## ASSOCIATION OF DIETARY FLAVONOID INTAKE WITH RISK OF CANCER IN THE CANCER SCREENING EXAMINATION COHORT IN KOREA

(1)Kim, So Young; (2)Wie, Gyung Ah; (3)Cho, Yeong Ah; (1)Kang, Hyun Hee; (1)Ryu, Kyoung A; (3)Yoo, Min Kyong; (4)Kim, Seong Ah; (4)Ha, Kyungho; (5)Joung, Hyojee.

(1)MS. Clinical dietitian. Department of Clinical Nutrition. Research Institute & Hospital. National Cancer Center. Republic of Korea; (2)Ph.D. Clinical Dietitian. Department of Clinical Nutrition. Research Institute & Hospital. National Cancer Center. Republic of Korea; (3)MPH. Clinical Dietitian. Department of Clinical Nutrition. Research Institute & Hospital. National Cancer Center. Republic of Korea; (4)MPH. Graduate School of Public Health and Institute of Health and Environment. Seoul National University. Seoul. Republic of Korea.; (5)PhD. Graduate School of Public Health and Institute of Health and Environment. Seoul National University. Seoul. Republic of Korea.

**Background and objectives:** Dietary flavonoids are thought to play a prominent role in cancer prevention through antioxidant capacity, but their association with cancer incidence has not been thoroughly investigated using epidemiological data in Korea. The purpose of this study was to investigate whether dietary flavonoid intake is associated with reduced risk of cancer based on data from the Cancer Screening Examination Cohort 2004–2008 of the National Cancer Center of Korea.

**Methods:** This study included 8,024 subjects who completed a written survey on demographics and lifestyles, as well as a 3-day dietary record. Prediagnostic flavonoid intakes were estimated using a flavonoid database of common Korean foods (KFDB). Hazard ratios (HRs) were estimated, comparing the highest quartile of flavonoid intake with the lowest, using Cox proportional hazard model. All statistical analyses were conducted using the STATA program version 14.0 (STATA Corporation).

**Results:** During the mean follow-up period of 9.0 years, 425 cancer cases were newly diagnosed. The median flavonoid intake was 111.6 mg/d. Mean of the highest quartile (287.6mg/d) was six times greater than that of the lowest quartile (46.6mg/d). After multivariable adjustment, there was a weak association between dietary flavonoid intake and overall cancer risk (HR=0.74; 95% CI 0.54-1.00; highest vs. lowest quartile; p-trend=0.088). Among men, significant association was observed in age-adjusted dietary flavonoid intake and risk of cancer (HR=0.66; 95% CI 0.46-0.94; highest vs. lowest quartile; p-trend=0.044). After multivariable adjustment, dietary flavonoid intake was associated with reduction in HR for total cancer incidence, but this association was only marginally significant (HR=0.66; 95% CI 0.45-0.98; highest vs. lowest quartile; P-trend=0.056). Among Women, there was no such an association.

**Conclusions:** Our results suggest that greater intake of flavonoid may reduce overall cancer risk, particularly among men. Additional research is necessary to clarify the association between dietary antioxidants including flavonoid and the risk of cancer.

**Keywords:** dietary flavonoid, antioxidant, cancer

## THE IMPACT OF FOUR SCHOOL FEEDING FOOD PRODUCTS ON THE NUTRITIONAL STATUS OF CHILDREN IN SOUTHERN GAUTENG, SOUTH AFRICA

(1)Kearney, Jeanette; (2)Oldewage Theron, Wilna.

(1)DTech Food Service Management. Department of Hospitality, Tourism & PR Management. Vaal University of Technology (VUT). South Africa; (2)PhD RD (SA). Professor of Nutrition. Department of Nutritional Sciences. Texas Tech University. USA.

**Background and objectives:** School feeding programmes have been used in many parts of the world for a number of years; with varying success. Four micronutrient dense products were introduced as part of the school feeding programme in Southern Gauteng, South Africa. The purpose of this paper is to provide an overview on the impact on the nutritional status by comparing anthropometric status and biochemical variables of the children. Biochemical variables, specifically iron was measured. Blood samples were drawn for the determination of serum vitamin A, haemoglobin, haematocrit, zinc, iron, ferritin, transferrin and total iron binding capacity.

**Methods:** The participation of all the children in this study was voluntary and all the children taking part in this study obtained written parental consent. The food consumption patterns of the school children was determined by a food frequency questionnaire as test measurement and a 24-hour recall questionnaire as reference measurement at baseline. The impact on nutritional status was determined by evaluating and comparing the anthropometric indices: weight-for-age, height-for-age and body mass index (BMI). For the anthropometric results, data was categorised according to the percentile system, in accordance with the National Centre for Health Statistics indicators. The duration of the intervention was seven months with a total of 332 participants in the four groups, each group receiving a different product.

**Results:** All the interventions showed improvement in the mean energy intake of the children. The mean weight, height and BMI increased with all the interventions. Anthropometric results indicated that children in the severely underweight category, as well as the group at risk of being underweight, decreased in two of the groups. The number of children at risk of being stunted (>5 and <25th percentile) declined, with the exception of the group consuming the sorghum based product. The biochemical results indicated that normal values were present for the majority of the parameters before and after the interventions.

**Conclusions:** Positive changes were observed in each of the groups, indicating that any one of these products can be successfully used as part of a school feeding programme and may have a beneficial effect on hungry, malnourished children.

**Keywords:** school feeding products; school intervention; nutrition; health promotion, malnutrition.
## FACTORS ASSOCIATED WITH THE CONSUMPTION OF SUGAR-RICH FOODS AMONG BRAZILIAN ADOLESCENTS: NATIONAL SCHOOL HEALTH SURVEY (PENSE 2015)

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

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

**Background and objectives:** Background: The excessive intake of sweets, deserts and sugar sweetened beverages among adolescents stands out as a major health issue in several countries.

**Objective:** This study aimed to analyze the consumption of high-sugar foods by Brazilian adolescents and to identify associated factors.

**Methods:** We used data from the National School Health Survey (PeNSE 2015) conducted by a partnership between the Brazilian Institute of Geography and Statistics (IBGE) and the Brazilian Ministry of Health. This is a cross-sectional study developed from a representative sample of ninth grade students living in all regions of Brazil, including urban and rural areas and attending public and private schools. Consumption of these foods was classified as: do not consume sweets and soft drinks regularly (≥5days/week); consume sweets or soft drinks regularly; and consume sweets and soft drinks regularly. Its association with sociodemographic information, eating habits, and family contexts were investigated by multiple ordinal regressions. All statistical analyses were performed using SAS and commands were performed taking into account the complex sample design of PeNSE. In the final model 101,812 students who presented complete information about the investigated variables were considered.

**Results:** About 16.0% of participants reported regular consumption of sweets and soft drinks and 35.9% regularly consumed one of these sugar-rich foods. The ordinal multiple regression analysis showed that the odds of regularly consuming sweets or/and soft drinks was higher among females; adolescents aged 15; students with mothers with higher education; those that eat meals in front of the TV; and those with a high amount of daily TV time. The largest magnitudes of association with the outcome variable were found for maternal education ≥ 12 years (OR = 1.39), being female (OR = 1.26), eating while watching TV (OR = 2.07) and time spent watching TV ≥ 5 hours per day (OR = 2.69).

**Conclusions:** The results highlight the clear association observed between daily time spent watching television and regular consumption of sweets and soft drinks. This scenario shows that changing these factors should be a priority for interventions to prevent negative health effects, particularly overweight and associated morbidities.

**Keywords:** adolescents, sugar, soft drinks, food consumption

## FEEDING PRACTICES AND MALNUTRITION AMONG UNDER FIVE CHILDREN IN COMMUNITIES OF KUJE AREA COUNCIL, FCT ABUJA, NIGERIA

(1)Okoro, Clementina; (2)Owolabi, O.A.; (2)James, D.B.; (3)Maduforo, Aloysius; (4)Mbewe, A.L.; (5)Isokpunwu, Chris Osa.

(1)M.Sc. Nutritionist. Nutrition Section. Federal Capital Territory Primary Health Care Board. Abuja. Nigeria.; (2)PhD. Nutritionist. Department of Biochemistry. Faculty of Sciences. Ahmadu Bello University. Zaria. Kaduna State. Nigeria.; (3)M.Sc. RDN. Lecturer. Department of Home Science, Nutrition and Dietetics. University of Nigeria. Nsukka. Nigeria; (4)Family and Reproductive Health Cluster Lead. World Health Organization. Nigeria.; (5)MD. MPH. Nutrition Division. Federal Ministry of Health. Abuja. Nigeria.

**Background and objectives:** Poor dietary practices and malnutrition, including severe acute malnutrition among under five children in Nigeria has remained a great public health concern. This study assessed infant and young child feeding practices and nutritional status of under-five children to determine the prevalence of malnutrition of under five children in Kuje area council, Abuja.

**Methods:** The study was a cross-sectional study. Multi-stage sampling techniques was used in selecting the population that was studied. Probability proportion by size was applied in choosing 30 clusters for the survey using ENA for SMART software 2011 version. Validated questionnaires were used to obtain information from the population, while appropriate equipment was used for measurements of anthropometric parameters. The data was also subjected to statistical analysis using statistical package and service solution version 20.

**Results:** The result showed that 96.7% of the children were breastfed, 30.6% had early initiation to breastfeeding within first hour of birth and 22.4% were breastfed exclusively up to 6 months, 69.8% fed infants' colostrum, while 30.2% discarded colostrum. About half of the respondents (49.1%) introduced complementary feeding before six months and 23.2% introduced it after six months while 27.7% had age appropriate timely introduction of complementary feeding. The anthropometric result showed that the prevalence of global acute malnutrition (GAM) was 12.8%, severe wasting prevalence was 5.4%, moderate wasting was 7.4%, underweight was 24.4%, stunting was 40.3% and overweight was 7.0%.

**Conclusions:** The result showed that there is high prevalence of malnutrition among under five children in Kuje which is generally consistent with National Average. Hence, there is need for urgent appropriate interventions to improve their nutrition and health status.

**Keywords:** Malnutrition, Under Five Children, Breastfeeding, Complementary feeding
NUTRITIONAL QUALITY, NUTRIENT CLAIMS AND '1 OF YOUR 5 A DAY' LOGOS IN PRE-PACKAGED FOODS MARKETED TO YOUNG CHILDREN IN THE UK

(1)Garcia, Ada; (2)Parrett, Alison.

(1)PhD. Nutritionist. Human Nutrition. University of Glasgow.
United Kingdom; (2)PhD. Nutritionist. Human Nutrition.
University of Glasgow. United Kingdom.

**Background and objectives:** High sugar consumption contributes to high energy intake and is linked to unhealthy eating behaviours associated with increased obesity risk in childhood. It is important that parents can understand the nutritional quality of pre-packaged foods targeted at pre-school age children to inform them about healthy choices and nutrients of concern such as sugar. We aimed to assess the nutritional quality, nutrient claims and use of '1 of your 5 a day' logos in pre-packaged foods targeted to young children (1.5-3 years) in the UK market.

**Methods:** A cross-sectional survey of all pre-packaged foods available from 4 major UK supermarkets. Foods were included in the survey only if they used cartoon imagery and/or child friendly related words on the packaging. Food labels were assessed for nutritional information, added vitamins, nutrient claims, and '1 of your 5 a day' logos. Nutritional quality was assessed using the Ofcom nutrient profiling model.

