; 3. PA levels were measured by the International Physical Activity Ques tionnaire; 4. Stage of Change (SOC) behaviors were measured in accordance to the Trans Theoretical Model; 5. Auto-efficacy and PA barriers were measured by questionnaire. Descriptive statistics, chi- squared test and factorial analysis of multiple correspondenc es were used.

**Results:** The prevalence of PI is 65.3%. The prevalence of excess of weight is 50% (40.8% overweight, 9.4% obesity). Overweight is higher in men (p<0.001), married (p=0.000), with primary educa-
tion (p=0.024) and increase with age (p<0.000). Physical activity
SOC is associated with PA levels (p=0.000). Sedentary and inactive
subjects are classified mainly in lower PA SOC (contemplation, pre
contemplation and preparation), whereas active and very active
subjects are categorized mostly in PA SOC maintenance. Subjects
who are classified in PA SOC action and maintenance are main-
ly men (39.8%), with high school education (41.8%) and belong
to 18-29 group age (41.6%). PA auto-efficacy levels are associated
with BMI. Lower PA auto-efficacy is associated with overweight
and obesity.

**Conclusions:** The prevalence of physical inactivity and obesity is high in apparently healthy workers at a private enterprise in Ecuador. Being obese and lack of time are common barriers for practicing PA. The PA's SOC are associated with PA levels. Research findings were used for designing and implementing a life promotion program at workplace investigated. It includes PA counselling for preventing and managing PI. It includes physical activity SOC and PA auto-efficacy levels.

**Keywords:** physical inactivity, behavior, obesity

**Further collaborators:**

Nicole Jiménez

Savinmed

lower-middle income countries. This study aimed to measure the
effect of a national salt reduction strategy in Samoa with a view to
sharing experiences to enhance future large-scale programs.

**Methods:** An 18-month multi-faceted salt reduction program was implemented in Samoa comprising of activities designed to influence policy, mobilise the community and raise awareness. Two nationally representative cross-sectional surveys of adults aged 18 to 64 years, measuring salt intake through 24-hour urine and knowledge, attitudes and behaviours related to salt, were conducted before (2013) and after (2015) the intervention to evaluate its impact.

**Results:** There were 234 participants at baseline (RR 47%) and 479 at 18 months (RR 61%) and samples were balanced in terms of age, gender, area, education and employment. There was no significant change in mean population salt intake between 2013 (7.31g/d) and 2015 (7.50g/d) (0.19, 95% CI -0.50 to 0.88; p=0.588). However, there were significant reductions in the proportion of the population who always or often; use discretionary salt when eating (-16.2%, p=0.002) and consume processed foods (-11.0%, p=0.02), increases in the population who understood the adverse health effects of high salt consumption (+9.0%, p=0.049) and used one or more methods to control their salt intake (+20.9%, p<0.001). 73% of the population reported that they had heard or seen messages from the salt reduction campaign.

**Conclusions:** Despite some population improvements in salt-related behaviours and knowledge after the intervention, there was no change in 24-hour urinary salt excretion. Inconsistencies in survey methodology, limited intervention dose and duration and the influence of a secular upward trend in salt intake are potential reasons for this. The widespread reach of the salt reduction messages and improvements in knowledge and behaviour suggest that the foundation for further interventions and improvements is in place. Structural policies to lower salt in the food supply and improve the environment are required to achieve a sustained reduction in population salt intake and blood pressure.

**Keywords:** sodium, public health nutrition, hypertension, NCDs, low and middle income countries.

**Conflict of Interest Disclosure:** JW is Director of the World Health Organization Collaborating Centre on Population Salt Reduction with a remit to support countries to implement and evaluate salt reduction programs in line with the WHO target for all countries to reduce population salt intake by 30% by 2025. All other authors declare that they have no conflicts of interests related to this study.

**Background and objectives:** Salt reduction is considered one of the most cost-effective and affordable interventions for the prevention of non-communicable diseases, but there are no studies evaluating the effectiveness of national strategies in low or

<footnote>(1)Trieu, Kathy; (2)Ieremia, Merina; (3)Santos, Joseph; (4)Neal, Bruce;</footnote>

<footnote>(5)Woodward, Mark; (6)Moodie, Marj; (7)Bell, Colin; (8)Snowdon, Wendy; (9)Faumuina, Taiaopo; (10)Webster, Jacqui.</footnote>

<footnote>(1)BAppSc (ExSpSc&Nutr). MPH. Food Policy Division. The George Institute for Global Health. The University of Sydney. Australia;
(2)BPlan. GDipHlthSci. Strategic Planning Policy and Research Division. Samoa Ministry of Health. Samoa.; (3)BSN. Food Policy Division. The George Institute for Global Health. The University of Sydney. Australia.; (4)MBChB. MRCP. PhD. Food Policy Division. The George Institute for Global Health. The University of Sydney. Australia.; (5)BSc. MSc. PhD. The George Institute for Global Health. The University of Sydney. University of Oxford. Johns Hopkins University. Australia.; (6)BA(Hons). DipEd. DipTRP. DrPH. Deakin Health Economics. Centre for Population Health Research. Deakin University. Australia.; (7)BSc(hons). MSc. PhD. GCHETL. Global Obesity Centre. Faculty of Health. Deakin University. Australia.; (8)BSc (Hons). MA (Hons). MPH. PhD. Global Obesity Centre. Faculty of Health. Deakin University. Australia.;
(9)BA. Division of Census. Survey and Demography. Samoa Bureau of Statistics. Samoa.; (10)PhD. Food Policy Division. The George Institute for Global Health. The University of Sydney. Australia.</footnote>
MEAN DIETARY SALT INTAKE AND THE ASSOCIATION WITH KNOWLEDGE, ATTITUDES AND BEHAVIOURS IN A POPULATION FROM NORTH AND SOUTH INDIA

(1)Johnson, Claire; (2)Mohan, Sailesh; (3)Shivashankar, Roopa; (4)Thout, Sudhir Raj; (5)Feng, He; (6)Webster, Jacqui; (7)Krishnan, Anand;

(8)Maulik, Pallab K; (9)Prabhakaran, Dorairaj; (10)Bruce, Neal.

(1)MIPH. Post-doctoral Research Fellow. WHO Collaborating Centre (salt). The George Institute for Global Health. Sydney. Australia.; (2)MD, MPH, PhD. Public Health Foundation of India. India.; (3)MD, MSc. Public Health Foundation of India. India.; (4)MA. Research and Development. George Institute for Global Health India. India.; (5)PhD. Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry. Queen Mary University of London. United Kingdom.; (6)PhD. WHO Collaborating Centre (salt). The George Institute for Global Health. Sydney. Australia.; (7)MD, PhD. Centre for Community Medicine. All India Institute of Medical Sciences. India.; (8)MSc, MD, PhD. Research and Development. George Institute for Global Health India. India.; (9)MSc, FRCP, FNASc, MD, DM. Public Health Foundation of India and Centre for Chronic Disease Control. India.; (10)MBChB, MRCP, PhD. Food Policy. The George Institute for Global Health. Australia. Imperial College, London. United Kingdom. Royal Prince Alfred Hospital. Australia.

**Background and objectives:** The scientific evidence base in support of population wide salt reduction is strong but current high quality data about salt intake levels in India are mostly absent. We sought to establish any associations between estimated daily salt consumption levels measured through 24-hour urinary sodium excretion and knowledge, attitudes and behaviours towards salt in selected communities of Delhi and Haryana in North India and Andhra Pradesh in South India.

**Methods:** Data were collected through a cross-sectional survey comprising a single 24-hour urine sample, participants' physical measurements and questionnaire data on consumer knowledge, attitudes and behaviour towards salt, in an age-and sex-stratified random sample of 1395 participants in urban and rural areas of North and South India. Measures were made for the overall population of each region and major subgroups by weighting the survey data to the population of Delhi and Haryana, and Andhra Pradesh.

**Results:** Complete 24-hour urine samples and data on KAB were available for 637 individuals from Delhi and Haryana and 758 from Andhra Pradesh (65% and 68% response rate, respectively). The mean age of participants was 40 years, 47% were women and mean 24-hour urinary salt excretion was 9.3 (8.9–9.7) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake—less use of salt while cooking, avoidance of snacks, namkeens (savoury snacks), and avoidance of pickles (all *p* < 0.003).

**Conclusions:** Salt consumption in India is high, with mean population intake well above the WHO recommended maxi-

mum of 5g/day. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. A national salt reduction programme, including community-wide education as part of a multifaceted strategy, would prevent large numbers of cases of hypertension as well as strokes and heart attacks, averting much premature death and disability

**Keywords:** India, salt, sodium, hypertension, 24-hour urinary sodium

**Further collaborators:**

K.Srinath Reddy. MSc, MD, DM. Public Health Foundation of India. India.

Kris Rogers. MBiostats, PhD. Statistics Division. The George Institute for Global Health. Australia.

Graham A MacGregor. FRCP. Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry. Queen Mary University of London. United Kingdom.

Priti Gupta. MD. Public Health Foundation of India. India.

TRADITIONAL DIETARY PATTERNS INCREASE THE RISK OF BREAST AND PROSTATE CANCER IN SMOKERS WITH OVERWEIGHT IN ARGENTINA

(1)Román, María Dolores; (1)Niclis, Camila; (2)Tumas, Natalia;

(3)Aballay, Laura; (4)Becaria Coquet, Julia; (5)Pou, Sonia Alejandra;

(3)Reartes, Gabriela; (3)Díaz, María del Pilar; (5)Muñoz, Sonia Edith.

(1)PhD. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba (UNC). Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Argentina.; (2)PhD. Centro de Investigaciones y Estudio sobre Cultura y Sociedad (CIECS). CONICET. Argentina.; (3)PhD. Escuela de Nutrición. Facultad de Ciencias Médicas. UNC. Argentina.; (4)BSc. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba (UNC). Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Argentina.; (5)PhD. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba (UNC). Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Argentina.

**Background and objectives:** Traditional dietary patterns characterized by fatty red meat, processed meat, starchy vegetables, sugars and sweets, candies, fats and vegetable oils in male and by fat-ty meat, barkery products and vegetable oils in female population, were identified in Córdoba (Argentina). A high adherence to these dietary patterns has been associated with an increased risk of pros-tate cancer (PC) and breast cancer (BC), in men and women respec-tively. The aim of this study was to analyze whether the association between adherence to Traditional Pattern and the risk of PC and BC differs according to smoking habit and weight status.

**Methods:** Two case-control studies were conducted in Cór-doba in 2008-2014 including 147/300 cases/controls of PC and
318/526 of BC. Adherence of each subject to Traditional Pattern identified through a principal component factor analysis was estimated. Two level logistic regression models were fitted using interaction terms of smoking habit (smoker-no smoker), weight status (normal weight-overweight) and tertiles of adherence to Traditional Pattern as covariates at level 1, and family history of the disease as clustering variable at level 2.

**Results:** An increased risk of BC was stronger in smokers with overweight who simultaneously have a high adherence to Traditional Pattern (OR: 2.54; 95%CI: 1.16-5.56). Interaction of high adherence to Traditional Pattern and overweight was significant and associated with an increased risk of PC (OR 2.73; 95%CI: 0.97-7.67). There were no interactions among smoking habit and weight status on PC risk. When stratifying by smoking habit, a greater risk of PC in smokers with overweight and high adherence to Traditional Pattern (OR: 3.52; 95%CI: 0.97-12.76) was found.