**Results:** In total, 485 food items were assessed and divided into 10 categories: fruit juice (20%) cereals (18%), ready meals (16%), yogurt (17%), fruit snacks (13%), various snacks (9%) cereal bars (5%) and smoothies (2%). The highest sugar content [mean (SD)/100g] was found in fruit snacks [44 (10)/100g] followed by cereal bars [30 (7)/100g] and cereals [24 (8)/100g]. For each of the major food categories, cereals, cereal bars and fruit snacks had the highest proportion of products assessed as being 'less healthy'. Nutrient claims were reported in 96% of products, 50% had added vitamins and 32% showed a '1 of your 5 a day' logo. Overall, 95% of foods contained at least 1 or more nutrient claim or '1 of your 5 a day' logo across all food categories but 52% (n=254) of the children's products were assessed as being 'less healthy' in accordance to the UK Ofcom nutrient profiling model.

**Conclusions:** Over half of children's pre-packaged food products targeted to young children were considered as less healthy food choices despite majority of these foods displaying a nutrient claim. This study suggests further efforts need to be taken to regulate advertisement of nutrient claims on products with unhealthy nutrient profiles.

**Keywords:** food labelling, food marketing, infants, nutrient claims, 5-a-day

**Conflict of Interest Disclosure:** There is no conflict of interest. This research was funded by Human Nutrition, University of Glasgow, UK.

TREND OF OVERWEIGHT AND OBESITY IN PERUVIAN SCHOOLCHILDREN OF THE PRIMARY LEVEL

(1)Tarqui-Mamani, Carolina; (2)Alvarez-Dongo, Doris; (2)Espinoza-Oriundo, Paula.

(1)Doctora. Centro Nacional de Alimentación y Nutrición. Instituto Nacional de Salud. Peru; (2)Nutricionista. Centro Nacional de Alimentación y Nutrición. Instituto Nacional de Salud. Peru.

**Background and objectives:** To analyze the tendency of overweight and obesity in Peruvian schoolchildren of the primary level.

**Methods:** A trend study that analyzed overweight and obesity in 24794 primary school children. The samples were representative and probabilistic of Peruvian households. The measurement of weight and size was made according to Peruvian regulations. Data collection was performed in Peruvian households during 2007-2014. Overweight and obesity were assessed using the body mass index for age (BMIZ); overweight was considered to be an BMIZ> 1 and ≤2 and obesity was an BMIZ> 2. It was analyzed by complex samples, prevalences and chi square of linear trend were calculated.

**Results:** Between 2007 and 2014, overweight increased from 15.5% to 18.1% and obesity from 6.1% to 14.1%. The trend of overweight (p <0.001) and obesity was increased (p <0.001). The trend of overweight and obesity was increased in children aged 8 to 10 years (p <0.01) and aged 11 to 13 years (p <0.01). In both sexes, the tendency of overweight (p <0.001) and obesity (p <0.001) was increased. In children that the head of the household had primary education level (p <0.001), secondary (p <0.01) and higher (p <0.01), the tendency of overweight and obesity was increasing. In the urban area (p <0.001) and rural (p <0.01), the tendency of overweight and obesity was to increase (p <0.001). In Lima Metropolitan (p <0.01), coast (p <0.001), saw (p <0.001) and jungle (p <0.001) the tendency was to increase. According to poverty condition, the tendency of overweight in the poor was to increase (p = 0.011), while obesity increased in the non-poor.

**Conclusions:** The trend of overweight and obesity increased in primary school students in Peru, to the predominance of obesity.

**Keywords:** Overweight, Obesity, School Health, Child, Students
## ACCEPTANCE OF SUGAR REDUCTION IN PRO-CESSED FOODS AMONG MOROCCAN POPULATION

(1)Benkirane, Hasnae; (1)Taboz, Youness; (2)Benajiba, Nada;

(3)Guennoun, Yasmine; (4)Khadmaoui, Abderrazzak; (3)Bouziani, Amina; (3)Bajit, Habiba; (1)El Kari, Khalid; (5)Barkat, Amina;

(1)Aguenaou, Hassan.

(1)PhD. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center of Energy Sciences and Nuclear Techniques. Regional Designated Center of Nutrition (AFRA. IAEA). Rabat. Kenitra. Morocco; (2)PhD. Clinical Nutrition Program. Department of Health Sciences. College of Health and Rehabilitation Sciences. Princess Nourah Bint Abdulrahman University. Riyadh. Saudi Arabia; (3)PhD Student. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center of Energy Sciences and Nuclear Techniques. Regional Designated Center of Nutrition (AFRA.IAEA). Rabat. Kenitra. Morocco; (4)PhD. Laboratory of Genetics and Biometrics. Faculty of Sciences. Kenitra. Morocco; (5)PhD. Health and Nutrition Research Team of the Mother Child Couple. Faculty of Medicine and Pharmacy. Mohammed V University of Rabat. Morocco.

**Background and objectives:** Morocco has recently developed a plan of reducing sugar consumption to reinforce prevention of non-communicable diseases and to contribute to the achievement of global voluntary targets for non-communicable diseases set by ICN2 by 2025. The objective of the present study is to assess acceptance of yogurts with different percentage reduction of sugar by Moroccan population.

**Methods:** A total of 201 participants (age >15 y.) were recruited to determine the level of sugar reduction in yogurt. Sucrose was added to a plain yoghurt in the following different concentrations 166.5; 149.8; 133.2; 116.5; 99; 83.2 mM/l, corresponding to the reduction of sugar of 0%, -10%, -20%, -30%, -40% and -50%, respectively, compared available yogurt in local market. Overall liking, "Just About Right" (JAR) and purchase scales was used to score the different yoghurts.

**Results:** Yogurts containing -20% and -30% added sugar were highly accepted by 81% and 74% of respondents. Based on JAR score, yoghurt with 20% (133.2mM/l) and 30% (116.5mM/l) reduction were considered as "just about right" by 42.7% and 44.3% respectively. Best average score of purchase intent is obtained for sucrose concentration of 149.8 mM/l. 35.8% and 40.3% for yoghurt with sucrose concentration of 133.2 mM/l and 116.5 mM/l respectively.

**Conclusions:** Finding of this study indicate that yogurts containing -20% and -30% added sugar were best accepted by respondents. Advocacy before dairy industry to make them commit toward sugar reduction in yogurt is needed, in order to help achieving the national sugar reduction strategy in Morocco.

**Keywords:** Sugar reduction. acceptance. yoghurt. Morocco.

## ORAL FAT TASTE SENSITIVITY AND THE DEVELOPMENT OF OBESITY IN MOROCCAN ADULT SUBJECTS

(1)Bajit, Habiba; (2)Benkirane, Hasnae; (2)Taboz, Youness; (3)Belghiti, Hakim; (3)Mrabet, Mustapha; (4)Elkari, Khalid; (1)Bouziani, Amina;

(1)Saeid, Naima; (5)Barkat, Amina; (2)Aguenaou, Hassan.

(1)PhD Student. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center of Energy Sciences and Nuclear Techniques. Regional Designated Center of Nutrition (AFRA. IAEA). Rabat. Kenitra. Morocco; (2)PhD. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center of Energy Sciences and Nuclear Techniques. Regional Designated Center of Nutrition (AFRA.IAEA). Rabat. Kenitra. Morocco; (3)Dr. Nutrition Unit Hygiene Service and Medicine of Collectivity. Military Hospital of Instruction. Rabat. Morocco; (4)PhD. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center of Energy Sciences and Nuclear Techniques. Regional Designated Center of Nutrition (AFRA.IAEA). Rabat. Kenitra. Morocco; (5)PhD. Health and Nutrition Research Team of the Mother Child Couple. Faculty of Medicine and Pharmacy. Mohammed V University of Rabat. Morocco.

**Background and objectives:** In recent decades the prevalence of obesity is become an alarming threat for human health. In 2014 about 13% of the world's adult population was obese and 39% was overweight (World Health Organization). In 2011, 10.3 million adult Moroccans were overweight; 3.6 million were obese (National Survey on Anthropometry).

It is known that fats properties including olfactory, visual and textural cues play a significant role in their attractiveness. Nonetheless developing proofs think also of "Fat Taste" as a sixth taste besides the previous five basic taste modalities: sweet, salt, sour, bitter and umami; that could participate in their palatability.

The aim of our project is to investigate whether an alteration of oro-gustatory detection of lipids is associated to high fat intake and then to the development of obesity among adult Moroccan people.

**Methods:** Till now a total of 80 adult subjects (age ≥ 20 years) were recruited and all anthropometric measures were taken to classify them into obese and control groups. Participants were also exposed to oral fat test using emulsions containing food-grade oleic acid (OA), at ascending concentrations (0.018, 0.18, 0.37, 0.75, 1.5, 3, 6 and 12 mmol / L) via three-alternative forced choice (3-AFC) method, in order to compare the detection thresholds and the sensitivity to fatty acids between the two groups.

**Results:** The average BMI (Body Mass Index) and fat content for obese were respectively 37.84kg/m2 and 40.94% and those of control were 22.26kg/m2 and 25.00%.

Obese participants exhibit high thresholds for OA oral detection (3.87mmol/l) than control (0.17mmol/l).

The subjects were classified into 4categories: Non Tasters (all of them belong to obese group), High Tasters (from control subjects only), Middle Tasters (from the both groups) and Low Tasters (predominated by obese group).
**Conclusions:** Fatty acid taste sensitivity can lead to high dietary fat intake and consequently to the development of obesity.

**Keywords:** Obesity. Fat taste. Oro-gustatory Detection thresholds.

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OVERWEIGHT, OBESITY AND METABOLIC SYNDROME IN MOROCCO: RESULTS FROM AN INTERGRATED INTERVENTION STUDY

(1)Heikel, Jaafar; (2)ElHsaini, Houda; (3)Raghni, Salwa.

(1)MD, PhD. Epidemiology. Interdisciplinary Center for Study and Research In Health. Casablanca. Morocco; (2)PhD. Nutrition. Interdisciplinary Center for Study and Research in Health. Casablanca. Morocco; (3)MD. Nutritionist. Interdisciplinary Center for study and Research in health. Casablanca. Morocco.

**Background and objectives:** The aim of this intervention study is to estimate the prevalence and determinants of metabolic syndrome (MS) in a urban overweight population and to assess the impact of an integrated approach to care including Mediterranean diet and a program of coached physical activity (DMAC) versus those adopting only the Mediterranean diet (DM).

**Methods:** Between September 2012 and September 2016 we have recruited 983 people who consulted for overweight at the University Center for Preventive Medicine in Casablanca.

All the patients were proposed to follow or not an integrated program with specific mediterranean diet and aerobic physical coaching even if they were already treated for hypertension or diabetes or hypercholesterolemia. The two groups DMAC and DM were followed during a minimum of six months and were assessed for clinical, biological and metabolic parameters.