**Conclusions:** A particular emphasis would be made on smoking and other lifestyle conditions, when promoting healthy eating habits.

**Keywords:** Dietary patterns; breast cancer; prostate cancer; smoking habit; overweight.

(p=0.97) and 28.0% (p=0.87) respectively. In both populations, anemia was associated with sex, while stunting was associated with age, sex, wealth, and social standing (caste or indigenous). In the Peruvian population, anemia was also associated with age, while stunting was associated with dietary diversity over the past month. In the Indian population, anemia was also associated with caste, dietary diversity over one day, and household hunger, while stunting was associated with maternal illiteracy.

**Conclusions:** These results suggest that the co-occurrence of anemia and stunting in individuals is as expected by chance, despite some shared basic factors (sex, age, and caste). Anemia and stunting should be treated as independent and addressed according to their context-specific causes.

**Keywords:** anemia, stunting, co-occurrence, infant nutrition

**Conflict of Interest Disclosure:** The authors have no conflicts of interest to declare. The Bill and Melinda Gates Foundation funded the original trial in Bihar, India. The regional government of Lambayeque, Peru funded its baseline survey.

## THE CO-OCCURRENCE OF ANEMIA AND STUNTING IN YOUNG CHILDREN

(¹)Gosdin, Lucas; (²)Young, Melissa; (³)Bartolini, Rosario; (²)Mehta, Rukshan; (⁴)Srikantiah, Sridhar; (²)Martorell, Reynaldo.

(¹)MPH. Hubert Department of Global Health. Rollins School of Public Health. Emory University. USA; (²)Nutrition and Health Sciences. Rollins School of Public Health. Emory University. USA;

(³)Instituto de Investigación Nutricional. Peru.; (⁴)CARE. India.

**Background and objectives:** Anemia and stunting are prevalent nutritional problems among children of low- and middle-income countries that have profound effects on child development, morbidity, and mortality. A single conceptual framework is used often to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co-occur in affected communities and individuals to a greater degree than by chance. We know from ecological analyses that stunting and anemia cluster across types of countries and their regions but is this also the case at the level of individuals, a question seldom asked and which we address.

**Methods:** In two separate populations of children – ages 6-18 months in Bihar, India (n=5664) and 0-36 months in Lambayeque, Peru (n=840) – we measured the frequency of the co-occurrence of anemia and stunting. We compared this value to the value expected by chance, the product of the prevalence of anemia and stunting using a chi-square test. Using an iterative model selection process, we built explanatory logistic regression models for each condition.

**Results:** The frequency of co-occurrence in the Indian population was 21.5%, and in the Peruvian population it was 27.1%, which are similar to frequencies expected by chance, 21.3%

## EVALUATION OF THE NUMBER OF DEATHS FROM MALNUTRITION IN SOUTH AMERICA IN THE PERIOD 1997 TO 2012

(¹)Velasquez, John Edinson; (²)Deossa Restrepo, Gloria Cecilia;

(³)Restrepo, Luis Fernando.

(¹)Nutricionista Dietista, Docente e investigador. Universidad de Antioquia. Colombia; (²). Magíster en Ciencias de la Alimentación y Nutrición Humana. Profesora Escuela de Nutrición y Dietética, Universidad de Antioquia. Medellín. Colombia.; (³)Estadístico, Especialista en Estadística. Especialista en Biomatemática. Profesor Titular.

**Background and objectives:** Background: Hunger is one of the main references in world politics, however thousands of people die every year because of the food starvation, South America is a reference of great availability and variety of foods, but it is no stranger to deaths from malnutrition. Objective: To evaluate the number of deaths from malnutrition in South America in the period 1997 to 2012.

**Methods:** Materials and methods: We used the database reported by the Pan America Health Organization (PAHO) which was accessed in March 2017 and complemented with databases of food availability and GDP from the FAOSTAT. The GENERAL LINEAR MODEL was used in order to carry out the contrasts between countries of South America incorporating the Tukey test, based on a statistical significance level of 5%. Additionally the multivariate Biplot technique was carried out, which aims to relate the different years evaluated by projecting the countries and was complemented with cluster analysis, to establish typologies or groups according with the dynamics of the variables. We used statistical packages SAS UNIVERSITY and R version 3.0.0.

**Results:** The highest number of deaths occur in child under one year, from one to four years and from 65 years of age. Brazil
is the country of South America where more deaths from malnutrition presented, followed by Colombia and Argentina. The countries in which are presented under statistics of deaths from malnutrition are Uruguay, Bolivia, Paraguay, and Chile.

**Conclusions:** Notwithstanding that the countries of South America have great availability of foods, the deaths from malnutrition are still prevalent in most of the continent.

**Keywords:** Hunger, malnutrition, Food safety

(¹)Duran, Ana Clara; (²)Khandpur, Neha; (³)Jaime, Patricia.

(¹)PhD. Center for Epidemiological Studies in Nutrition and Health. University of São Paulo. Brazil; Department of Epidemiology. School of Public Health. University of São Paulo. Brazil.; (²)PhD. Post-doctoral research fellow. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (³)PhD. Associate Professor. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** Exposure to advertising within retail food stores may influence food purchase and consumption, and ultimately health conditions. Understanding the nature and heterogeneity of in-store advertising is therefore crucial. The objectives of this study were to: (1) describe the availability of in-store food advertising; and (2) examine differences in the availability of in-store advertising by store type and neighborhood socioeconomic characteristics.

**Methods:** This was a cross-sectional study conducted in 2010-2011 in Sao Paulo city, Brazil. Our sample included all retail food stores in 52 census tracts, representing neighborhoods of high, medium and low socioeconomic strata. Retail food stores were categorized as (1) grocery stores and supermarkets and (2) limited-service stores [fruit and vegetable (F&V) specialty stores, convenience stores, bakeries/delis, and corner stores]. Data were collected using a reliable Food Store Observational Tool. Counts of different signs/advertisements of F&V, sugar-sweetened beverages (SSB) and snacks (cookies and salty snacks) were recorded. Mixed-effects Poisson regressions with robust variance and clustered at the census tract where each store were located were used to estimate the relationships between recorded foods and neighborhood socioeconomic characteristics (percent black and mixed-race residents and income of the head of the household) and store type.

**Results:** The sample included 9 grocery stores and supermarkets (2.9%), 229 corner stores (75.1%), 60 convenience stores (10.7%), and 7 F&V specialty markets (2.3%). F&V were advertised in 26.0% of the stores where F&V were sold (23.9% of the total sample of stores), and 19.0% had in-store advertising for SSB/snacks (96.1% of the stores sold these products). Advertising for both F&V and SSB/snacks was 2.5 times more prevalent in grocery

stores and supermarkets than in other store types. Availability of F&V in-store advertising did not vary by neighborhood characteristics. Although stores located in low-income areas were more likely to sell SSB/snacks, no differences were found for advertising.

**Conclusions:** Advertising for F&V and SSB/snacks was more prevalent in grocery stores and supermarkets. However, availability of advertising for these products did not vary by neighborhood socioeconomic characteristics. Policies aimed at regulating unhealthy foods advertising should include in-store advertising and reach people from different socioeconomic backgrounds.

**Keywords:** Advertising, Food Retail Stores, Brazil, Sugar-sweetened beverages

(¹)Franco-Arellano, Beatriz; (²)Kim, Min Ah; (³)Vandevijvere, Stefanie;

(⁴)Bernstein, Jodi T.; (⁵)Labonté, Marie-Eve; (³)Swinburn, Boyd;

(⁵)L'Abbé, Mary.

(¹)MSc. Department of Nutritional Sciences. University of Toronto. Canada; (²)BSc. Department of Nutritional Sciences. University of Toronto. Canada; (³)PhD. Department of Epidemiology and Biostatistics. University of Auckland. New Zealand; (⁴)MPH RD. Department of Nutritional Sciences. University of Toronto. Canada; (⁵)PhD. Department of Nutritional Sciences. University of Toronto. Canada.

**Background and objectives:** The increase in diet-related non-communicable diseases (NCDs) is a concern and actions are needed to reduce this health burden. Obesogenic food environments are a key factor and it is therefore important to assess the nutritional quality (e.g., "healthfulness") of the food supply, including health-related labelling on food packages. In Canada, the "healthfulness" of foods is not a criterion required for a product to carry a health-related claim and it is unknown if products carrying health-related claims are "healthier" than those which do not. This study examined the health-related claims displayed on the "healthiest" and "least healthy" food categories in the Canadian food supply using the internationally standardized International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) taxonomy.

**Methods:** Cross-sectional analysis of the University of Toronto 2013 Food Label Information Program, a database that contains information on pre-packaged products (n=15,342) of the Canadian food supply. The six "healthiest" and six "least healthy" food categories were determined using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (FSANZ-NP-SC). Health-related claims were classified using the INFORMAS taxonomy.

**Results:** Analyses included 7055 products in the "healthiest" and "least healthy" food categories. Among these products,
38.6% of products were considered “healthy” (n=2,721). Any type of health-related claim was carried on 63.3% of products classified as “healthy”, whereas 45.5% of “less healthy” foods displayed health-related claims on their food labels. Nutrient content claims were the most popular claims used on “healthy” (55.8%) and “less healthy” foods (30.5%). Nutrient-function type claims were the least used: 2.2% and 0.3%, respectively for “healthy” and “less healthy” foods.

**Conclusions:** A substantial proportion of health-related claims were displayed in “less healthy” foods, potentially misleading consumers towards less nutritious choices.

**Keywords:** Nutrition labelling, Health-related claims, Public health, INFORMAS

**Conflict of Interest Disclosure:** Prior this study Beatriz Franco-Arellano was a PepsiCo employee. The company had no connection with the research. The rest of the authors have no conflicts.

**Further collaborators:** Dr. Mike Rayner. British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention. Nuffield Department of Population Health. University of Oxford. United Kingdom.

**Conclusions:** Judging from the numbers found in the databases, the number of immigrants enrolled in the municipal education network is still not significant for measures in the normative bases of the PNAE to be taken. However, discussing cultural identity through experiences among the students themselves and between the educators can represent a more respectful and receptive generation.

**Keywords:** Immigration, Cultural Identity, Brazilian National School Feeding Program.

**Further collaborators:**

Betzabeth Slater

Nutritionist. Public Health Faculty. Sao Paulo's University. Brazil.

144/1396

## IMMIGRATION AND CULTURAL IDENTITY: HOW TO CONSIDER THESE DIMENSIONS IN THE NATIONAL SCHOOL FEEDING PROGRAM

**Background and objectives:** The cultural dimension of eating, intricate in the symbolic value of food, is strongly related to the identity and sense of social belonging to a territory. Immigration is a constant movement in Brazil, making the environment changeable and alive. The present work intended to analyze and discuss the normative bases of the National School Feeding Program (Programa Nacional de Alimentação Escolar - PNAE) in relation to the incorporation of the perspectives of cultural identity, culture and immigration and to describe the profile of immigrant students enrolled in 2016 in the municipal education of São Paulo.

**Methods:** In relation to the incorporation of the cultural identity and immigration perspectives a documentary analysis and a PNAE's normative bases discussion were carried out using a qualitative approach. A description of the immigrant students profiles enrolled in the Sao Paulo's municipal education system in 2016 was also made.

**Results:** The word culture appears in the selected documents as a guide and reference for food choice, culinary traditions and habits. Regarding immigration and its derivations, no citation was found. In relation to the profile of the immigrant students enrolled in the network, it is noticed that the great majority of these students are Bolivian (58%), followed by Angolans (11%) and the Japanese (5%).

144/1412

## RELATIONSHIP BETWEEN VITAMIN K INTAKE AND BODY COMPOSITION INDICATORS

**Background and objectives:** In contrast to other fat-soluble vitamins, little is known about the association between vitamin K and adiposity. Is assumed that this vitamin is fat soluble, therefore it can be considering that the adipose tissue may physiologically serve as a storage site for the same. However, the action of vitamin K on adipose tissue as well as the metabolic implications are not yet elucidated. Research into the association between vitamin K intake and body composition may contribute to identifying additional metabolic pathways that relate micronutrient inadequacy to obesity. Thus, the objective of this study is to investigate the relationship between vitamin K intake and body composition indicators between adults and elderly.

**Methods:** We evaluated 293 individuals of both sexes, adults and elderly participants of the ISA- Capital 2014 survey (cross-sectional study using a population-based household survey). Vitamin K intake was evaluated by means of a 24-hour food recall performed on two non-consecutive days, with an interval of more than one week, in person and by telephone. In order to structure the data collection in detail, the procedures described in the Multiple Pass Method developed by the United States Department of Agriculture were used. Body composition was assessed by means of anthropometry (weight and height) and dual-energy X-ray absorptiometry (DXA) by means of which the absolute values of fat and lean mass were obtained and the Fat Mass Index (FMI) and Appendicular Lean Mass Index (ALMI) by IMC. Linear Person Correlation, Pearson's Chi-Square test and Multiple Linear Regression were used. Significance was set at P <0.05.

<footnote>(1)Figueiredo Barata, Mayra; (1)Capezzuto Fernandes Dias, Manuela;</footnote>

<footnote>(2)Barata, Mayra; (1)Constante Jaime, Patrícia.</footnote>

<footnote>(1)Nutritionist. Public Health Faculty. Sao Paulo's University. Brazil.; (2)Sao Paulo. Brazil.</footnote>

<footnote>(1)Santos, Elizabete; (2)França, Natasha; (3)Peters, Barbara; (4)Fisberg, Regina; (5)Martini, Lígia.</footnote>

<footnote>(1)MD. Nutritionist. Nutrition Department. School of Public Health. University of São Paulo. São Paulo. Brazil; (2)PhD student. Nutrition Department. School of Public Health. University of São Paulo. São Paulo. Brazil; (3)PhD. Nutritionist. Nutrition Department. School of Public Health. University of São Paulo. São Paulo. Brazil; (4)PhD.Associate Professor. Nutrition Department. School of Public Health. University of São Paulo. São Paulo. Brazil.</footnote>
**Results:** 28.86% of the individuals were classified as obese (BMI>30 kg/m²). According to the FMI, 74.83% of the individuals have excess body fat and in relation to the lean mass, 83.89% presented adequate values according to the ALMI (by BMI). Vitamin K intake was associated only with the FMI (p=0.027). There was no correlation between vitamin K intake (p=0.78), BMI (p=0.47), body fat and lean mass in kg (p=0.93 and p=0.85, respectively) and ALMI (p=0.79).

**Conclusions:** Intake of vitamin K was only associated with FMI. This fact may be related to a better quality of the diet, considering that vegetables are among the main sources of vitamin K.

**Keywords:** Vitamin K. Food intake. Body composition. Obesity.

## AN EVALUATION OF THE HEALTHINESS OF PACKAGED AND PROCESSED FOODS SOLD BY MAJOR MANUFACTURERS IN INDIA

(1)Jones, Alexandra; (2)Dunford, Elizabeth; (3)Taylor, Fraser; (4)Raj, Thout Sudhir; (5)Crossley, Rachel; (6)Rayner, Michael; (7)Neal, Bruce.

(1)LLM. Food Policy Division. The George Institute for Global Health. Sydney. Australia.; (2)Carolina Population Centre. University of North Carolina at Chapel Hill. Chapel Hill. United States.; (3)MEng. Food Policy Division. The George Institute for Global Health. Sydney. Australia; (4)Food Policy Division. The George Institute for Global Health. Bangalore. India; (5)MSc. Access to Nutrition Foundation. Utrecht. The Netherlands.; (6)PhD. Nuffield Department of Population Health. University of Oxford. Oxford. UK.; (7)PhD. Food Policy Division. The George Institute for Global Health. Sydney. Australia.

**Background and objectives:** India is one of many countries facing a rapid rise in overweight, obesity and diet-related non-communicable diseases. Around 20% of children and adolescents are overweight, and India now ranks third in absolute numbers of obese people after the United States and China. The traditional Indian diet based upon fruits, vegetables, unprocessed cereals and pulses is being eroded by packaged and processed foods high salt, sugar and harmful fats. To contribute to the first India Access To Nutrition Index, our objective was to determine the healthiness of packaged processed foods sold by major manufacturers in India.

**Methods:** Nutrient information for 943 packaged foods and drinks sold by the 11 largest manufacturers between 2014 and 2016 was obtained from product packaging, company websites or directly from the company. The Australian Health Star Rating (HSR) and the World Health Organization's European Regional Office (WHO EURO) nutrient profile models were used to analyse the nutritional quality of the products. Each company was ranked by the mean HSR of their portfolio, the proportion of 'healthy' products using a HSR cut-off of 3.5 out of 5.0 stars, and the proportion of products meeting WHO EURO criteria. Analysis was undertaken both at the company and food category level; both with and without sales-weighting.

**Results:** The mean HSR of products was low overall (1.9 out of 5.0) with substantial variation between companies (mean 0.6 to 2.7). Only one in six products were 'healthy' (HSR>=3.5) and only 9% met WHO criteria for marketing to children. There were marked differences in the healthiness of similar products within food categories. There was some variation of company rankings depending upon the metric of healthiness used and whether rankings used estimates that were or were not weighted for sales.

**Conclusions:** The healthiness of packaged food products made by the largest manufacturers in India was sub-optimal. Improvements in product mix and reformulation of less healthy products should be priorities for companies. The Government of India could support corporate actions by strengthening nutrition labelling requirements and establishing targets for reductions in salt, sugar and fat in packaged foods.

**Keywords:** public health, packaged foods, nutrient profiling, food manufacturers, India

**Conflict of Interest Disclosure:** Alexandra Jones, Elizabeth Dunford, Fraser Taylor, Thout Sudhir Raj, Mike Rayner and Bruce Neal received support of a grant from the Access to Nutrition Foundation for this research.

## INTAKE AND DIETARY SOURCES OF CALCIUM AMONG AUSTRALIAN ADOLESCENTS AND YOUNG ADULTS

(1)Rouf, Anika; (2)Sui, Zhixian; (2)Rangan, Anna; (2)Grech, Amanda;

(2)Allman-Farinelli, Margaret.

(1)PhD Candidate. School of Life and Environmental Sciences. Australia; (2)School of Life and Environmental Sciences. Australia.

**Background and objectives:** Adolescence to young adulthood is an important transitional phase, with high requirements for calcium. The Nutrient Reference Values in Australia are 1300 mg for adolescents and 1000 mg for young adults. This study aimed to examine the calcium intake of adolescents and young adults in Australia from food sources and supplements, taking consideration of lifestyle, anthropometry and socio-demographic variables.

**Methods:** This study utilised dietary data from 490 adolescents (14-18 years) and 561 young adults (19-25 years) from the 2011-12 National Nutrition and Physical Activity Survey. A single 24-hour recall was used to estimate the mean intake of calcium which included food and supplements. Descriptive statistics were used to report the calcium intake for plausible reporters (energy intake vs. Basal Metabolic Rate ≤0.87 to ≥2.67). Chi-square, trend analysis and linear regression were conducted to identify associations between calcium intake and anthropometric and demographic characteristics and consumption of other food groups.

**Results:** Total calcium intakes (foods and supplements) were a mean (SD) of 905.5 (501.9) mg for adolescents and 913.1 (504.3) mg for young adults. Calcium supplement use was relatively uncommon, and provided 0.8% and 1.0% of total intake for adolescents and young adults, respectively. Adolescent females had much
lower calcium intakes 775.5 (435.4) mg compared to males 1048.4 (588.7) mg, as did young adults 835.7 (474.6) mg for females and 1014.2 (544.3) for males. The food sources contributing to calcium were similar across age groups and gender, with regular milk (15-24%), cheese (10-12%), refined low fibre bread (10%) and low fat milk (7-9%) as the largest contributors of calcium. Alternative milk beverages contributed <1% to calcium intake. Higher intake of core food groups (vegetables, fruits, dairy) and BMI was associated with higher calcium intakes for adolescents and young adults adjusted for energy intake. For both adolescents and young adults, a higher socio-economic status was associated with greater intakes of calcium.

**Conclusions:** Mean calcium intake among Australian adolescents and young adults remains below recommendations, especially in females. The findings from this study will be used to inform the development of future interventions.

**Keywords:** Calcium, dairy, adolescents, young adults, nutrition survey

with greater Body Mass Index (BMI). Red meat, poultry, and processed meat consumption all increased with Waist Circumference (WC). Consumption of vegetables was positively associated with red meat but inversely associated with poultry and processed meat consumption. Discretionary foods/beverages consumption was associated with processed meat consumption. Compared with the nutrient intake profiles from red meat and poultry, processed meat consumption was associated with lower protein, long-chain omega 3 fat, niacin equivalents, vitamin C, magnesium, and potassium intakes and vitamin D biomarker, and the highest total fat, saturated fat, and sodium intakes and sodium biomarker.

**Conclusions:** Processed meat consumption was associated with higher BMI/WC and poorer diet quality, compared to red meat and poultry.

**Keywords:** Processed meat; red meat; poultry; obesity; diet quality

**Conflict of Interest Disclosure:** The authors declare that there are no conflicts of interest. This research was funded by the Meat and Livestock Australia, but the sponsors had no input into the results presented in the current analysis.

144/1447

PROCESSED MEAT CONSUMPTION WAS ASSOCIATED WITH HIGHER BODY MASS INDEX AND POORER DIET QUALITY, COMPARED TO RED MEAT AND POULTRY

(1)Sui, Zhixian; (2)Raubenheimer, David; (3)Rangan, Anna.

(1)PhD. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia; (2)Professor. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia; (3)Assoc Professor. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia.

**Background and objectives:** The nature and extent of the relationship between red meat, poultry, and processed meat consumption and obesity and total diet quality has not been clearly established. This study aimed to investigate the associations between red meat/poultry/processed meat consumption and diet quality, taking consideration of demographic and anthropometric characteristic, lifestyle factors, consumption of other food groups and other relevant nutrients and nutrient biomarkers.

**Methods:** This study utilised 24-hour recalls of 9,113 adults participating in the 2011-12 National Nutrition and Physical Activity Survey and National Health Measures Survey. Red meat, poultry, and processed meat consumption data were captured in detail from all meals and recipes. Chi square analysis and multivariate regression models were conducted to examine the association between red meat/poultry/processed meat consumption and anthropometrics, demographic categories, weight status, intakes of different food groups, nutrients, and nutrient biomarkers.