**Results:** Among 983 patients, 830 have completed their program DM or DMAC with a minimum of six months follow-up. In terms of risk factors, 54.3% had a family history of diabetes, hypertension or hypercholesterolemia, 26.1% were regular smokers, 39.2% were regular alcohol drinkers. Weight and BMI means were respectively 86.77 kg and 28.66 kg/m2. In total, the prevalence of metabolic syndrome (IDF 2009 criteria) was 28.1% (37, 3% in men and 21.6% in women). After 6 months of intervention, the prevalence of MS was 11.6% among those who opted for the DMAC and 23.1% among those who opted for DM (OR = 0.43 (0.19 to 0.98) p = 0.04), indicating a reduction in the prevalence of 57%. In a multiple logistic regression, factors associated with metabolic parameters improvement were the DMAC (ORadj = 9.6, p = 0.000), BMI (ORadj = 6.9, p = 0.000) and sex (ORadj = 0.48, p = 0.038).

**Conclusions:** Integrated intervention including specific Mediterranean diet and adapted physical activity improve Metabolic syndrome or prevent it in the Moroccan population. The incidence of some MS parameters could decrease by 25 to 50%.

**Keywords:** Obesity - Metabolic syndrome - Mediterranean Diet- Intervention

**Further collaborators:** Adamir Kaltoum. Loukili Najoua. Adamir Fatima Zahra

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STRUCTURAL RELATIONSHIPS BETWEEN DIEDATORY DIVERSITY AND SUBJECTIVE FACTORS AMONG HEALTHY ELDERLY IN AN OKINAWAN FARM VILLAGE, JAPAN

(1)Kodama, Sayuri; (2)Kurimori, Sugako; (3)Hoshi, Tanji; (4)Ojiri, Yoshihiko.

(1)Ph D. Resistered nutritionist. Lecturer. Department of food and nutrition science. Sagami Women's Junior College. Japan;

(2)Professor. Department of Nursing. Seitoku University. Japan;

(3)Emeritus Professor. Tokyo Metropolitan University. Japan;

(4)Professor. School of Health Sciences. Faculty of Medicine. University of the Ryukyus. Japan.

**Background and objectives:** In Japan, dietary diversity (DD) called "Japanese diet" characterized by rice staple, diverse plant origin foods, and fish intake, might be contributed to extend our healthy life expectancy (HLE), however, structural relationships between DD and HLE including subjective factors still remains unclear. Especially, not only direct effects, but also indirect ones between DD and subjective health (SH), which are both independently predictors of HLE, have not fully been elucidated. The purpose of this study was to clarify the structural relationships between DD and SH among healthy elderly in Japan.

**Methods:** A home visit survey was conducted in 2012 for elderly aged 65 years or over living in A municipality in Okinawa. A total of healthy elderly 1,525 respondents excluding long-term care needs participants were examined. "DD" was characterized by a combination of dishes, i.e. staple, main dishes, sub-dishes, milk and dairy product, and fruits, making it as a latent variable. As the subjective factor's indicators, we used economic satisfaction (ES), subjective well-being (SWB), life satisfaction (LS) and SH. Direct relationships among them were evaluated by using correlation analysis. The fit of hypothetical models was evaluated using covariance structure analysis.

**Results:** The largest direct relationship was identified between SWB and LS (r=0.718), then we made them for a latent variable named "mental and emotional well-being (MEWB)". We set ES for our hypothetical model's base, SH for its outcome, and DD and MEWB for mediating factors. Four groups' models; from 65 years to 74 years (<75), and 75 years or over (≥75) by men and women separately, were evaluated. The most fitted models showing indirect effects mediated by MEWB and by DD were statistically more acceptable (CFI=0.958, NFI=0.923, RMSEA=0.026), in comparison with the direct effects of ES on SH in models except men of <75. The effect of MEWB on DD was largest in women of ≥75.

**Conclusions:** The present findings suggest that creating support for the subjective well-being and life satisfaction based on economic satisfaction might enhance the subjective health of healthy elderly over 75 years old through improvement of dietary diversity.

**Keywords:** Okinawa, dietary diversity, subjective health, covariance structure analysis
# TIME TRENDS IN THE AVAILABILITY AND APPARENT CONSUMPTION OF PROCESSED FOODSTUFFS IN GUATEMALAN HOUSEHOLDS IN 2006 AND 2011

(1)Sánchez León, María; (2)Ramirez-Zea, Manuel; (3)Corvalán Aguilar, Camila.

(1)MSc. Nutritionist. Institute of Nutrition and Food Technology. University of Chile. Chile.; (2)MD. PhD. INCAP Research Center for the Prevention of Chronic Diseases. Institute of Nutrition of Central America and Panama. Guatemala.; (3)MD. MPH. PhD. Institute of Nutrition and Food Technology. University of Chile. Chile.

**Background and objectives:** Even though consumption of processed foodstuffs is increasing in the world, trends in food consumption has not been analyzed in Guatemala. The objective is to assess time trends in the availability and apparent consumption of processed foodstuffs in Guatemalan households and to identify factors that had influenced food consumption change in the last 10 years.

**Methods:** Mixed methods approach. Quantitative: We classified foods from the Guatemalan National Living Conditions Survey (NCLS) 2006 and 2011 (12,766 and 12,666 representative household sample respectively), according to the NOVA classification. The availability and consumption in terms of energy, macronutrients, saturated fat, cholesterol, fiber, and sodium were calculated for each processed food group. We run T-Test analyses using Stata. Qualitative: to identify changes in food consumption, 12 focus groups with parents of children who attended public schools in three Guatemalan departments were performed, considering different geographic areas, ethnicity and socioeconomic level. Data was analyzed using QDA Miner-Lite4.

**Results:** Processed and ultra-processed foodstuffs accounted for almost 25% of the household food availability, without changes over time. The contribution of this group to the total energy consumption in households was 20%, with a decrease trend over time, as well as in macronutrients, saturated fat, cholesterol and fiber. Non-poor, non-indigenous and urban area households showed greater food availability and consumption. Participants perceived that consumption of processed foodstuffs in households was higher at present than 10 years ago.

**Conclusions:** Trend in the availability and consumption of processed and ultra-processed foodstuffs in Guatemala apparently decreased between 2006 and 2011. This was more pronounced in the non-poor, non-indigenous and urban area households. These results contradicted people's perception. The fact that the NCLS does not capture information from new processed foods in the market might explain part of these inconsistencies.

**Keywords:** Processed foodstuffs, food availability, apparent consumption.

# CAPACITY BUILDING OF TEACHERS AND SCHOOL GIRLS THROUGH TRAINING AND EDUCATION BALANCED NUTRITION IN SENIOR HIGH SCHOOL IN MAROS DISTRICT SOUTH SULAWESI INDONESIA

(1)Patimah, Sitti; (2)Arundhana, Andi Imam; (3)Royani, Ida; (4)Thaha, Abdul Razak.

(1)Ph.D. Nutritionist. Public Health Nutrition. School of Public Health. Universitas Muslim Indonesia. Indonesia; (2)MPH. Nutritionist. Nutrition Department. School of Public Health. Hasanuddin University. Indonesia; (3)MPH. Nutritionist. School of Medicine. Universitas Muslim Indonesia. Indonesia; (4)Prof. Ph.D. Nutritionist. Nutrition Department. School of Public Health. Hasanuddin University. Indonesia.

**Background and objectives:** There are many nutritional problems in adolescent girls such wasting, stunting, obesity, and anemia (10.3%, 23.6%, 6.8%, and 15.5%, respectively). This study aims to build the capacity of teachers and students through training and education to achieve balanced nutrition behavior and improvement of the nutritional status of adolescent girls.

**Methods:** The study is a multi-year study (3 yrs). A balanced nutrition CIE (communication, information and education) media has been developed in previous year (2015) and tested in the training for teachers and as education for the students (2016). There were four senior-high-schools selected and each school was represented by three teachers. The training for teachers (n=12) has been conducted for 2 days, then trained teachers taught the students for 4 months. For exact students, the balanced nutrition material has been inserted into biology, and physical and health education subjects, while for social science students, the material delivered through extracurricular activities.

**Results:** This study found that training of balanced nutrition successfully enhances teachers' knowledge in answering correctly (90%). Based on the evaluation of teachers regarding to students knowledge, they answered correctly and showed increasing score from 67 to 82. Based on the assessment of researcher, it was found that nutritional knowledge of students increase significantly before and after intervention (median score 32 to 62; p = 0,000). The eating behaviors become better for breakfast (34%), bringing food to school (46%), two-fold increase in daily fruit consumption (19%), never consume fruit reduced (13%), always consume complete food group (43.2%), BAZ-score increased significantly before and after intervention (p = 0,000), wasting student decreased 2%, microcytic anemia decreased almost half became 46.2% (p = 0,000), and anemia based on hematocrit level decreased three-fold became 4.6% (p = 0,000),.

**Conclusions:** By giving the training to teachers and balanced nutrition education to students, the capacity could increase in understanding the concept of balanced nutrition. It has implications for improvement of students' eating behavior and nutritional status.

**Keywords:** girls adolescent, balanced nutrition, education, nutritional status
**Further collaborators:** We potentially collaborate with the counselors to see the effect of the balanced nutrition CIE media effect in peer-counselling.

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MEASURING BLOOD RETINOL CONCENTRATIONS OF INFANTS FED WITH COMPLEMENTARY FOODS FORTIFIED WITH MORINGA OLEIFERA LEAF POWDER - A PILOT STUDY

(1)Boateng, Laurene; (2)Ohemeng, Agartha; (3)Asante, Matilda;

(4)Steiner-Asiedu, Matilda.

(1)MPhil. PhD Candidate. Department of Nutrition and Food Science. University of Ghana. Ghana. Lecturer. Department of Nutrition and Dietetics. University of Ghana. Ghana.; (2)PhD. Nutritionist. Department of Nutrition and Food Science. University of Ghana. Ghana.; (3)PhD. Dietitian. Department of Nutrition and Dietetics. University of Ghana. Ghana.; (4)PhD. Nutritionist. Department of Dietetics. University of Ghana. Ghana.

**Background and objectives:** Vitamin A deficiency (VAD) in the developing world remains a widespread public health problem. Investment in surveillance of VAD in high burden regions, using consistent methods, would provide improved information for intervention priorities. Improvement in the overall nutrition of high VAD burden populations, through dietary diversification and improved access to vitamin A rich foods, may be beneficial in combatting VAD. Leaves of the Moringa Oleifera plant reported to be a rich source of micronutrients particularly vitamin A, could be cheaply dried and stored for use in improving micronutrient content of diets of households in low resource settings. This study aimed at piloting measurement of blood retinol concentrations (using the i-check® fluorometer) among infants aged 8-12 months, whose complementary foods were supplemented with Moringa Oleifera leaf powder (MLP), in a rural district in Ghana.

**Methods:** Retinol concentration was measured (in 5ml of whole blood), at baseline and after 6 weeks, in a sub-sample of 103 infants participating in a 3-arm randomised controlled trial (RCT), ISRCTN14377902. One arm (n=35) received a cereal-legume blend fortified with (MLP) named MCL-35g, a second arm (n=34) received MLP as a supplement to be sprinkled on infants' usual foods (MS-5g) and a third arm (n=34) which received a cereal-legume blend, without MLP (CF-35g) served as controls. Data were analysed using SPSS for descriptive statistics, paired t-test and analysis of covariance.