**Results:** Approximately 49% of respondents consumed red meat (mean per-capita intake: 57g), 38% consumed poultry (42g), and 39% consumed processed meat (28g). Higher consumption of red meat and processed meat but not poultry was associated

144/1451

PRIMARY PREVENTION OF EXCESSIVE FAT GAIN AMONG 2-6 YEAR OLDS. RESULTS FROM THE "HEALTHY START" RANDOMIZED INTERVENTION

(1)Olsen, Nanna Julie; (2)Ångquist, Lars; (3)Mortensen, Erik Lykke;

(4)Heitmann, Berit Lilienthal.

(1)Postdoc. Research Unit for Dietary Studies at the Parker Institute. Bispebjerg og Frederiksberg Hospital. Denmark;

(2)Postdoc. Department of Clinical Epidemiology. Bispebjerg and Frederiksberg Hospital. Denmark; (3)Professor. Department of Public Health and Center for Healthy Aging, and Section for General Practice. Department of Public Health. University of Copenhagen. Denmark; (4)Professor. Research Unit for Dietary Studies at the Parker Institute. Bispebjerg and Frederiksberg Hospital. Denmark.

**Background and objectives:** Previous obesity prevention interventions all targeted groups where both normal weight and overweight children were present, e.g. in school settings. Only about 1/4 of these previous interventions were effective in reducing weight gain, and studies have proposed, that the few positive effects were restricted to those already overweight, or to high-risk individuals. The objective of this primary prevention RCT was to examine, if excessive weight and fat gain over on average 1.3 years can be prevented among normal weight, but obesity susceptible, young children aged 2-6 years. ClinicalTrials.gov NCT01583335.

**Methods:** All children born in 2004-2007 from 11 greater Copenhagen municipalities, with either a high birth weight, maternal pre-pregnancy obesity, or maternal low education, were identified from public registries, and invited to participate. Totally 21% agreed to be included (n=635) and were randomized as interven-
tion or control children. All children who were already overweight or obese were subsequently excluded (n=92). The intervention delivered improvement in diet and activity habits, optimization of sleep quantity and quality, and reduction of stress.

**Results:** Intention-to-treat analyses showed a lower gain in %-fat mass in the intervention group compared to the control group (difference D=-2.1% (95% CI -3.7; -0.5; p=0.01)), but non-significant differences in BMI z-score gains (p=0.55).

**Conclusions:** Gain in fat may be prevented among normal weight young children at high risk of future obesity, suggesting not only a more favorable growth, despite a similar weight development, but also that primary prevention of obesity is possible.

**Keywords:** Primary weight gain intervention, individualized family intervention, pre-school age, sleep optimization, stress management.

stated in 19.7% of examined girls and in 22.6% of boys, and underweight in 27.7% of girls and 6.5% of boys. Symptoms of eating disorders were observed in 11.6% of girls (n=414). There was no significant association between BMI and body dissatisfaction among boys. Weight control behaviors were more characteristic for girls. Overweight and underweight among girls were associated with high score of drive for thinness, body dissatisfaction, bulimia and low self-esteem.

**Conclusions:** Weight control behaviors may be considered as one of indicators of the association between BMI and eating disorder symptoms. The risk of eating disorders is more characteristic for adolescent girls and more educational and intervention programs is needed especially in this group of teenagers.

**Keywords:** Eating disorders, adolescents, BMI, self-esteem

## ASSOCIATIONS BETWEEN BODY MASS INDEX AND EATING DISORDER SYMPTOMS AMONG ADOLESCENTS IN POLAND

(1)Ostachowska-Gasior, Agnieszka; (2)Zająć, Joanna; (3)Kwiatkowski, Jacek; (4)Piwowar, Monika.

(1)PhD. Nutritionist. Department of Hygiene and Dietetics. Dietary Lab Counseling. Medical College. Jagiellonian University of Krakow. Poland.; (2)MSc. Biologist. Department of Hygiene and Dietetics. Medical College. Jagiellonian University of Krakow. Poland; (3)MSc. Computer programmer. Department of Hygiene and Dietetics. Dietary Lab Counseling. Medical College. Jagiellonian University of Krakow. Poland; (4)PhD. Biotechnologist. Department of Bioinformatics and Telemedicine. Medical College. Jagiellonian University of Krakow. Poland.

**Background and objectives:** Eating disorders are characterized by changes in eating patterns associated with low self-esteem, perfectionism, poor empathy, and an obsession with a body image. The aims of presented study were: 1. Determination of eating disorders risk among Polish adolescents; 2. Evaluation of the relationship between BMI and eating disorder symptoms.

**Methods:** A cross-sectional survey was performed in a random sample of adolescents from secondary and high schools of Southern Poland, aged between 13 and 19 years old. Information on weight control concerns and behaviors, and eating disorder symptoms (EDI) has been collected using a self-administrated questionnaire. Data obtained from questionnaire were analyzed with using multiple logistic regression model. Differences between categorical variables have been tested by chi-square test. Crude odds ratios (OR) have been calculated to evaluate the risk of independent variables and associated 95% confidence intervals. Statistical analysis has been performed with R software (2.15.3 version), GLM procedure.

**Results:** A total of 3572 adolescents (average age 16.13±1.54) have been analyzed (1899 girls and 1673 boys). Overweight was

## "DISCRETIONARY FOODS" VERSUS "ULTRA-PROCESSED FOODS" – COMPARISON OF THE AUSTRALIAN DIETARY GUIDELINES FOOD CATEGORIZATION AND THE NOVA PROCESSED FOOD CLASSIFICATION SYSTEM

(1)Sui, Zhixian; (2)Rangan, Anna; (3)Raubenheimer, David; (4)Gill, Timothy.

(1)Postdoc. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia;
(2)Assoc Professor. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia;
(3)Professor. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia.

**Background and objectives:** The Australian Dietary Guidelines (ADG) categorize foods into core and discretionary foods on the basis of their nutrient contribution, and advises limiting the intake of discretionary choices. A new food classification system (NOVA) has been proposed which categorizes foods by the level of processing, with processed foods, particularly the most highly processed category called ultra-processed foods, being associated with lower overall diet quality. This study aimed to apply the two systems to the current Australian diet and examine the coherence between discretionary food and ultra-processed food.

**Methods:** All foods, beverages, and recipes in the Australian Food and Nutrient database 2011 (AUSNUT) were categorised: 1) as core or discretionary food according to ADG criteria; and 2) according to the degree of processing based on the NOVA criteria (unprocessed food, culinary ingredient, processed food, ultra-processed food, or mixed dish containing multiple degrees of processing). Both categorisations were applied to dietary data collected using 24-hour recalls of 9,431 adults participating in the 2011-12 National Nutrition and Physical Activity Survey (NNPAS) in order to calculate the proportion of energy contribution from each category.

**Results:** Of the 1,616 discretionary food items within AUSNUT, 15% were classified under NOVA as processed, 40% as
ultra-processed and 40.5% as mixed dishes containing a large proportion of ultra-/processed food. Data from NNPAS showed discretionary food consumption contributed approximately 33.7% of total energy intake in Australia. In comparison, ultra-processed food (20.7%) and processed food (23.5%) together contributed 44.2% of total energy intake. Among Australian adults, less than a quarter of total energy intake was contributed by unprocessed foods (22.3%).

**Conclusions:** Ultra-processed foods make up a significant proportion of the discretionary food consumed by Australians. However, the definition of discretionary does not strongly correlate with the degree of food processing. The two food categorization systems thus measure different dietary features within the same population. It remains to establish their relative merits as guides for research, dietary advice and public health policy.

**Keywords:** Foods; processed; ultra-processed; database; NOVA

**Background and objectives:** In Tanzania, undernutrition among children and mothers, especially in rural areas, is a common phenomenon. Evidence-based strategies for nutrition intervention mainly address direct determinants such as food intake whereas, community based interventions tend to have higher efficacy when combined other proximal determinants such as women's economic and social empowerment. Women's education, access to economic means of production, ownership of assets and ability to purchase inputs are very limited, which increases their income and food insecurity.

**Objective:** to create cooperative farming project a collective way to cultivate soybean to improve the quality of the existing diet and an infrastructure to effect the women's economic sustainability and empowerment.

**Methods:** The orientation of this project is Community Based Participatory Research (CBPR) which begin with a research topic of importance to the community with an aim of combining knowledge and action for social change to improve community health. Focus groups of Bukoba Women's empowerment Association (BUWEA) were conducted to share the findings of the first Tanzania Mainland Nutrition Survey. The focus group discussions led to identification of direct determinants of undernutrition as lack of availability; accessibility; and utilization of food whereas identified proximal determinants were women's lack of sustainable purchasing power; decision making power; business acumen; horticultural and technical assistance. These latter implied the lack

of women's social empowerment in their family and community context.

**Results:** BUWEA members (420) were provided minimal financial resources and technical expertise to grow soybean on 20 acres of land. After this initial harvesting, educational interventions on related topics as benefits and uses of soy in local diets; accounting and business skills; marketing; value added products, and grant writing. Women's Economic Development Personal and Social Impact Survey (WEDIS), administered in Swahili indicated significant consumption of soy in family diets, along with evidence of increased knowledge application in business and farming skills, utilization of technology, greater involvement in family decision-making, and more participation in social/political affairs. These are relevant indicators of women's personal and social empowerment in developing countries.

**Conclusions:** Recognizing a community as an essential research partner is key element of CBPR

**Keywords:** Community Based Participatory Research/CBPR, Social Empowerment, Undernutrition

**Background and objectives:** As with most developing countries Papua New Guinea (PNG) is undergoing rapid economic development which is expected to have an important impact on dietary habits and population health. However, the type and rate of change is expected to vary greatly across cultural groups in PNG and affected by extent of economic development. Understanding these differences is fundamental to developing effective health promotion measures. This study examined dietary patterns in four populations groups in PNG with different exposures to a major project.

**Methods:** The study applied a cross-sectional design conducted in two phases. Phase one used observation and participatory methods to document diet patterns and validate methods. Phase two used the four step 24-hour recall to collect detailed descriptions of intakes. Study sites included two coastal locations (Hiri, Karkar) and two in the highlands (Hides/Komo, Asaro), with a major project affecting Hiri and Hides/Komo. In phase one, 220 households
and 448 adults were involved, and phase two had 3247 participants selected purposively to reflect SES profile in the populations.

**Results:** Major components of traditional diets continue to exist in rural areas with more than 70% of participants consuming traditional staples (sweet potato, banana). However, all study sites incorporated store-bought food items. A majority of participants in Komo/Hides, Asaro, and Karkar consumed 20-30% of their diet as rice and tinned fish while it was 70-80% in Hiri. Vegetable oil was widely used in food preparation though used differently across sites - in the Highlands added either when boiling food or after the food is cooked while in Hiri frequently used for frying. Eating behaviours (types of meals, number of meals per day, snacking behaviours) differed by sites reflecting cultural norms.

**Conclusions:** The level and nature of diet change differed across study sites. Even though traditional diets were common, modern Western foods were essential dietary components with extent of use associated with project exposure. This may predict both favourable and adverse health outcomes. The results show a need to consider differences across populations in the way that the nutrition transition occurs, and to ensure that health promotion measures are suitable.

**Keywords:** Papua New Guinea, diet, eating behaviour, Western food, traditional

144/1477

IRON INTAKE ASSOCIATED WITH SOCIAL FACTORS AMONG WOMEN OF REPRODUCTIVE AGE IN JAPAN: FINDINGS FROM THE NIPPON DATA2010

**Background and objectives:** This study aimed to examine the relationship between iron intake and social factors among women of reproductive age in Japan.

**Methods:** A baseline survey of a prospective cohort study, which is entitled NIPPON DATA2010, was conducted along with the National Health and Nutrition Survey of Japan in November 2010. A total of 486 women aged 20-49 years old participated in the study were included in the analysis after excluding ineligible observations. Adequate iron intake was defined if the amount of iron intake was 9mg and more per day in accordance with the recommendation amount of Dietary Reference Intakes for Japanese (2015). Multivariable logistic regressions were performed to assess the relations between social factors as independent variables and iron intake. Social factors were educational status, marital status, household income, job, regional area and BMI. Total energy and some food groups such as pulses and vegetables were included in this analysis as confounding factors.

**Results:** The prevalence of adequate iron intake among women of reproductive age was 21.0%. After adjustments for confounding factors, women with lower household income (adjusted odds ratio (OR) 2.28, 95% confidence interval (95%CI) 1.28-4.05) was more likely to have poor iron intake, while women lived in southwest Japan (OR 0.47, 95%CI 0.23-0.95), women with underweight (OR 0.48, 95%CI 0.24-0.99) were less likely to have poor iron intake.

**Conclusions:** Social factors such as household income, regional area, and BMI were statistically significantly associated with iron intake among women of reproductive age in Japan.

**Keywords:** Iron intake, social factor, income and regional disparity, women of reproductive age, Japan

**Further collaborators:**

NIPPON DATA2010 Research Group

144/1480

GLUTTONY AND GUILT: COMPARING MONTHLY TRENDS IN INTERNET SEARCH QUERY DATA WITH DATA FROM THE AUSTRALIAN NATIONAL NUTRITION AND PHYSICAL ACTIVITY SURVEY

**Background and objectives:** Health professionals require contemporaneous information to assess progress and prioritize action relating to overweight and obesity, which is now a global epidemic. Yet, systems for monitoring population-level diet and nutritional intake have been considered insufficient in the majority of countries. The purpose of this study was to investigate whether trends in search query data related to behavioural change associated with obesity can be used to inform actual population nutritional intake and dieting behaviour.

**Methods:** We first examined long term (2004 to 2016) trends in Australian Google relative search volume (RSV) for the terms

<footnote>(1)Shinsugi, Chisa; (2)Nishi, Nobuo; (3)Kadota, Aya; (4)Hozawa, Atsushi;</footnote>

<footnote>(5)Ohkubo, Takayoshi; (6)Okuda, Nagako; (7)Okamura, Tomonori;</footnote>

<footnote>(8)Ueshima, Hirotsugu; (9)Okayama, Akira; (10)Miura, Katsuyuki.</footnote>

<footnote>(1)MPH. Researcher. Center for International Collaboration and Partnership. National Institutes of Biomedical Innovation. Health and Nutrition. Japan; (2)MD. PhD. MSc. MBA. Chief. Center for International Collaboration and Partnership. National Institutes of Biomedical Innovation. Health and Nutrition. Japan.; (3)MD. PhD. Associate Professor. Department of Public Health. Shiga University of Medical Science. Japan.; (4)MD. PhD. Professor. Division of Personalized Prevention and Epidemiology. Tohoku University Graduate School of Medicine. Japan.; (5)MD. PhD. Professor. Department of Hygiene and Public Health. Teikyo University School of Medicine. Japan.; (6)MD. PhD. Professor. Department of Health and Nutrition. University of Human Arts and Sciences. Japan.; (7)MD. PhD. Professor. Department of Preventive Medicine and Public Health. Keio University. Japan.; (8)MD. PhD. Professor. Department of Public Health. Shiga University of Medical Science. Japan.; (9)MD. PhD. Director. Research Institute of Strategy for Prevention. Japan.</footnote>

<footnote>(1)Sui, Zhixian; (2)Coogan, Sean; (3)Raubenheimer, David.</footnote>

<footnote>(1)Postdoc. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia;</footnote>

<footnote>(2)PhD. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia; (3)Professor. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia.</footnote>
“weight loss”, “diet” and “fitness” to establish monthly patterns in search term usage. We then examined the monthly energy, macronutrient, and food intake of the Australian population, and the proportion of self-reported dieters, using data collected from the National Nutrition and Physical Activity Survey (NNPAS) 2011/12. Decompositional time series analysis and least squares means contrasts of generalized linear mixed models (GLMMs) were used to examine monthly differences in RSV. Nutritional geometry and ANCOVA was used in the analysis of NNPAS data.

**Results:** We found that RSV was significantly higher than the mean during January, and lower during December, for all search terms. The decline in RSV was not linear, however, as there was a significantly lower RSV for terms during May to July, and significantly higher from August to October. The pattern of energy intake (kJ) (highest in December and lowest in February) of survey participants, and the percentage of self-reported dieters, closely followed monthly patterns in RSV. The proportion of energy from protein was consistent across months examined; however, energy from lipid and carbohydrate + fiber were variable between months. Likewise, patterns of food-group consumption was variable across months.

**Conclusions:** Our analysis suggests that search query data can be used to inform the timing of national public health strategies to combat obesity.

**Keywords:** Weight Loss; Google; Big Data; Diet; Nutritional Geometry

laboration the ‘default’ behaviour and utilising existing platforms to deliver targeting messaging.

The objective is to reduce the prevalence of stunting in children under two years of age through collective multi-sector action

**Methods:** Hamutuk is taking an evidence based approach to improve the quality and coverage of nutrition promoting behaviours at the household level by:

1. Strengthening nutrition capacity across partners

2. Using m nutrition tools to trigger behaviour change and create a nutrition enabling environment amongst partners

**Results:** The program is in early implementation. Measured activities to date include partner workshops on behavioural insights, gender, nutrition and the making of a multisector nutrition video for household consumption.

The joint monitoring platforms has sped up the monitoring and evaluation cycle providing faster insights of intervention reach and impact

**Conclusions:** Hamutuk will allow the Government of Timor-Leste to measure the collective impact of existing nutrition specific and nutrition sensitive interventions on stunting, and model an approach to support effective scale up of multi-sector nutrition programming and m-nutrition interventions.

**Keywords:** Stunting, multisector nutrition programming, m-nutrition

**Further collaborators:**

Catalpa

DFAT Innovation Xchange

144/1482

MAKING COLLABORATION THE DEFAULT TO DELIVER MULTISECTOR NUTRITION PROGRAMMING - A NEW APPROACH IN TIMOR-LESTE

(1)Grieve, Heather; (2)Da Sousa, Erkulana.

(1)Public Health Nutritionist (Bsc.MND MPH) Australian Embassy. Timor-Leste; (2)Technical Nutrition Lead (BA) Partnership for Human Development. Timor-Leste.

**Background and objectives:** Despite progress, preliminary data from the 2016 Demographic and Health Survey indicates that undernutrition in women and children continues to be a major development issue, across all municipalities, in urban and rural areas and across all wealth quintiles in Timor-Leste. On the contrary, the prevalence of overweight and obesity is increasing, raising concerns of the emerging double burden of malnutrition.

Global evidence suggests that no single policy or intervention can create sustained reductions in malnutrition. Instead, a mix of coordinated interventions, across sectors is required to address the immediate and underlying causes of malnutrition across the lifecycle.

While integrated multi-sector programming presents great potential, the evidence-base on which to achieve this potential remains weak. In practice, poor program targeting and evaluation has resulted in limited evidence demonstrating the impact of integrated programming on improving nutrition status. The Hamutuk (“together”) program is using technology to make col-

144/1485

PEOPLE'S CHOICE – FOOD AND MACRONUTRIENT SELECTION IN AN OBESOGENIC ENVIRONMENT

(1)Sui, Zhixian; (2)Coogan, Sean; (3)Rangan, Anna; (4)Simpson, Steve;

(4)Raubenheimer, David.

(1)Postdoc. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia;

(2)PhD. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia; (3)Assoc Professor.

Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia; (4)Professor. Charles Perkins Centre. School of Life and Environmental Sciences. The University of Sydney. Australia.

**Background and objectives:** Studying intake of macronutrients and their inter-correlations is complex. People do not have one sum of food intake per day and do not typically plan the macronutrient ratios for their meals. Rather, people have a large variety of meals with variable nutrient ratios and complex dishes comprised by mixed foods throughout the day by spreading nutrient/ food intakes into different meals/eating periods. This study aimed to investigate how people regulate their macronutrient intakes under free-living conditions, and whether protein is the regulatory priority, in relation to diet quality.
**Methods:** This study utilised 24-hour recalls of 9,113 adults participating in the 2011-12 National Nutrition and Physical Activity Survey and National Health Measures Survey. Nutritional Geometry was used to examine how people regulate proportions of macronutrients consumed meal by meal, and over the whole day, while also adjusting for significant anthropometric and demographic features.

**Results:** Respondents that consumed higher protein density food at the start of the day reduced their proportion of energy from protein during subsequent eating periods; however, their total daily protein intake remained high, and energy intake lower, by the end of the day. In contrast, respondents that consumed lower protein density food at the start of the day increased their proportion of energy from protein in the following meals, but remained low protein density and high energy intake for the day. Over the whole day, the percent protein consumed was inversely associated with total energy intake and positively associated with total diet quality, as indicated by higher consumption of healthy meat and alternatives, vegetable, and dairy products, and lower consumption of discretionary choices. Respondents that consumed a higher proportion of protein energy also reported significantly higher unprocessed food intake and lower processed and ultra-processed food intake.

**Conclusions:** Total daily energy intake is strongly associated with the proportion of protein in foods chosen early in the day, the proportion of protein over the entire day (daily diet), and the foods available in the environment.

**Keywords:** Protein; protein leverage hypothesis; energy intake; nutritional geometry; processed food

**Background and objectives:** According to World Health Organization in the world there are more than 1900 million adults overweight and obese. Health professionals are not stranger to this reality, and in them the impact is greater because they affect the health behaviors of the patients. The nutritional status of health professionals is important because they serve as health role models and because they are more likely to counsel their patients about health behavior change if they practice healthy habits themselves. Therefore, the objective of this study is to evaluate the nutritional status of health professionals in a hospital.

**Methods:** Descriptive research with a quantitative approach and cross-sectional design was applied. The sample was composed of 106 health professionals from 5 specialties: nursing, medicine, obstetrics, nutrition and medical technology. The anthropometric nutritional status was evaluated according to Body Mass Index (BMI), Waist Circumference (WC), Body Fat Percentage (BFP) and Visceral Fat. The statistical program IBM SPSS Statistics 22.0 was used for the analysis of data.

**Results:** According BMI of health professionals evaluated, 45.3% were overweight, 20.8% were obese grade I, 1.9% were obese grade II, 2.8 were thin, and 29.2% were normal. About WC, 39.6% had a high cardiometabolic risk, 31.1% had a very high cardiometabolic risk and 29.2% had a low cardiometabolic risk. According to BFP, 58.5% presented a very high level, 30.2% high, 10.4% normal and 1% low. About visceral fat, 34% presented a high level. According to specialties, medical professionals had the highest prevalence of obesity (35.1%), very high percentage of body fat (67.6%) and high visceral fat (54.1%). Midwives had 61.1% of overweight and nurses presented 43.6% of very high cardiometabolic risk. Nutritionists were the only group with normal values of BMI, WC and visceral fat.