**Results:** Sixty-five infants completed the study. Compared to World Health Oragnization (WHO) cut off for VAD (0.70 µmol/L) , mean retinol concentrations for all groups were low at both baseline and endline. There was a marginal increase at endline for all groups, but this was not statistically significant; 0.466 µmol/L at baseline to 0.548 µmol/L at endline for CF-35g (n=26), 0.509 to 0.631µmol/L for MC-35g (n=20), and 0.639 to 0.652 µmol/L for MS-5g (n=19).

**Conclusions:** The i-check® fluorometer has potential as a convenient tool for measuring blood retinol concentrations. Further studies on its reliability are however needed. Adequately powered RCTs with bigger sample size, which last for extended periods are needed to test the efficacy of MLP in combatting VAD.

**Keywords:** Vitamin A deficiency, i-check, Moringa Oleifera leaf powder, infants

**Conflict of Interest Disclosure:** The i-check® fluorometer was purchased with the main author's PhD grant and training on its use was provided by the manufacturer's (Bioanalyt Inc) training support staff. Aside this, there are no conflicts of interest to declare.

**Further collaborators:**

There are no further authors. We however wish to acknowledge Prof. Anna Lartey for her guidance and helpful inputs through all the phases of this work.

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EVALUATION OF POLITICAL COMMITMENTS TO NUTRITION PROGRAMMES IN LAGOS STATE, NIGERIA

(1)Oni, Blessing; (2)Oyewole, Oyediran; (3)Ariyo, Oluwaseun; (4)Atinmo, Tola.

(1)M.Sc. Nutritionist. Department of Human Nutrition. University of Ibadan. Nigeria.; (2)PhD. Nutritionist. Department of Human Nutrition. Nigeria.; (3)Professor. Nutritionist. Department of Human Nutrition. Nigeria.

**Background and objectives:** Under-and over-nutrition have public health consequences including disease burden, decreased cognitive development and possible mortality. Political involvement has been proven to be a potent tool in nutrition programmes development. However, there is need to conduct an evaluation on the level of political commitment in nutrition programmes in Lagos State, which is one of the economically buoyant States in Nigeria.

The study was designed to evaluate the level of political commitments to nutrition programmes in Lagos State.

**Methods:** The study was exploratory and the study location was purposively selected to justify the purpose of the study. Two research tools were developed and pretested, which included: key informant interview guide and record assessment guide. The interview guide was administered to stakeholders involved in implementation of nutrition programmes in Lagos State. Available documents on nutrition programmes from the State were assessed using the developed themes from the study objectives. The interview sessions were transcribed verbatim and were analysed thematically.

**Results:** Nutrition programmes were developed through various methods such as survey gaps and participatory rural appraisal. This evolved into the formation of strategic plans for nutrition intervention programmes to be implemented. The priority accorded to the nutrition sector has been a major drawback. The Commis-
**Methods:** Nutrition information for 34,135 packaged foods available in Australian supermarkets were used. Products were classified as 'core' or 'discretionary' based on the Australian Dietary Guideline dichotomy between those everyday foods intended to make up the bulk of a healthy diet and those which should only be eaten occasionally. Fibre content (g/100g) and FVNL content (%) were estimated using a validated method for each product. HSRs were calculated using both the standard HSR algorithm and a simplified HSR algorithm excluding fibre and FVNL values. The performance of the simplified HSR was determined by comparing the capacity to discriminate between core and discretionary foods using the area under the receiver operating characteristic curve (AUC).

**Results:** 15,965 core and 18,350 discretionary foods were included. The AUC (95% confidence interval) for the standard HSR algorithm with all components was 0.820 (0.816; 0.825). Removing FVNL, fibre, and both together changed the AUC by -0.0106 (-0.0134; -0.0079), 0.0001 (-0.0027; 0.0029), and -0.0099 (-0.0127; -0.0071), respectively.

**Conclusions:** The ability of the HSR to discriminate between core and discretionary foods did not change with the removal of fibre from the equation. Removing FVNL from the algorithm did reduce HSR performance by a small margin. Removal of both fibre content and FVNL content from the current HSR algorithm would have little material impact on performance but would greatly simplify HSR calculation for food manufacturers and researchers.

**Keywords:** public health; food policy; nutrition labels; front-of-pack labelling; Health Star Rating

**Conflict of Interest Disclosure:** Cliona Ni Mhurchu is a member of the New Zealand Health Star Rating Advisory Group. The New Zealand Health Star Rating Advisory Group had no role in study design, data analysis, decision to publish, or preparation of the abstract. Alexandra Jones is a member of the HSR Technical Advisory Group. The Technical Advisory Group had no role in study design, data analysis, decision to publish, or preparation of the abstract.

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COMPARISON OF DIETARY DIVERSITY SCORES (DDS) ACCORDING TO THE STATURO-PONDERAL STATUS AND GENDER AMONG RURAL MIDDLE SCHOOL CHILDREN IN THE NORTHWEST OF MOROCCO

(1)Sbaibi, Rachid; (2)Aboussaleh, Youssef; (2)Zeghari, Lotfi; (2)Agoutim, Naima.

(1)PhD. Laboratory of Nutrition Health and Environment. Department of Biology. Faculty of Sciences. University Ibn Tofail. Kénitra. Morocco; (2)PhD. Nutritionist. Laboratory of Nutrition Health and Environment. Department of Biology. Faculty of Sciences. University Ibn Tofail. Kénitra. Morocco.

**Background and objectives:** Internationally, data on the nutritional health of adolescents (10-19 years) in rural areas are much rarer than those for infants (0-4 years), and adults (> 19 years). this study aims to compare the dietary diversity scores

according to the staturo-ponderal status and gender among rural middle school children in the northwest of Morocco.

**Methods:** A sample of 300 middle school children was observed in a rural school in the northwest of Morocco. The dietary diversity scores are calculated by counting the number of the 11 most frequented food groups (grains, sweet tea, fatty substances, dairy products, vegetables, sweets, poultry, fruits, legumes, red meat, fish) consumed during the preceding 7 days by the middle school children. The staturo-ponderal status is determined by height for age and body mass index (BMI) for age.

**Results:** The sample consists of 102 girls (34%) and 198 boys (66%). The average age is 15.45 ± 1.64 years, ranging from 12.3 to 19.74 years. Stunting and thinness are respectively 9.7% and 10%. The comparison by Mann-Whitney test with a risk α = 5% shows that there was no significant difference in dietary diversity scores between the normal group (N = 271) and the group with stunting (N = 29): (u = 3046, p = 0,051 > 0.05), same thing between normal group (N = 270) and the group with thinness (N = 30) (u=3566; p=0,26>0,05). Also between girls and boys (u = 9588.5, p = 0.46 > 0.05).

**Conclusions:** The study suggested that dietary diversity is not associated with the staturo-ponderal status or gender. A focused analysis is needed to determine the part of socioeconomic status.

**Keywords:** the dietary diversity scores, staturo-ponderal status, gender, middle school children. Morocco.

144/625

NUTRITION CONTENT OF BREAKFAST CEREALS AFTER THE FRONT OF PACKAGE LABELING REGULATION IN MEXICO

(1)Nieto, Claudia; (2)Castillo, Alejandra; (3)Carriedo, Angela;

(4)Tolentino Mayo, María Lizbeth; (5)Barquera, Simon.

(1)MSc. Nutritionist. Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública. México.; (2)Nutritionist. Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública. México.; (3)PhD candidate. London School of Hygiene & Tropical Medicine. England.; (4)PhD candidate. Nutritionist. Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública. México.; (5)M.D. PhD. Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública. México.

**Background and objectives:** Breakfast cereals substantially contribute to daily energy and nutrient intakes in the Mexican population. One of the main dietary patterns of breakfast among Mexican children is cereals with milk. The Mexican National Health and Nutrition Survey of 2012 indicated that 49% of children aged <2 years consumed sweetened cereals. Due to the high prevalence of obesity and non-communicable diseases, the Mexican government implemented a Front of Package Labeling (FOPL) regulation. Such mandatory regulation displayed the nutrition content per package, not per serving. This regulation might have encouraged food industry to reformulate their products, since the total nutrition content of nutrients of concern would be displayed in the front of the package. The aim of this study was to identify the differences in the
nutrition content of breakfast cereals between 2013 and 2014, after
the FOPL regulation was implemented in Mexico.

**Methods:** This is a cross-sectional study. Data was collected from supermarkets. Trained nutritionist took photographs of breakfast cereals (n=371) in eight food retail chains. For 2013, data of n=155 breakfast cereals were collected; and after the regulation, in 2014, data of n=216 breakfast cereals were collected. Nutrient content was standardized by 100g. Since the data was non-parametric, we used Wilcoxon test to compare the nutrition content of breakfast cereals.

**Results:** We assessed the nutrition content of saturated fat, sug-
ar, sodium, energy, carbohydrates and proteins. The mean nutrition
content (2013 vs 2014) was: saturated fat (1.04 vs. 1.34), sugar (26.6
vs 23.3), and sodium (462 vs. 357), and energy (382 vs. 374 kcal).
Significant differences in the nutrition content of breakfast cereals in
year 2013 and 2014 were found (p<.05), except for energy. We also
found significant differences in the content of carbohydrates and
proteins which means that reformulation of products was made by
increasing the content of other nutrients in the product.

**Conclusions:** The nutrition content of breakfast cereals changed after the implementation of the FOPL regulation. Most of the breakfast cereals decreased the content of nutrients of concern, especially sodium content.

**Keywords:** breakfast cereals, nutrition content, labeling.

**Conflict of Interest Disclosure:** This research was part of a larger study funded by the International Development Research Centre. The authors state that there is no potential conflict of interest in relation to this investigation.

University Hospital and Taipei Municipal Wan Fang Hospital from 2007 to 2011. Age-gender matched 440 controls were recruited from a hospital-based pool, including those receiving senior citizen health examinations and adult health examinations. Concentration of urinary arsenic species, including arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMAV) and dimethylarsinic acid (DMAV) were determined by a HPLC-HG-AAS. Polymorphisms of SNPs including PON1 (R192Q), PON1 (M55L), PPAR-γ(C1431T) and PPAR-γ(C[-681]G) were examined by PCR-RFLP.

**Results:** Study participants who had high educational levels, or alcohol, coffee or tea consumption had a significantly low risk of CKD, while those with diabetes, hypertension and analgesic usage routinely had a higher risk of CKD. Subjects carrying PPAR-γ (C1431T) CT genotype had a descending OR of CKD compared with CC genotype. PPAR-γ (C[-681]G)CG genotype had a lower OR of CKD than CC genotype. We also found a significant dose-response relationship between CKD risk and urinary total arsenic levels, or and erythrocytes lead and cadmium levels. The coffee non-drinkers and had higher urinary total arsenic levels, or and high erythrocytes lead and cadmium levels had a significantly higher OR of CKD than those sometimes or often drink coffee and had lower metal levels, respectively.

**Conclusions:** The present study is the first study to explore the association and joint effects among personal lifestyle, hypertension, diabetes, urinary total arsenic levels, erythrocytes lead and cadmium levels on CKD.

**Keywords:** Chronic kidney disease (CKD), Arsenic, Paraoxonase1 (PON1), Peroxisome proliferator activated receptor-γ (PPAR-γ), Polymorphism.