**Conclusions:** 70% of the health professionals evaluated were overweight and obese, in addition to high and very high cardiometabolic risk; also 90% had a high and very high body fat percentage, and 34% had a high level of visceral fat.

**Keywords:** Overweight, obesity, health professionals, nutritional status.

**Background and objectives:** The rising trend in the prevalence of overweight and obesity has been recognized as a public health problem in Thailand, particularly in urban settings. However, comprehensive data on the dietary sources of energy and nutrients in Thai obese children are lacking. This study aimed to identify the dietary intake of urban Thai preadolescents by weight status and to determine food contributing to sex-, age-specific BMIZ scores (BAZ), by using a new proposed food group classification.

**Methods:** Dietary intake of 263 children aged 10-12 y in Bangkok Metropolitan Regions, Thailand, was assessed through three non-consecutive 24-h recall interviews. Lifestyle and socio-demographic characteristics were obtained from questionnaires. BAZ was calculated from data obtained from the school health records, and was then classified into non-obese, and overweight/obese groups based on WHO Growth Charts. Differences in dietary intake and contribution to micronutrients were analyzed by analysis of covariance. Individual food items were classified into thirteen groups based on Thai dietary guidelines, and the context of Thailand's food environment around children, including
“street-side snacks”. Street-side snacks was defined as a light meal or snack mostly available at a street vendor’s, road-side shop, without food label, and included traditional fast food, local dishes, or western fast food and could be eaten between main meals. The relation between food consumption and BAZ was evaluated using multiple linear regression analysis.

**Results:** After adjustment for sex and misreporting of energy, overweight/obese children had higher intake of daily energy and all primary macronutrients, and consumed more cereal grains, meats/fish, eggs, flavored milk, and street-side snacks. Stepwise multiple regression showed that there were ten food groups that were significantly and positively associated with BAZ. Of these, consumption of street-side snacks had the highest impact to BAZ, and remained at the top even after further controlling for energy intake.

**Conclusions:** Our finding implies that children's weight status can be affected by the food environment around the school, by showing the association between the consumption of street-side snacks on BAZ. This may help in encouraging future dietary strategies on the prevention of childhood obesity through environmental approach in the Thailand context.

**Keywords:** dietary intake, food group, overweight/obesity, preadolescents, Thailand

**Further collaborators:**

Napaphan Viriyautsahakul. MD.

144/1498

RELATIONSHIP AMONG HYDRATION STATUS AND PHYSICAL ACTIVITY IN ADOLESCENTS. HYDRATION UP & DOWN SUBSTUDY

**Background and objectives:** Hydration and physical activity are very important concepts on which we must go more deeply since they are essential for the evaluation of the nutritional status and health during adolescence, a key stage in the acquisition of behavioral habits.

The objective was to evaluate the possible relationship between hydration status and physical activity (PA) in adolescents.

**Methods:** This is a cross-sectional substudy from the Up & Down Study. A total sample of 67 adolescents (39 males and 28 females) was analyzed, with a mean age of 15.9 years ± 0.3. The subjects were grouped according to their sex. The PA level was measured through the Physician-based Assessment and Counseling for Exercise questionnaire (PACE), and the hydration parameters [Total Body Water (TBW) and ExtraCellular Water (ECW)] by bioimpedance.

**Results:** Adolescents showed normal weight in both sexes (mean BMI = 21 kg/m2). Triceps fold values were higher in girls (16.7 ± 5.6 mm) than in boys (10.3 ± 4.4 mm). Water composition values (TBW and ECW, in litres), were higher in boys than in girls (36.8 ± 5.2 vs 29 ± 2.7 and 15.9 ± 2.5 vs 12.7 ± 1.6), respectively.

Boys were more active than girls according to their score in the PACE questionnaire, obtaining 3.1 ± 1.7 vs 2.1 ± 1.3 days of commitment with PA recommendation of 60 min/day (p=0.028).

82.1% boys and 64.3% girls had an optimal ECW range. However, when evaluating hydration according to TBW, 33.3% boys were within the optimal range while none of the girls met this range.

When studying the relationship among hydration and physical activity, we observed that the subjects who had an optimal hydration range for TBW were the most active ones according to the PACE questionnaire (p=0.011).

**Conclusions:** Girls were less active than boys in general, and this inadequate habit may be related to a less optimal hydration status. Therefore, physical activity should be taken into account when promoting healthy habits among adolescents, particularly those related to their hydration status.

**Keywords:** Hydration, Physical activity, Adolescence.

144/1506

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

**Background and objectives:** As several Mediterranean countries, Tunisia has experienced an epidemiological and nutritional transition resulting in an increase in overweight, obesity

<footnote>(1)Gómez-Martínez, Sonia; (2)Rodríguez-Laprast, Juan Alberto;</footnote>

<footnote>(3)Hernández González, Aurora; (4)García-Cervantes, Laura;</footnote>

<footnote>(5)Cabanas-Sánchez, Verónica; (6)Marcos, Ascensión.</footnote>

<footnote>(1)PhD. Biologist. Institute of Food Science, Technology and Nutrition. Spanish National Research Council. Madrid. Spain;</footnote>

<footnote>(2)MSc. Nutritionist. Institute of Food Science, Technology and Nutrition. Spanish National Research Council. Madrid. Spain.; (3)PhD. Quemist. Institute of Food Science, Technology and Nutrition. Spanish National Research Council. Madrid.</footnote>

<footnote>Spain.; (4)MSc. Sports Science Degree. Department of Physical Education, Sport and Human Movement. Autonomous University of Madrid. Madrid. Spain.; (5)PhD. Sports Science Degree. Department of Physical Education, Sport and Human Movement. Autonomous University of Madrid. Madrid. Spain.;</footnote>

<footnote>(6)PhD. Pharmacist. Institute of Food Science, Technology and Nutrition. Spanish National Research Council. Madrid. Spain.</footnote>

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

<footnote>(1)PhD. Nutritionist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (2)PhD. Nutritionist. Institut National de Nutrition et de Technologie Alimentaire. Tunisia.; (3)PhD. Environmental Physician. Unité Mixte de Recherche Information, Technologies, Analyse environnementale, Procédés agricoles (UMR ITAP). Montpellier SupAgro. France.; (4)PhD. Economist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (5)INRA.</footnote>
and co-morbidities. In the last decades, food consumption de-
parted from traditional diets towards higher consumption of an-
imal-based and sweet products. Tunisia also faces environmental
issues such as water scarcity, soil erosion and biodiversity loss. This
growing concern for health issues and climate change has empha-
sized the need to promote sustainable diets, i.e. nutritionally ade-
quate, affordable, culturally acceptable, and with low environmen-
tal impact. The objective was to identify dietary changes needed
to move towards nutritionally adequate diets without increasing
their environmental impact.

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

**Results:** Calcium, copper, iron, magnesium, potassium and vitamin D intakes were below their recommendations in the mean observed diets, while sodium and fats exceeded them. Under the NUTRI scenario, i.e. reaching nutritional adequacy without controlling for the environmental impacts, the main dietary changes were the increases of fruits and dairy products, and decreases of meat and starchy foods. All the environmental indicators were impaired, except erosion resistance and biotic production. Under the NUTRIENV scenario, i.e. when environmental indicators were limited to their observed levels, the changes in fruits, dairy products and starchy foods quantities were lower than in the NUTRI scenario, in favor of vegetables.

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

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

**Further collaborators:**

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

TREND OF MATERNAL AND CHILD HEALTH AND NUTRITION INDICATORS IN KENYA: IMPLICATION FOR POLICY DEVELOPMENT

Makokha, Anselimo.

Professor. Jomo Kenyatta University of Agriculture and
Technology. Kenya.

**Background and objectives:** The Kenya Demographic and Health Surveys (KDHS) were published in 1989, 1993, 1999, 2003, 2009 and 2014. The objective of the study was to assess changes in key maternal and child health and nutrition indicators in this reports.

**Methods:** It was a desk study.

**Results:** Fertility steadily declined from 6.7 births in 1989 to 3.9 in 2014, as the use of contraceptives increased from 27% to 58%. One fifth of teenage girls had either given birth or were pregnant in each of the KDHS reports. By 19 years, 40 – 45% had their first child or pregnancy. Ante natal clinic attendance ranged from 92% to 96%. However, only about one half made the recommended minimum four visits. The proportion of women who delivered in health facilities was below 50%, except in 2014, when it was 61%. By 2014, over a quarter of the women, 28%, were still assisted by traditional birth attendants during birth. Full vaccination coverage among children was at a rate of 79% in 1989 and 2014, but 57% in 2003. Though universal breastfeeding was observed in all the reports, complementary foods were introduced to 25-75% of the babies by the age of two months. Initiation of breastfeeding was done within one hour after birth among only about half of the babies. The proportion of under five children (U5) who had received Vitamin A supplements was 30-33%, except in 2014, when it doubled to 62%. In the five reports from 1989 to 2009, the stunting rates of U5 remained constant, at one third, but reduced to 26% in 2014. The U5 mortality rates increased from 96 to 115 deaths per 1000 between 1993 and 2003, then dropped to 52 in 2014. The infant mortality rate followed a similar trend, increasing from 66 to 77 deaths per 1000, then decreasing to 39 in 2014.

**Conclusions:** The observed changes in the maternal and child health and nutrition indicators can be evaluated to inform policy and future programme interventions.

**Keywords:** Maternal, Child, Health, Nutrition, Kenya.
# DEVELOPMENT OF A ROADMAP FOR MAINSTREAMING CONTEXTUAL NUTRITION-SENSITIVE INTERVENTIONS AT KEBBI AND ANAMBRA STATES, NIGERIA

(1)Ezekannagha, Oluchi; (2)Mbhenyane, Xikombiso; (3)Drimie, Scott.

(1)BSc. MPH. PhD Student. Division of Human Nutrition. Faculty of Medicine and Health Sciences. Stellenbosch University. South Africa; (2)BSc. MSc. PhD. Professor. Division of Human Nutrition. Faculty of Medicine and Health Sciences. Stellenbosch University. South Africa.; (3)BA. MPhil. PhD. Adjunct Professor. Division of Human Nutrition. Faculty of Medicine and Health Sciences. Stellenbosch University. South Africa.

**Background and objectives:** Continued high prevalence of malnutrition in Nigeria calls for emerging strategies to tackle existing burden and prevent newer incidences. Applying sub-national contextual programming to nutrition-sensitive interventions creates a pathway to sustainable malnutrition reduction. Given the variations at these sub-national levels such as varying malnutrition profiles, political dynamics, state finances and program implementations. This study thus aims to evaluate the epidemiological, operational and socio-political domains of mainstreaming nutrition sensitive interventions in Kebbi and Anambra states, Nigeria to inform the development of roadmap.

**Methods:** This study employs the Mainstreaming Nutrition Initiative Framework in an explanatory sequential mixed methods design. Kebbi in the North-West geopolitical zone and Anambra in the South-East geopolitical zone was chosen purposively as a high undernutrition state (Stunting – 60.6%) and low undernutrition (Stunting – 18.4%)/emerging overweight state respectively. In Phase 1, the local government area estimates of malnutrition will be sought using Nigeria's Living Standard Measurement Survey. In Phase 2, Firstly, the program documents of ministries of agriculture, welfare, education and environment will be assessed using a nutrition-sensitivity assessment checklist and a potential-to-be nutrition-sensitive checklist. Finally, a program observation site visit will be carried out in which an in-depth interview (Program manager) and two exit interviews will also be conducted on participants that use the program. For Phase 3, a one-day workshop in both states will be conducted with the instrument Political Commitment and Opportunity Measurement – Rapid Assessment Tool (PCOM-RAT). Finally Phase 4 will include synthesis of results from the above phases to develop and validate a roadmap for mainstreaming nutrition-sensitive programming in the study states. The development will use program impact pathway and take cognizance of political, operational and epidemiology findings.

**Results:** Outcomes of this study will provide a case study to show that the Mainstreaming Nutrition Initiative framework provides a theoretical basis for mixed methods research to enable understanding of epidemiological, operational and socio-political domain of mainstreaming nutrition-sensitive actions.

**Conclusions:** If the pragmatic roadmap is implemented, this study provides a template for strengthening nutrition-sensitivity and aligning already existing programs in nutrition sensitive sectors.

**Keywords:** Mainstreaming nutrition, Nutrition-sensitive programming, Protocol, Mixed methods, Contextual programming

**Conflict of Interest Disclosure:** Ezekannagha Oluchi received NRF-TWAS funding for her doctoral studies. All authors have no conflict of interest.

# SALT REDUCTION IN BREAD AMONG MOROCCAN POPULATION

(1)Taboz, Youness; (1)Benkirane, Hasnae; (1)Guennoun, Yasmine;

(2)Elammari, Laila; (2)Elberri, Hicham; (2)Mouzouni, Fatima-Zahra;

(3)Benajiba, Nada; (1)Elkari, Khalid; (4)Barkat, Amina; (1)Aguenaou, Hassan.

(1)Joint Research Unit in Nutrition and Food. Ibn Tofail University. CNESTEN. Kenitra. Rabat. Morocco; (2)Ministry of Health. Morocco; (3)Clinical Nutrition Program. Department of Health Sciences. College of Health and Rehabilitation Sciences. Princess Nourah BintAbdulrahman University. Riyadh. KSA.; (4)Health and Nutrition Research Team of the Mother Child Couple. Faculty of Medicine and Pharmacy. Mohammed V University of Rabat. Morocco.

**Background and objectives:** To contribute to the achievement of global voluntary targets for non-communicable diseases set by the World of Health Organization and the Second International Conference on Nutrition (ICN2), Morocco has developed a plan of reducing salt consumption to combat the non-communicable diseases. The objective of the present study is to assess acceptance of bread with different percentage reduction of salt by Moroccan population.

**Methods:** In this study, 201 participants (age >15 y.) were recruited to determine the level of salt reduction in bread. Different salt contents par 100g were tested and compared: 1,74g, 1,62g, 1,56g, 1,46g, 1,34g, 1,21g et 0,81g, corresponding to the reduction of salt of 0%, 7%, 10%, 16%, 23%, 30% and 53%, respectively, compared available bread in local market. Overall liking, "Just About Right" (JAR) and purchase scales was used to score the different salt contents in bread.

**Results:** Bread with a reduction of 10% and 16% is highly accepted by 76,11% and 78,60% of respondents. Based on JAR score, bread with 10% (1,56g/100g) and 16% (1,62g/100g) of reduction were considered as "just about right" by 50,54% and 56,92% respectively. Best average score of purchase intent is obtained for salt content in bread of 1,62g and 1,56g for a reduction of 10% and 16% respectively.

**Conclusions:** The results show that reducing salt levels is easily achievable and is acceptable to customers. Bread with a reduction on salt of 10% and 16% is highly accepted by respondents. Food Industry is needed to reduce salt in bread to accompany the national salt reduction strategy in Morocco.

**Keywords:** Salt reduction, acceptance, bread, Morocco
## VALIDITY OF WAIST TO HEIGHT RATIO IN PREDICTING DYSLIPIDAEMIA AMONG SRI LANKAN CHILDREN AGED 8-9 YEARS

(1)Kalaichelvi, Thillan; (2)Samaranayake, Dulani; (3)lanerolle, Pulani;

(4)Thoradeniya, Tharanga; (5)Wickramasinghe, Pujitha.

(1)MSc. Post graduate student. Department of biochemistry and Molecular Biology. Faculty of Medicine. University of Colombo. Sri Lanka; (2)Senior Lecturer. MBBS.MSc.MD.Department of Community Medicine. University of Colombo. Sri Lanka; (3)BScHons.PhD. Senior Lecturer. Department of Biochemistry and Molecular Biology. Faculty of Medicine University of Colombo. Sri Lanka; (4)BVSc. PhD. Senior Lecturer. Department of Biochemistry and Molecular Biology. Faculty of Medicine University of Colombo. Sri Lanka.; (5)MBBS.DCH.MD.PhD.Professor in paediatrics. Department of Paediatrics. Faculty of Medicine. University of Colombo. Sri Lanka.

**Background and objectives:** Dyslipidaemia, an important risk factor associated with cardio vascular disease is increasingly observed among paediatric populations. There is a need for a simple and quick screening tool to predict this condition. The present study evaluated the validity of Waist to Height Ratio (WHtR) in predicting dyslipidaemia among 8-9 years old Sri Lankan children.

**Methods:** Cross sectional study was conducted among 8-9 years old school children within Colombo Municipal area comprising of 146 children with high adiposity (body fat > 28.6% in boys and >33.7% in girls) and 148 children with normal adiposity assessed by bioelectrical impedance analysis (BIA). Weight, height, waist circumference (WC) and serum lipids (Triglyceride-TG, HDL, LDL cholesterol and Total Cholesterol-TC after 12 hours of overnight fasting) were measured. Simple correlation analysis was done to investigate the association between the lipid parameters and anthropometric indices (Body mass index, WC and WHtR). Dyslipidaemia was defined as 2 or more abnormal parameters in the lipid profile. Receiver operating characteristic (ROC) curves were analyzed for WHtR in predicting dyslipidaemia. Youden index was used to determine the optimum cut off values for WHtR predicting dyslipidaemia.

**Results:** WHtR showed significant correlations with lipids in boys (TC-r=0.216, p<0.01, TG-r=0.362, p<0.001, LDL-r=0.230, p<0.01, HDL-r=-0.208, p<0.05) and in girls (TG-r= 0.329, p<0.001, LDL-r=0.175, p<0.05, HDL-r=-0.349, p<0.001)). The cut off value of WHtR was 0.486 for boys (sensitivity-69.4%, specificity-65.7%) and 0.481 for girls (sensitivity-61.4%, specificity-64.5%). The positive and negative predictive values were 66.9% and 68.2% for boys whereas in girls these values were 63.4% and 62.6% respectively.

**Conclusions:** WHtR can be used as a screening tool to predict dislipidaemia among 8-9 year old Sri Lankan children. These cut off values are similar to the values defined in other populations. Since the WHtR is a simple, quick and non invasive anthropometric technique it could be feasible for use in screening for dyslipidaemia in this population group. A practical cut off for both genders would be 0.5.

**Keywords:** Dyslipidaemia, Waist-height ratio, Children, Screening tool

## DETERMINATION OF THE SALTY TASTE THRESHOLD IN THE MOROCCAN POPULATION

(1)Guennoun, Yasmine; (1)Taboz, Youness; (1)Benkirane, Hasnae;

(1)Elkari, Khalid; (2)Raji, Fatiha; (2)Elammari, Laila; (3)Benajiba, Nada;

(2)Elberri, Hicham; (4)Barkat, Amina; (1)Aguenaou, Hassan.

(1)Joint Research Unit in Nutrition and Food. Ibn Tofail University. CNESTEN. Kenitra. Rabat. Morocco; (2)Ministry of Health. Morocco; (3)Clinical Nutrition Program. Department of Health Sciences. College of Health and Rehabilitation Sciences. Princess Nourah BintAbdulrahman University. Riyadh. KSA.; (4)Health and Nutrition Research Team of the Mother Child Couple. Faculty of Medicine and Pharmacy. Mohammed V University of Rabat. Morocco.

**Background and objectives:** Following the recommendations of the World Health Organization to reduce the average salt consumption in the populations by 30% to reach a target of less than 5 g per day by 2025, Morocco has recently developed a plan of salt reduction in order to reinforce prevention of non-communicable diseases which is a major problem at the national level. The present study is a masterpiece of this national strategy since its objective is to determine the threshold of perception of salt taste in the Moroccan population. The national plan for the reduction of salt consumption will take this into account in order to gradually reduce the salt content in processed foods

**Methods:** The study involved 201 testers divided into 4 age groups [15-29 years], [30-44 years] [45-59 years] and over 60 years. The panelists tested NaCl solutions at concentrations of 1, 2, 4, 8, 15, 30, 60, 125, 250, 500 mmol/l in random order using the blind Alternative Forced Choice method. The rinsing between each test was carried out using flat water. Informations on age, sex, height, weight and Body Mass Idex was collected and transcribed on SPSS software for statistical processing

**Results:** Results show that 38.80% of the testers began to perceive the salty taste from the concentration of 30 mmol/l (1.75 g/l) and 31.84% from the concentration of 15 mmol/l (0.875 g/l), while 10.94% and 13.93% of the testers perceived the salty taste respectively at concentrations of 8 mmol/l (0.46g/l) and 60 mmol/l (3.5g/l). The khi2 test shows a significant correlation between the perception of the salty taste and the sex (p value = 0,035) and the perception of the salty taste and the BMI (p value = 0,034). The age has no significant effect on the threshold of perception of the salty taste (p value 0.500).

**Conclusions:** The results obtained are very important data that can be used as part of the national salt reduction strategy to convince industrials to reduce salt levels in processed foods

**Keywords:** Determination, salty taste, perception, Morocco
**Methods:** Multi-group, ecological design (23 provinces and the Autonomous City of Buenos Aires). A cluster analysis was conducted to identify clusters by proximity among geographical units, based on similarities among NT indicators (nutritional state, physical activity, and food intake), obtained from official sources of information: Nationwide Nutrition and Health Surveys (2005), Risk Factors of Non-Transmissible Diseases (2005, 2009, 2013), and Population, Household, and Housing Census 2010. Summary measures of these indicators and of sociodemographic variables were calculated (based on the 2010 census), with the aim of characterizing each cluster identified. These were incorporated into a GIS (Geographical Information System) to draw up maps using the ArcGIS 10.2 software

**Results:** Three NT clusters were identified in Argentina: 1) provinces in the Pampas region, Cuyo and part of Patagonia; 2) the Autonomous City of Buenos Aires and the south of Patagonia; 3) the provinces in the northwest and northeast of Argentina. Cluster 2 displayed the highest levels of adult (19.99%) and child (11%) obesity, use of computers (71.3%), frequent salt consumption (23.63%) and consumption of at least 5 daily portions of fruit and vegetables (5.28%), while cluster 3 recorded the highest prevalence of low weight, low height and anemia in children (2.69%, 9.69%, 19.06%; respectively). Physical inactivity, alcohol intake and overweight in adults were similar in the clusters identified. Cluster 3 showed the worst relative situation concerning indicators of socio-economic level, health coverage, education, and degree of urbanization.

**Conclusions:** There are geographical clusters in Argentina with specific nutritional and sociodemographic characteristics. This might indicate different NT processes in the interior of the country.