144/630

THE ASSOCIATION BETWEEN COFFEE, ARSENIC, LEAD, CADMIUM AND POLYMORPHISMS OF PON1 AND PPAR-Γ AND CHRONIC KIDNEY DISEASE

(1)Hsueh, Yu-Mei Hsueh; (2)Chen, Wei-Jen; (2)Ao, Pui-Lam.

(1)PhD. Pharmacist. Department of Family Medicine. Taipei Medical University Hospital. Taipei, Taiwan; Department of Public Health. School of Medicine. College of Medicine. Taipei Medical University. Taipei, Taiwan; (2)Ms. School of Public Health. College of Public Health. Taipei Medical University. Taiwan.

**Background and objectives:** Environmental pollutants such as arsenic, lead and cadmium may increase the risk of CKD, by the reason of oxidative damage induced by these metals. Paraoxonase1 (PON1) as an important antioxidant enzyme, and peroxisome proliferator activated receptor-γ (PPAR-γ) as a transcription factor for regulating the gene expression of PON1. The aim of present study is to investigate the relationship among arsenic, lead, and cadmium, genetic polymorphisms of PON1 and PPAR-γ and CKD. In addition, we also explore the joint effects of the polymorphisms of PON1 and PPAR-γ on lifestyle related CKD.

**Methods:** Two hundred twenty CKD patients were defined using estimated glomerular filtration rate lower than 60 ml/min/1.73 m2, and recruited from the Department of Internal Medicine/Nephrology of Shin Kong Wu Ho-Su Memorial Hospital, Taipei Medical

144/634

HEALTH, NUTRITION AND DIETARY HABITS AMONG SCHOOL-AGE CHILDREN LIVING IN SOCIOECONOMIC INEQUALITIES CONTEXTS: PRELIMINARY OUTCOMES OF "SPORT FORGOOD" PROJECT IN ITALY AND ARGENTINA

(1)Buonomo, Ersilia; (2)Moramarco, Stefania; (3)Scarcella, Paola;

(2)Fusco, Giampaolo; (4)Tappa, Alessandro; (5)Palmieri, Sandro; (6)Di

Michele, Sara; (7)Palombi, Leonardo.

(1)PhD. Associate Professor. Department of Biomedicine and Prevention. University of Rome Tor Vergata. Italy.; (2)MSc. Nutritionist. Department of Biomedicine and Prevention. University of Rome Tor Vergata. Italy.; (3)PhD. Researcher. Department of Biomedicine and Prevention. University of Rome Tor Vergata. Italy.; (4)President. Sport Senza Frontiere ONLUS. Italy; (5)PhD. Director. Sport Senza Frontiere ONLUS. Italy; (6)MSc. Psychologist. Sport Senza Frontiere ONLUS. Italy.; (7)PhD. Full Professor. Department of Biomedicine and Prevention. University of Rome Tor Vergata. Italy.

**Background and objectives:** Children living in socioeco-
nomic inequalities contexts are at greater risk of health and nu-
tritional diseases. This preliminary study assesses growth, health
and dietary habits of a sample of school-age children living in Italy and Argentina, enrolled in a promoting healthy lifestyle program.

**Methods:** Socio-demographic conditions, health, blood pressure (National High Blood Pressure Education Program-Pediatrics 2004) and anthropometry assessment (WHO standards/BMI Cole's cutoff), dietary habits (food frequency/24hours food recall) were analyzed at baseline. All children were living in socioeconomic inequalities context in Italy (Rome, Naples, Milan - (n.184, 76.7%) and Argentina (Buenos Aires - n.56, 23.3%), and were included in "Sport Forgood" program, promoting sport and healthy diet. Odds ratios (OR: 95% CI) were calculated to identify predictors of unhealthy dietary habits and malnutrition, both over and undernutrition.

**Results:** High rates of malnutrition were observed in 240 multi-ethnic children (72.1% males, mean age 10.2± 2.7 years). The prevalence of overweight (BMI Cole's cutoffs) was 17.5% (Italy 16.8%, Argentina 19.6%), obesity 15.4% (Italy 14.1%, Argentina 19.6%), underweight 6.7% (Italy 6.5%, Argentina 7.1%). Italian immigrant children with lack of access to water (OR:6.4; CI 1.3-30.8) and sanitation (OR:8; CI 1.7-38.4), and illiterate mothers (OR:8.8; 1.6-47.2) were at higher risk of being stunting (WHO height-for-age z-score <-2). Elevated blood pressure (>90th percentile) was detected in 7.6% of the sample, with an higher risk when BMI >25 (OR:3.7; CI: 1.2-11.7). Nearly twenty percent of the children had familiarity for chronic diseases. Dietary habits analysis showed: 41.4% of children not having breakfast or having inadequate breakfast (22.6%); having illiterate mothers increased the risk of not having breakfast (OR:2.4; CI:1.1-5.2); 53.8% of the sample not consuming adequate fruit or vegetable portions (<1 serving/day); 65.8% exceeding in sweet food consumption (>2 serving/daily) and 55.5% in sugar-sweetened beverages, especially when fathers were illiterate (OR:3.2; CI 1.1-9.2).

**Conclusions:** This finding adds to the growing literature that suggests living in socioeconomic inequalities contexts increases risk of childhood malnutrition, both overnutrition and undernutrition. The current study will continue to investigate changing in dietary habits after "Sport Forgood" healthy lifestyle intervention.

**Keywords:** dietary habits, school-age children, social inequalities context, sport.

that in LMIC mothers are more concerned about their babies not eating enough rather of being overweight. Understanding the factors that are associated to stunting, underweight and overweight could contribute to identify the population at risk and to better guide mothers on how to monitor growth and weight gain during infancy and early childhood. The aim of this study is to relationship between maternal and household characteristics and feeding practices to infant's height and weight status from 6-59m.

**Methods:** We combined 47 nationally representative and standardized Demographic and Health Surveys (DHS) spanning the period 2006-2015 which include over 250,000 children. We split the children population into two age groups: 6 to 23 months old; 24 to 59 months. For children aged 6 to 23 months, in some surveys there is 24 hours food intake information, which is also included in the association analysis. We ran multilevel regression models with country and year fixed-effects: a binary logistic regression on overweight, underweight and stunting and a quintile regression of z-score weight for height.

**Results:** For children 6-23m, we found that household wealth and maternal education was significantly negatively associated with stunting and underweight but positively with overweight. Breastfeeding status, consumption of fortified baby foods and fruits and vegetables were associated with lower rates of overweight. Infant formula, fortified baby food and fruits-and-vegetable were associated with lower rates of stunting and anemia. For children 24-59m, maternal education was no longer associated to overweight but household wealth was. Maternal overweight was associated with higher rates of child overweight in both age groups.

**Conclusions:** There is a strong association between maternal characteristics and children's health outcomes including weight status. The association between maternal education, household wealth and overweight should be further study. There could be cultural belief on child's healthy weight that is bias towards overweight in infancy.

**Keywords:** Child overweight, maternal education, infant feeding and stunting.

**Conflict of Interest Disclosure:** Authors are employees of Nestec. S.A. Industry Food Company

**Background and objectives:** While stunting and underweight have been gradually declining, childhood obesity has become an increasing public health problem in low and middle-income countries (LMIC). However, some studies have reported

<footnote>(1)Prieto Patron, Alberto; (2)Detzel, Patrick.</footnote>

<footnote>(1)Nutrition Health Economist. Phd. Nestle Research Center. Switzerland; (2)Health Economics. PhD. Nestle Research Center. Switzerland.</footnote>
## MONITORING OF BREASTMILK SUBSTITUTE ACT 2013 IN BANGLADESH

(1)Roy, Swapan Kumar; (2)Jahan, Khurshid; (3)Ara, Ferdous;

(4)Chaklader, Hasina; (4)Salam, Suraya Bintay; (5)Islam, Sayeda Sumaiya.

(1)MBBS, MSc, Dip in Biotech, PhD, FRCP. Senior Scientist. Chairperson. Board of Trustees. Bangladesh Breastfeeding Foundation. Chairperson. Nutrition Foundation. Bangladesh;

(2)MSc. Director. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (3)MSc., MPhil. Senior Program Officer. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (4)M.Sc. Program Manager. Bangladesh Breastfeeding Foundation (BBF).

Bangladesh.; (5)M.Sc. Assistant Program Officer. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.

**Background and objectives:** Deaths of 823,000 children in each year could be averted through universal breastfeeding, along with economic savings of US$300 billion. Bangladesh Breastfeeding Foundation (BBF), supported by Institute of Public Health Nutrition (IPHN) & Ministry of Health and Family Welfare (MoHFW) aimed to establish Breast milk Substitute (BMS) code monitoring system in Bangladesh.

**Methods:** In eight divisions, two trained BBF divisional officers monitored BMS Act 2013 by visiting health care facilities, doctor's chambers, markets in divisional town and media monitoring. Health care facilities included District hospitals, Upazila Health Complex (UHC), Maternal and Child Welfare Center (MCWC), Private hospitals and Clinics etc while doctor's chambers and markets. Media monitoring was also done.

**Results:** From September 2016 to February 2017, a total of 120 divisional markets from eight divisions were monitored to detect the violation of BMS ACT 2013 for print, exhibit, circulate or publish any advertisement of any BMS among departmental stores and pharmacy. On the other hand, a total of 693 government and private hospitals were visited under the same project. In Mymensingh division, among 25 health facilities, BMS products were existed among 30% of government and private hospitals while 36% hospitals have breastfeeding corner established by BMS company. Among 76 visited health facilities of Sylhet division, 18% hospitals had breastfeeding corner established by BMS company whereas 28% showed to have BMS product and 34% found to have poster/ leaflet/booklet of BMS Companies in the HF. However, there were no representatives from BMS companies. Social sites (Facebook, Twitter etc) were found to be used for promoting BMS products.

**Conclusions:** Violation of BMS Act 2013 in government and private hospitals and shops was quite high in Bangladesh which needs to be addressed to protect IYCF practice in Bangladesh.

**Keywords:** Breastmilk substitute, Breastmilk substitute Law, Bangladesh

## UNDERSTANDING THE FACTORS THAT INFLUENCE THE DIET AND FEEDING PRACTICES OF POOR URBAN HOUSEHOLDS AND CHILDREN IN NAIROBI, KENYA

(1)Ngombalu, Assumpta Ndumi Ngombalu; (2)Kiswii, Brian;

(3)Mwangome, Martha; (4)Hall, Andrew.

(1)MPH. Nutritionist. Save the Children. East and Southern Africa Regional Office. Nairobi. Kenya; (2)Msc. Food Security Adviser. Save the Children. East and Southern Africa regional Office. Nairobi. Kenya; (3)PhD. Post Doctoral Research Fellow. Kenya Medical Research Institute/Wellcome Trust Research Programme. Kilifi. Kenya; (4)PhD. Nutrition Adviser. Save the Children. London. UK.

**Background and objectives:** Research was undertaken in the informal settlement of Kibera, Nairobi, to assess the dietary habits and monetary cost of meeting the energy and nutrient specifications of households and children aged 2-5 years and their anthropometric status.

**Methods:** The study was undertaken in three stages. First a Household Economy Analysis (HEA) was done involving 36 focus group discussions to assess typical income and expenditure on essentials such as food and fuel. Second a Cost of the Diet (CotD) assessment was undertaken, which involved a market survey to calculate the cost per 100 g of all fresh foods followed by focus group discussions with local women to understand their typical food habits. These data were applied to CotD software to calculate the cost of meeting the energy and nutrient specifications of households, including children aged 2-5 years. Third, a cross-sectional survey was done of children aged 2-5 years in 409 households to assess their anthropometric status and feeding habits and to obtain a 24-hour dietary recall on a sub-sample of 26 households.

**Results:** The HEA indicated that approximately 60% of the population were classified as poor or very poor, earning less than USD 200 monthly. Households purchased cooked food to save on fuel and commonly on credit; school meals were an important source of food for school children. The CotD assessment indicated that a nutritious diet for a family of 6 costs about USD 380 per month, so was unaffordable to most people. The survey showed that 44% of children aged 2-5 years were stunted while 10% were wasted. Their median meal frequency was 4 meals a day, including snacks. The 24-hour dietary recall found that only 31% of children had consumed any animal protein, and 88%, 65% and 54% had consumed inadequate amounts of calcium, iron and zinc respectively, compared with the recommended daily nutrient intake.

**Conclusions:** The studies revealed poor diets among children aged 2-5 years with poverty playing a major role in the affordability of nutritious foods and the purchasing preferences of households.

**Keywords:** dietary habits, urban poor, household economy, cost of the diet.
# DEVELOPING AND TESTING REPORTING GUIDELINES FOR OBSERVATIONAL STUDIES IN NUTRITIONAL EPIDEMIOLOGY: A CONSENSUS BASED METHOD AND A RCT

(¹)Hawwash, Dana; (²)Pinxten, Wim; (³)Kolsteren, Patrick; (⁴)Lachat, Carl.

(¹)PhD Student. Nutritionist. Department of Food Safety and Food Quality. Ghent University. Belgium; (²)Professor. Faculty of Medicine and Life Sciences. Hasselt University. Belgium; (³)Prof. Dr. Patrick Kolsteren. Scientific staff. Director MSc. NuRuDe programm. Department of Food Safety and Food Quality. Ghent University. Belgium; (⁴)Professor. Department of Food Safety and Food Quality. Ghent University. Belgium.

**Background and objectives:** The need to strengthen the evidence base, replicate studies and systematic reviews in health research led to the development of reporting guidelines. A reporting guideline is a checklist, a flow diagram or a combination that specifies the items to be reported concerning what was done and found during the study. For use within nutritional epidemiology, Strengthening the reporting of observational studies in epidemiology – nutritional epidemiology (STROBE-nut) an extension of the STROBE reporting guideline, was developed in 2016.

The mere existence of a reporting guidelines, does not guarantee adherence or correct use. Better understanding of how to implement reporting guidelines is required. We investigate whether the implementation of a checklist as an embedded tool in Microsoft Word increases the understanding and adherence to reporting guidelines (i.e., STROBE-nut, STROBE, CONSORT, and PRISMA) compared to traditional checklists.

**Methods:** In the first phase of this study, STROBE-nut guidelines were developed following a recommended procedure using the Delphi method. A steering group of 21 members with varied expertise coordinated the development of the reporting guidelines while external international experts were consulted to reach consensus on the proposed items. In the second phase of the study, the reporting guidelines were developed as a Word Add-in in VisualBA. Through a Randomized Controlled Trial, we compare the traditional way of administering reporting guidelines through paper checklists (control) with administering them through an embedded writing tool during manuscript drafting (intervention). Perceived usefulness, ease of use and completeness of reporting are the main outcome measures of the study. Participants are authors of nutritional epidemiology studies, randomly recruited from protocol repository websites (i.e. clinicaltrials.gov and PROSPERO).

**Results:** In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist to compose STROBE-nut. STROBE-nut is translated and disseminated widely through the website http://www.strobe-nut.org. The comparison of the Word add-in to traditional implementation of reporting guidelines is ongoing and pilot results will be presented at the congress.

**Conclusions:** It is hypothesized that using the guidelines improves the readability of the published literature. If reporting guidelines are appropriately translated in a user-friendly tool, they might be used more consistently and rigorously.

**Keywords:** Guidelines as Topic, Nutritional epidemiology, Reporting, Randomised Controlled Trial, writing aid

**Conflict of Interest Disclosure:** There is no conflict of interest. Dana Hawwash receives funding from the Schlumberger Foundation's Faculty for the Future Programme (France)

# TRENDS IN THE PREVALENCE OF OVERWEIGHT AND OBESITY AMONG BRAZILIAN SCHOOL-CHILDREN, 2002, 2007, AND 2012/13

(¹)Leal, Danielle; (¹)De Assis, Maria Alice; (²)Lobo, Adriana; (¹)Hinnig, Patrícia; (²)Engel, Raquel; (¹)Soar, Claudia.

(¹)PhD. Postgraduate Program in Nutrition. Health Sciences Center. Federal University of Santa Catarina. Florianopolis. Santa Catarina. Brazil.; (²)MSc. Postgraduate Program in Nutrition. Health Sciences Center. Federal University of Santa Catarina. Florianopolis. Santa Catarina. Brazil.

**Background and objectives:** The negative health consequences of childhood overweight/obesity (OW/OB) are well known. Therefore, an accurate monitoring of the OW/OB prevalence is essential. Anthropometry is the most practical and cost-effective method for nutritional status evaluation. The purpose of this study was to describe trends in the nutritional status among 7-10-year-old children by investigating changes in the prevalence of overweight (including obese) and obesity.

**Methods:** A school-based sample of 7-10-year-old children participated in three cross-sectional studies in 2002 (n=2,936), 2007 (n=1,232) and 2012/13 (n=1,531) in Florianopolis, southern Brazil. The WHO Child Growth Standards were used to define the prevalence of overweight and obesity.

**Results:** In 2012/13, 40.2% of the boys and 33.9% of the girls were overweight (including obese), which is a substantial increase since 2002 (boys 32.9%, girls 27.6%) and 2007 (boys 36.2%, girls 32.5%). Similarly, 15.9% of the boys and 11.2% of the girls were obese, which is higher than in 2002 (boys 11.9%, girls 8.3%) and which is much higher than in 2007, mainly among girls (boys 13.9%, girls 6.9%).

**Conclusions:** Over the period 2002 to 2007, there were a potential leveling off in the prevalence of obesity, and an increase in the prevalence of overweight. Over the period 2007 to 2012/13, the prevalence of overweight and obesity was still rising, and at an even faster rate than the preceding period. Evidence-based interventions are needed to counter the obesity epidemic, and there is an urgent need for school intervention programs.

**Keywords:** Overweight. Obesity. Body mass index. Children. Trends
# DIET QUALITY INDICES IN RELATION TO METABOLIC SYNDROME IN AN INDIGENOUS CREE (EEYOUCH) POPULATION IN NORTHERN QUÉBEC, CANADA

(1)Lavigne-Robichaud, Mathilde; (2)Moubarac, Jean-Claude;

(3)Lantagne-Lopez, Stéfanie; (4)Johnson-Down, Louise; (5)Batal,

Malek; (6)Laouan Sidi, Elhadji A.; (7)Lucas, Michel.

(1)MSc. Nutritionist. Department of Social & Preventive Medicine. Laval University. Québec. QC. Canada; Population Health and Optimal Health Practices Research Unit. CHU de Québec Research Centre. Québec. QC. Canada.; (2)PhD. Transition Nutritionnelle (TRANSNUT). WHO Collaborating Centre on Nutrition Changes and Development. Department of Nutrition. Faculty of Medicine. University of Montreal. Montreal. QC. Canada.; (3)Nutritionist. Department of Social & Preventive Medicine. Laval University. Québec. QC. Canada; Population Health and Optimal Health Practices Research Unit. CHU de Québec Research Centre. Québec. QC. Canada.; (4)Nutritionist. Centre for Indigenous Peoples' Nutrition and Environment. School of Dietetics and Human Nutrition. McGill University. Montreal. QC. Canada;

(5)PhD. Nutritionist. TRANSNUT. Department of Nutrition. Faculty of Medicine. University of Montreal. Montreal. QC. Canada;

(6)Department of Social & Preventive Medicine. Laval University. Québec. QC. Canada; Population Health and Optimal Health Practices Research Unit. CHU de Québec Research Centre. Québec. QC. Canada.; (7)PhD. Nutritionist. Department of Social & Preventive Medicine. Laval University. Québec. QC. Canada; Population Health and Optimal Health Practices Research Unit. CHU de Québec Research Centre. Québec. QC. Canada.

**Background and objectives:** To assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec Canada.

**Methods:** 811 Eeyouch (≥18 years old) from seven James Bay communities participated in the 2005-09 cross-sectional "Nituuchischaayihititaaú Aschii" Environment-and-Health study. The alternative-Healthy Eating Index (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to the total dietary energy intake using the NOVA classification were calculated from 24-hour food recalls. MetS was determined with the harmonized International Diabetes Federation (IDF) definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components.

**Results:** MetS prevalence was 56.6% with 95.4% abdominal adiposity, 50.1% elevated fasting plasma glucose, 43.4% high blood pressure, 38.6% elevated triglycerides and 44.5% reduced high-density lipoprotein-cholesterol. Comparing highest to lowest quintiles of scores, adjusted odds ratios (ORs) of MetS was 0.70 [95% CI: 0.39-1.08; p-trend=0.05] for aHEI-2010, 1.06 [95% CI: 0.63-1.76; p-trend=0.87] for FQS and 1.90 [95% CI: 1.14-3.17; p-trend=0.04] for the contribution of UPP to the total dietary energy intake.

**Conclusions:** Although diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored

to the food environment of northern communities are essential to further understand the impact of diet quality in this context.

**Keywords:** Ultra-processed products, diet quality, metabolic syndrome, aboriginal health, NOVA classification

# IS MEDITERRANEAN DIET ADHERENT IN A YOUNG ADULT ALBANIANS TO PREVENTION OF CARDIOVASCULAR DISEASES?

(1)Andreoli, Angela; (2)Dragushia, Pranvera; (3)Dibra, Arvin; (4)Cenko, Fabian.

(1)MD, PhD, Nutritionisti. Physiologist. 1Human Physiology and Nutrition. Department Medicine of System. University of Rome "Tor Vergata, University of Rome Tor Vergata; (2)MD Cardiologist. Catholic University Our Lady of Good Counsel Tirane, Albania;

(3)MD Anatomist. Catholic University Our Lady of Good Counsel Tirane, Albania; (4)PhD Statistician. Catholic University Our Lady of Good Counsel Tirane, Albania.

**Background and objectives:** Mediterranean diet (MD) is associated with lower risk of major chronic diseases. Despite the overall documented health benefits, adherence to this MD pattern has been rapidly declining over the last decades due to youth tendency toward unhealthy foods. Albania is a Country that is living a transitional economical realty from the rural life to a more developed and westernized state. This transition is seen also in the change of lifestyles. The aim of the study to assess the adherence to MD through the Mediterranean Adequacy Index (MAI) in young adult Albanians and verify the risk for the development of cardiovascular diseases.