**Keywords:** nutritional transition, sociodemography, spatial epidemiology, Argentina

144/1561

URINARY SODIUM EXCRETION AND RISK OF ISCHEMIC STROKE

(1)Kieneker, Lyanne; (2)Eisenga, Michele; (3)Gansevoort, Ron; (4)de Boer, Rudolf; (3)Navis, Gerjan; (5)Muskiet, Frits; (3)Dullaart, Robin; (6)Joosten, Michel; (3)Bakker, Stephan J.L.

(1)MSc. Department of Internal Medicine. University Medical Center Groningen. The Netherlands.; (2)MD. Department of Internal Medicine. University Medical Center Groningen. The Netherlands.; (3)MD, PhD. Department of Internal Medicine. University Medical Center Groningen. The Netherlands.; (4)MD, PhD. Department of Cardiology. University Medical Center Groningen. The Netherlands.; (5)PhD. Department of Laboratory Medicine. University Medical Center Groningen. The Netherlands.; (6)PhD. Department of Internal Medicine. University Medical Center Groningen. The Netherlands.

**Background and objectives:** Results: **Methods:** We studied 7,330 subjects free of cardiovascular events at baseline in the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and

women aged 28-75 years. UNaV was measured in two 24-hour urine specimens at baseline (1997-1998) and two specimens during follow-up (2001-2003).

**Results:** Baseline median UNaV was 137 mmol/24h (IQR: 106-171 mmol/24h). During a median follow-up of 12.5 years (IQR: 11.9-12.9 years), a total of 131 ischemic stroke events occurred. In primary analyses, we observed an inverse association between UNaV and risk of ischemic stroke (HR per 1 SD [51 mmol/24h] decrement, 1.53; 95% CI, 1.17-2.02) after adjustment for lifestyle and dietary variables. The association of UNaV with risk of ischemic stroke was modified by smoking status (Pinteraction=0.017), in such a way that the association was only observed among current smokers (HR per 1 SD decrement, 2.58; 95% CI, 1.60-4.15; n=53) and not among former/never smokers (HR per 1 SD decrement, 1.08; 95% CI, 0.77-1.52; n=78). In secondary analyses, we found that current smoking was associated with a higher hematocrit (st.β=0.11, P<0.001), particularly in subjects with low sodium intake (Pinteraction<0.001).

**Conclusions:** In this population-based study, lower UNaV is associated with an increased risk of ischemic stroke, particularly among current smokers. We found indications that – analogous to the increased risk of stroke observed on treatment with erythropoietin-simulating agents – adverse rheological effects exaggerated by low sodium intake may play a role.

**Keywords:** sodium, stroke, risk, diet

144/1567

COMPARISON OF TWO PREGNANCY NUTRITIONAL EVALUATION STANDARDS USING NATIONAL DATA FROM URUGUAY

(1)Mardones, Francisco; (2)González, Nely; (3)Bove, Maria Isabel;

(4)Rosso, Pedro; (5)Villarroel, Luis; (6)Bacallao, Jorge; (7)Farias, Marcelo.

(1)MD. MSc. Department of Public Health. Pontificia Universidad Catolica de Chile. Chile.; (2)Nutritionist. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (3)Nutritionist. PhD. Instituto de Salud y Bienestar. Universidad Católica del Uruguay. Uruguay.; (4)MD. Department of Pediatrics. Pontificia Universidad Católica de Chile. Chile.; (5)PhD. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (6)PhD. Universidad de Ciencias Médicas. Cuba.; (7)MD. PhD. Department of Obstetrics and Gynecology. Pontificia Universidad Católica de Chile. Chile.

**Background and objectives:** The USA Institute of Medicine (IOM) and the Rosso-Mardones maternal weight gain guidelines are widely used in Latin America. The purpose of this study was to compare some indicators of fetal growth related to the use of each chart at the beginning of pregnancy with national Uruguayan information.

**Methods:** Data of 23,832 healthy pregnant women and their term single newborns registered at the national level in the maternity hospitals between 2010 and 2012 were considered. Maternal nutritional status was classified at the beginning of pregnancy ac-
cording to both guidelines. The diagnostic ability of both instru-
ments regarding inadequate fetal growth was compared using sen-
sitivity and specificity values. Inadequate fetal growth was defined
as birth weight < 3000 g, birth weight > 4,000 g, and birth length
< 50 cm.

**Results:** Proportions of BL < 50 cm and both BW < 3000 g and > 4000 g were similar at each nutritional category of both charts; absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart at the beginning of the pregnancy.

**Conclusions:** The higher sensitivity of the RM chart would sup-
port its use for prevention purposes in countries such as Uruguay.

**Keywords:** Nutrition during pregnancy, maternal body mass index, birth length, birth weight.

materials for the promotion of behavioural change and lifelong life
skills for good nutrition.

**Conclusions:** Preliminary results support the conclusion that long-term investments for the organization of the family farming sector remains a fundamental bottleneck for the majority of countries. Findings have indicated the need for efforts to concentrate on ensuring greater participation of the Ministries of Agriculture and other stakeholders in the development, implementation and management of HGSF programs in Africa. The development of family farming specific support programs, the re-orientation of rural extension services for this purpose, and the facilitation of innovative procurement mechanisms to allow local purchases and sustainable and reliable supply of diversified food for school food and nutrition initiatives in Africa are critical parameters that should be combined with nutrition education at all levels.

**Keywords:** Home Grown School Feeding, Family farming, School Food and Nutrition, Agriculture, Social Protection

144/1571

INNOVATIVE HOME GROWN SCHOOL FEEDING
LINKED TO FAMILY FARMING: FAO SCHOOL
FOOD AND NUTRITION APPROACH IN SUB-SAHARAN AFRICA

**Background and objectives:** Home Grown School Feed-
ing (HGSF) has been considered a simple win-win scenario for
countries seeking to promote greater levels of school attendance,
school performance economic integration of local family famers
and increased access to a diversified school meals for improved
nutrition and educational outcomes. However, the complex poli-
cy and programmatic design required in order to ensure efficient
inter-ministerial as well as inter-sectoral collaboration (often be-
tween the ministries of Education, Social Protection, Agriculture
and Health) in the implementation and in particular the procure-
ment and delivery of home grown school meals, the constant chal-
lenges to ensure that local family farmers can cope with the pro-
duction needs of a diversified nutritionally balanced school meals.

**Methods:** FAO in partnership with the Government of Brazil have been working in the implementation of comprehensive sustainable pilots HGSF in diverse Sub-Saharan African countries in order to identify the strategic needs as well the most common bottle-necks for effective implementation of HGSF programs.

**Results:** As a direct result of this partnership, two countries (Sao Tome and Principe and Malawi) have been provided with technical support in the areas of policy & legal frameworks, agricultural mapping assessments for identification and design and local school meals menus as well as tailor-made nutrition education

144/1580

THE ROLE OF THE NUTRITIONIST IN AN INTER-
DISCIPLINARY APPROACH OF COGNITIVE STIM-
ULATION IN PEOPLE OVER THE AGE OF 60

**Background and objectives:** People over the age of 60 can have several functional limitations. Depression, neurodegenerative diseases, arthritis and osteoporosis can increase obstacles to developing and maintaining daily activities. Environmental and psychological factors can reinforce or relieve this situation (Olazarán-Rodríguez, 2012). Therefore poor nutrition can lead to mal-nourishment.

The advancements of knowledge into neurological, vascular and degenerative diseases highlight the need for an integral approach through interdisciplinary work (Allegri, 2013) (Demey, 2010).

Using this model, PAMI has been offering a program of cog-
nitive stimulation by using an holistic approach to the over 60's in
the La Matanza district since 2011. By providing weekly activities
such as music, games, art and physical exercise, we aim to improve
the quality of life for this client group.

The multidisciplinary team includes a neurologist, psychologists, nutritionists, a physical education teacher, and a music therapist.

Nutritional objectives:

* Encouraging healthy nutrition.

* Promoting independence by adapting utensils, and food preparation

* Stimulating preserved cognitive functions.

* Encouraging satisfaction during meal times.

<footnote>(1)Polo Galante, Andrea; (2)Mireles, Mauricio; (3)Kiamba, Josephine;</footnote>

<footnote>(4)Mamadoulaibou, Aissa; (5)Sablah, Mawuli; (6)Boitshepo, Giyose;</footnote>

<footnote>(4)Sanou, Dia.</footnote>

<footnote>(1)PhD Nutritionist Senior Consultant. FAO. Nutrition and Food Systems Division. Rome. Italy; (2)Regional Project(s) Coordinator. FAO Regional Africa; (3)PhD Consultant. FAO Regional Africa;</footnote>

<footnote>(4)Nutrition Officer. FAO Sub Regional Office for Central Africa;</footnote>

<footnote>(5)Chief Technical Adviser. FAO Regional Africa; (6)Senior Nutrition Officer Nutrition and Food Systems Division. Rome. Italy.</footnote>

<footnote>(1)Ragusa, Marina; (2)Andracchi, Rita; (1)Billaud, María de los Angeles;</footnote>

<footnote>(3)Cantisani, María Isabel.</footnote>

<footnote>(1)Nutritionist. Instituto Nacional de Servicios Sociales para Jubilados y Pensionados. Argentina.; (2)Neurologist. Instituto Nacional de Servicios Sociales para Jubilados y Pensionados. Argentina.; (3)Social psychologist. Instituto Nacional de Servicios Sociales para Jubilados y Pensionados. Argentina.</footnote>
**Methods:** The program is aimed at people over 60 with physiological aging or initial to moderate stage of cognitive impairment; additionally we provide support groups for care givers.

Activities carried out in the Nutrition area:

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

* Healthy modifications of Argentine recipes

* Practice with adapted kitchen utensils.

* Specialist talks.

* Evoking an emotional value of food

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

* A memory recollection game with matched cards

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

* A decrease in caregiver's workloads.

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

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

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

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

**Keywords:** Elderly, Nutrition, Cognitive

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

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

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

144/1599

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

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

(5)Agudo, Antonio.

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

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

144/1583

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Age, sex and anemia play major roles.

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

**Further collaborators:**

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

**Further collaborators:**

Tsuruoka metabolomics cohort study team

144/1658

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

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

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

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

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

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

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

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

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

144/1663

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

144/1696

AGGREGATION OF CHRONIC DISEASES AND AS-
OCIATED FACTORS IN THE MIDWEST REGION
OF BRAZIL IN 2012

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

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

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

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

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

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

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

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

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

144/1698

PREVALENCE OF METABOLIC SYNDROME IN A
GHANAIAN POPULATION

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

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

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

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

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

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

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

**Further collaborators:**

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

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

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

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

144/1706

PANORAMA OF NUTRITION LANDSCAPE IN
EAST AFRICAN COMMUNITY

Ouma, Cyprian.

WFP.

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

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

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

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

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

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

**Keywords:** EAC, Malnutrition

144/1708

NUTRITION INEQUALITIES IN EAST AFRICA

Ouma, Cyprian.

World Food Programme (WFP). Kenya.

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

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

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

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

**Keywords:** Nutrition, Inequality, EAC

144/1712

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

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

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

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

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

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

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

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

144/1717

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

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

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

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

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

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

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

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

<footnote>(1)MSc. Department of internal medicine. University Medical Center Groningen. The Netherlands.; (2)MD; (3)MD-PhD.</footnote>