**Methods:** In 78 males and 165 females, belonging to Albanian young adults aged 18-27 years. Weight, height werw mMeasured and body mass index (BMI) was calculated. Body composition ((fat mass (FM), fat free mass (FFM), body cell mass (BCM)) by bioelectrical impedance analyses (BIA), blood pressure (BP), waist hip circumferences were assessed. Food intake by food frequency questionnaire (FFQ) and physical activity questionnaires were measured. Mediterranean Adequacy Index (MAI) was computed by dividing the sum of the percentage of total energy from typical Mediterranean food Groups by the sum of the percentage of total energy from non-typical Mediterranean food groups

**Results:** BMI were 23.5 ± 5.0 and 22 ± 4 kg/m2 men and women respectively. FM 14.6 ± 8.0 kg, 14.0 ± 6.0 kg; %FM 18.7 ± 8.1 and 24.0±6.2; BCM 33.6±3.9 kg and 22.3 ± 2.9 kg males and females respectively There was a significant correlation between diastolic BP and waist/hips ratio in females (p< 0.05) as well as diastolic BP and MAI (p< 0.05); fat mass and MAI (p< 0.03) women; in men waist/hips and MAI (p<0.03). Overweight subjects had an higher blood pressure, practiced less physical activity and their food habits were less adherent to MD.

**Conclusions:** Young Albanian population is moving from a traditional rural life-style to more westernized way-to-live that can also be understood in the nutritional habits of our population
with an increasing risk for overweight/obesity and cardiovascular
diseases.

**Keywords:** Mediterranean diet, cardiovascular diseases, fat mass

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DIETARY LEUCINE, ISOLEUCINE AND VALINE
INTAKE AND THEIR ASSOCIATION WITH MET-
ABOLIC SYNDROME: A POPULATION-BASED
STUDY

(1)Pallottini, Ana Carolina; (2)Aliete dos Santos Vieira, Diva;

(2)Hermes Sales, Cristiane; (3)Machado Miranda, Andreia Alexandra;

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

(1)MSc. student. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (2)Ph.D. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (3)Ph.D. student. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** Metabolic syndrome (MetS) is considered a cluster of factors that raises risk for cardiovascular disease and other health problems. Evidences from epidemiological studies suggest that BCAA intake may be related to chronic diseases, especially MetS, but this association is not yet clear. The aim of this study was to investigate the relationship between BCAA intake with MetS

**Methods:** Data of 591 adults and older adults, of both sex-
es, were obtained from the 2008 Health Survey of São Paulo, a
cross-sectional population-based survey. Baseline characteristics
were collected from a structured questionnaire and the data of
consumption of BCAA was obtained from two 24-hour recalls,
analyzed in the Nutrition Data System for Research (NDSR). The
leucine, isoleucine and valine intake were adjusted for total ener-
gy intake and the usual intake were estimated using the Multiple
Source Method. MetS was defined as the presence of at least three
of the following: hypertension, hyperglycemia, dyslipidemia and
central obesity. Multiple logistic regression was used to investigate
the association between BCAA intake and the presence of MetS.
The models were adjusted by sex, age, alcohol consumption, per
capita income, smoking status, race, BMI (Body Mass Index),
physical activity level, total energy intake, high-sensitivity C-re-
active protein, monounsaturated fat, polyunsaturated fat and sat-
urated fat intakes. All analyzes considered the complexity of the
sample design and the significance level of 0.05 was considered.

**Results:** Individuals with higher leucine intake (fifth quintile) was positively associated with MetS when compared to those of the first quintile (OR=3.85, 95%CI=1.67-8.87). The same occurs with valine (OR=4.33 95%CI=1.75-10.69) and isoleucine intake comparing fifth with first quintile (OR=3.58 95%CI=1.46-8.77)

**Conclusions:** The highest dietary leucine, isoleucine, and valine intake were positively associated with MetS.

**Keywords:** food consumption; branched chain amino acids; Metabolic Syndrome; health survey.

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INFLUENCE OF EXERCISE ON OBESE CHILDREN
6-12 YEARS IN ENUGU SOUTH LOCAL GOVERN-
MENT AREA OF ENUGU STATE, NIGERIA

(1)Nnam, Ngozi; (2)Oly-Alawuba, Nkeiruka.

(1)PhD. Lecturer. Department of Home Science Nutrition and Dietetics. University of Nigeria Nsukka. Nsukka. Nigeria.; (2)PhD. Lecturer. Imo State University. Owerri. Nigeria.

**Background and objectives:** Social environment or life style of an individual is created through the different social activities around him and it could affect his nutritional status. Exercise is a life style that could have positive influence on obesity. Overweight and obesity in children are increasingly becoming public health concern in the world. Obesity is a risk factor for many chronic non-communicable diseases like type 2 diabetes, high blood pressure, heart diseases and some cancers. The study assessed the effect of physical exercise on weight of obese children 6-12 years in Enugu south Local Government Area (LGA) of Enugu State, Nigeria.

**Methods:** A preliminary study was conducted on school chil-
dren 6-12 years in Enugu south LGA of Enugu State, Nigeria, to
determine those who are obese. A total of 60 children representing
49.6% of the 121 obese children identified were randomly select-
ed for the study. The children were divided into test and control
groups (n = 30) based on body weight. Test group was subjected to
physical exercise (jogging, dance aerobics, rope skipping, handball
and football) 2 hours a day for 8 weeks. The control group had
no physical exercise. Weight measurements of the children were
taken at baseline and endline of the exercise.

**Results:** The test group had a weight decrease of 9.88% while the control group had 7.2% weight gain. The females in the test group had a weight decrease of 9.68% while the males had 11.84% decrease. There was 8.09% and 6.37% weight increase in the female and male children, respectively in the control group.

**Conclusions:** Physical exercise reduced obesity in the school children and should be encouraged in children as a way of fighting obesity.

**Keywords:** Obesity, Physical exercise, School children.

**Further collaborators:**

Ministry of Education. Enugu state. Nigeria.
# THE ASSOCIATION BETWEEN SOCIOECONOMIC STATUS, PLACE OF RESIDENCE, OVERWEIGHT AND CENTRAL OBESITY IN POLISH FEMALES. THE GEBAHEALTH STUDY

(¹)Kowalkowska, Joanna; (²)Wadolowska, Lidia; (³)Czarnocinska, Jolanta; (⁴)Jezewska-Zychowicz, Marzena; (⁵)Babicz-Zielinska, Ewa.

(¹)MSc. Faculty of Food Science. University of Warmia and Mazury in Olsztyn. Poland.; (²)Prof. Faculty of Food Science. University of Warmia and Mazury in Olsztyn. Poland; (³)Assoc. Prof. Faculty of Food Science and Nutrition. Poznan University of Life Sciences. Poland; (⁴)Prof. Faculty of Human Nutrition and Consumer Sciences. Warsaw University of Life Sciences. Poland; (⁵)Prof. Faculty of Physiotherapy and Health Sciences. Gdansk Management College. Poland.

**Background and objectives:** Socioeconomic (SES) and demographic factors can influenced weight status. It was found that people with low SES are more likely to be overweight and obese [1]. The aim of this study was to assess the effect of SES, its single factors and place of residence on the prevalence of overweight and central obesity in Polish females.

**Methods:** A cross-sectional study was carried out in representative sample 1107 of Polish females aged 13-21 years. The SES index was calculated based on categorical variables: mother's education, father's education, self-declared economic status, description of household. Six regions of the country (ordered from the poorest to the richest) and rural/urban place of residence were analyzed. The prevalence of overweight was assessed using IOTF 2012 standards. The criterion of central obesity was $WHtR≥0.5$ [2]. Odds ratios (ORs) adjusted for age were calculated.

**Results:** Overweight (including obesity) was observed in 12.1% and central obesity in 7.9% of females. Females with high SES were less likely to be overweight (OR=0.52) and to have central obesity (OR=0.51). Overweight was less likely in females having father with higher education (OR=0.33) and good economic situation of the household (OR=0.49). Central obesity was less likely in females having mother with upper secondary education (OR=0.50). Compared to eastern region of the country (the poorest one), females living in northern (OR=2.61), north-western (OR=2.52) or south-western (OR=3.25) region were more likely to be overweight and females living in south-western region (OR=2.56) to have central obesity. The ORs for rural/urban place of residence were not significant.

**Conclusions:** SES, its single factors and region of residence were linked with overweight and central obesity in Polish females. High SES was associated with lower prevalence of overweight and central obesity. The relation with place of residence was inconsistent.

**References:** [1] Due P et al. Socioeconomic position, macroeconomic environmental and overweight among adolescents in 35 countries. Int J Obes, 2009, 33:1084-1093.

[2] Ashwell M et al. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev, 2012, 13:275-286.

**Keywords:** socioeconomic factors, BMI, abdominal obesity, girls, young women

**Conflict of Interest Disclosure:** None disclosed. Research relating to this abstract was funded by National Science Centre (NCN) Project no. N N404 068540.

# PHYSICAL ACTIVITY LEVEL MEASURED BY PAQ-C IN 8-11 YEARS OLD SCHOOL-AGED CHILDREN: A MULTICENTRIC STUDY IN THREE WEST AFRICAN COUNTRIES

(¹)Diouf, Adama; (²)Katile, Mariam; (³)Idohou-Dossou, Nicole;

(⁴)Wague, Tidiane; (⁵)Diagana, Yacouba; (⁶)Ag Iknane, Akory;

(⁷)Sembéne, Pape Malick; (³)Wade, Salimata.

(¹)PhD. Nutritionist. Laboratoire de Nutrition. Faculté des Sciences et Techniques. University Cheikh Anta Diop de Dakar. Senegal;

(²)MD. Ms. Physician. Laboratoire de Nutrition. Département de Biologie Animale. Faculté des Sciences et Techniques. Université Cheikh Anta Diop de Dakar. Sénégal; (³)PhD. Nutritionist.

Laboratoire de Nutrition. Département de Biologie Animale.

Faculté des Sciences et Techniques. Université Cheikh Anta Diop (UCAD) de Dakar. BP 5005. Dakar-Fann. Senegal; (⁴)Ms.

Nutritionist. Laboratoire de Nutrition. Département de Biologie Animale. Faculté des Sciences et Techniques. Université Cheikh Anta Diop (UCAD) de Dakar. BP 5005. Dakar-Fann. Senegal; (⁵)PhD.

Nutritionist/Food chemisty. Faculté des Sciences et Techniques. Université des Sciences de Technologies et de Médecine de Nouakchott. Mauritania; (⁶)MD. PhD. Physician. Institut National de Recherche en Santé Publique. Faculté de Médecine de Pharmacie et d'Odontostomatologie Bamako. Mali; (⁷)MD. PhD.

Division du Contrôle Médical Scolaire. Ministère de l'Education Nationale. Dakar Sénégal.

**Background and objectives:** Physical inactivity is an important risk factor of childhood obesity and highlight the need for more physical activity (PA) data surveillance. The aim of this study was to use a common tool: Physical Activity Questionnaire for Older Children (PAQ-C) to compare the prevalence of PA levels among school children from three West African countries.

**Methods:** The study is a cross-sectional one conducted in Senegal, Mali, and Mauritania. Overall 471 school-aged children, 8-11 years old (235 boys, 236 girls) were randomly selected from elementary public schools in urban area of Dakar (n=156), Bamako (n=155) and Nouakchott (n=161). BMI-for-age and Height-for-age (z-scores) were calculated according to WHO growth standard reference. PA level was assessed by PAQ-C using a harmonized protocol, and was categorized as low (score=1), moderate (score=2-4) and high (score=5).

**Results:** The prevalence of overweight/obesity (BMI> +1 z-score) and stunting (HAZ< -2 z-score) were comparable among the children: 4.5% and 1.92% in Senegal, 3.9% and 4.5% in Mali, and 2.5% and 5.7% in Mauritania, respectively. Thinness affected significantly more children in Senegal (30.1%) than in Mali.
(13.5%) and Mauritania (15.7%, p<0.01). Mean PAQ-C score was significantly lower in the Senegalese (2.34±0.74), compared to the Malian (2.60±0.59) or the Mauritanian children (2.62±0.67, p<0.01). In the three countries, the lowest score value was recorded in girls with significant difference between boys and girls (p<0.001). Overall, 79% of the children in the 3 countries were engaged in moderate PA level (score=2-4), but the proportion was significantly lower in Senegal (65%) than in Mali (83%) and Mauritania (84%; p=0.002). Across all countries, boys more frequently reported moderate PA than girls (p<0.05). Whatever the country or sex any intense PA level was observed among the children.

**Conclusions:** Similar physical activity patterns were found in the three West African countries indicating moderately active school-aged children. PAQ-C could be a suitable tool for the assessment and surveillance of PA as well as data comparisons across countries. Although PAQ-C is an uncomplicated routine method, various activities were not adapted for genuine activities and therefore need further validation.

**Keywords:** PAQ-C, School-aged children, Senegal, Mali, Mauritania.

**Further collaborators:** Supported by International Atomic Energy Agency (IAEA) through the RAF/6/042 project, the Ministry of Higher Education and Scientific Research of Senegal (PA-PES : Projet d'Appui aux Enseignantes-Chercheures du Sénégal) and the Islamic Development Bank (IDB).

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### SOCIO-DEMOGRAPHIC AND BIRTH CHARACTERISTICS INFLUENCE THE DURATION OF BREASTFEEDING IN COLOMBIA: RESULTS FROM THE 2010 DEMOGRAPHIC AND HEALTH SURVEY

(1)Lopez Arana, Sandra; (2)Barragán-González, Ana María; (3)Moreno-Montoya, José.

(1)Nutritionist, MSc, PhD. Institute of Nutrition and Food Technology. University of Chile. Chile.; (2)MPH. MD. Assistant Professor. Epidemiology, Biostatistics and Public Health Research Group, EPIBIOS_UR. School of Medicine and Health Sciences (EMCS). Universidad del Rosario. Bogotá. Colombia.; (3)PhD. Assistant Professor. Community Medicine Research Group. Universidad El Bosque. Bogotá. Colombia.

**Background and objectives:** Breastfeeding is associated with positive maternal and infant health benefits. In high-income countries, socially disadvantaged women breastfed less often. However, there is limited research in low- and middle-income countries. This study assessed the duration of total breastfeeding by region and estimated the role of socio-demographic, life-style related and birth characteristics on the duration of breastfeeding in Colombia.

**Methods:** We used cross-sectional data from the 2010 Colombian Demographic Health Survey. Six regions were defined according to particular physical and climatic characteristics. 16,594 mothers aged 13-49 years were included in the study. Univariate

and bivariate analyses were conducted. Time-to-event analyses were employed for the analysis of breastfeeding-related data.

**Results:** The association between breastfeeding duration and region varies substantially. Overall, women who reported higher age at first birth (Sub hazard ratio (SHR= 1.05, 95% CI 1.04, 1.06), higher parity (SHR= 1.13, 95% CI 1.10, 1.16) and delivery by cesarean (SHR= 1.07, 95% CI 1.02, 1.12) discontinued breastfeeding sooner than their counterparts. In contrast, breastfeeding duration was longer among lower educated (SHR= 0.77, 95% CI 0.73, 0.82) and poorest (SHR= 0.83, 95% CI 0.78, 0.89) women. Life-style related characteristics such as alcohol consumption and smoking had no significant associations on breastfeeding duration.

**Conclusions:** Socio-demographic and birth characteristics play a role in explaining regional differences in duration of breastfeeding. Therefore interventions looking for increasing the duration of breastfeeding should be more focused on women who are most at risk of early cessation of breastfeeding, also integrating the different regional needs to reduce the socioeconomic inequalities in breastfeeding.

**Keywords:** Breastfeeding, Infant health, Colombia, Cesarean delivery, Maternal education,

## 144/690

### SUGAR-SWEETENED BEVERAGE CONSUMPTION AND OBESITY IN CHILDREN'S META-ANALYSES: REACHING WRONG ANSWERS FOR RIGHT QUESTIONS

(1)Nissensohn, Mariela; (2)Fuentes Lugo, Daniel; (3)Serra-Majem, Lluis.

(1)PhD. Nutritionist. Research Institute of Biomedical and Health Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria. Spain. CiberObn Physiopathology of Obesity and Nutrition. Carlos III Health Institute. Madrid. Spain. ;

(2)MD. Faculty of Health Sciences. Universidad Autónoma del Carmen. Ciudad del Carmen. México.; (3)MD,PhD. Research Institute of Biomedical and Health Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria. Spain. CiberObn Physiopathology of Obesity and Nutrition. Carlos III Health Institute. Madrid. Spain.

**Background and objectives:** Recent studies assert that sug- ar-containing drinks may play a key role in the etiology of over- weight at all ages. However, scientific literature shows contradic- tory findings. Whether this association is a leading cause or not is a matter of debate. It is also subject to discussion whether the quality/adequacy of studies may influence the outcome. Our aim was to explore the most recent scientific evidence focused on sug- ar-sweetened beverages (SSB) and child obesity and to further analyze the adequacy of the meta-analyses in terms of their results, with special emphasis in the methodology, clarity and transpar- ence of their procedures.

**Methods:** We selected only meta-analyses of randomized con- trol trial studies on PubMed database and Cochrane Website until January, 2016. Adherence to PRISMA was assessed.
**Results:** Six meta-analyses were included. All of them showed some degree of evidence of heterogeneity in theirs pool estimates. Two of them showed a positive association between SSB and obesity but the other four found no association. The adherence to the PRISMA criteria was higher in two of the meta-analyses that showed opposite conclusions regarding the association or non-association of SSB and obesity in children. Thus, there is no relation between the adherence of the meta-analyses to the PRISMA criteria and the results obtained.

**Conclusions:** The use of meta-analysis as a scientific tool requires further promotion, better refinement and widespread agreement. Available quality-assessment tools have limitations, and many contextual factors beyond the intrinsic characteristics of the reviews may influence their results. Sugary drinks are often blamed as a potential cause of the obesity pandemia, but this possible association requires a broader approach that includes a detailed analysis of the whole diet and lifestyle.

**Keywords:** Sugar-sweetened beverage, obesity, children, mental analyses

**Background and objectives:** Poor maternal mental health may affect productivity and livelihood opportunities as well as diminish mothers' ability to provide adequate care for their young children and themselves. The objective of this analysis was to examine the association between symptoms of maternal mental health and maternal and child nutritional indicators.

**Methods:** Nutrition Links is a 5-y project to improve rural health and economic well-being in the Upper Manya Krobo district, Ghana. In 2013-2014, an exhaustive survey of 1096 households with infants < 12 months was completed; a one-year follow-up survey was carried out with 943 households (86%). The Self-Reporting Questionnaire with 20 symptoms of depression and anxiety (SRQ20) estimated probable mental disorder among mothers. The survey also included a socio-demographic questionnaire and a 24-hour and 7-day food frequency questionnaire for children and mothers, respectively. Child dietary diversity score (DDS) was the

number of food groups (7 maximum) consumed and maternal DDS was based on 15 food groups. Weight and height were taken and WHO standardized indicators [child] and BMI [mother]) were calculated. The analysis excluded communities randomly selected to participate in an agricultural and nutrition education intervention, leaving 687 households for the linear regression models.

**Results:** The median SRQ20 score was 7 at baseline and 8 one year later; the two scores were strongly correlated (r = 0.56; p<0.0001). The SRQ20 score at baseline was negatively associated with both maternal (b=-0.08; p<0.001) and child (b=-0.27; p=0.01) DDS one year later. Having the highest increase in symptoms between baseline and one year (i.e., ≥ 75th percentile: 4+ symptoms) was associated with a further lower DDS for mothers only (b=-0.72; p<0.01). A higher SRQ20 score tended to be associated with a lower maternal BMI (b=-0.059; p=0.07) but was not directly associated with any anthropometric indicators among the children.

**Conclusions:** The limited association between maternal mental health symptoms and child outcomes may reflect support from alternative caregivers. Integrated nutrition programs must consider mechanisms to address mental health. The Nutrition Links project is registered as Clinical Trials # NCT01985243.

**Keywords:** Mental health, diet, nutrition, maternal, child

**Background and objectives:** Herbs and spices as a food category have a significant role in culinary traditions around the world, and are highly traded food commodities. However, as usual consumption is low, e.g., in amounts of a few grams per person per day, dietary surveys often fail to capture their contribution, and food composition databases often omit their inclusion. Nevertheless, they are generally acknowledged as contributing to intakes of micronutrients and beneficial bioactive non-nutrients for households and communities, particularly where there is significant adherence to food traditions. Of equal interest are the exposures to contaminants and chemical residues. This paper examines the risks and benefits of herbs and spices specific to the nutrients, beneficial bioactive non-nutrients, chemical residues and contaminants.

**Methods:** Nutrient data from national and regional food composition databases, and data from pesticide residue and heavy metal analyses in the USA and New Zealand, and from import refusals for EU and USA, were examined for ginger, turmeric, pepper, paprika, cinnamon, nutmeg, garam masala and curry powder from various countries of origin. Original analyses for heavy metals are carried out using Graphite Furnace Atomic Absorption Spectrometry.

<footnote>(1)Marquis, Grace; (2)Colecraft, Esi; (3)Aryeetey, Richmond; (4)Aboud, Frances; (5)Aidam, Bridget; (6)Bannerman, Boat; (7)Thompson-Colon, Theresa.</footnote>

<footnote>(1)McGill University. Canada; (2)PhD. Dept of Nutrition and Food Science. University of Ghana. Legon. Ghana; (3)PhD. School of Public Health. University of Ghana. Legon. Ghana; (4)PhD. Dept of Psychology. McGill University. Montreal. Canada; (5)PhD. World Vision International. Washington DC. USA; (6)Dept of Nutrition and Food Science. University of Ghana. Legon. Ghana; (7)PhD. School of Dietetics and Human Nutrition. McGill University. Montrea. Canada.</footnote>

<footnote>(1)Burlingame, Barbara; (2)Kim, Nick; (3)Eme, Paul.</footnote>

<footnote>(1)Professor. College of Health.; (2)Senior Lecturer. Applied Environmental Chemistry. Massey University. New Zealand; (3)Doctorate scholar. College of Health. Massey University. New Zealand.</footnote>
**Results:** Compositional data from popularly traded spices show levels of nutrients and beneficial phytochemicals that justify their inclusion in diets. Noteworthy are the provitamin A carotenoid contents of highly pigmented spices. The data also reveal chemical contaminants that exceed the maximum levels stipulated by global (Codex Alimentarius) and national (Food Standards Australia New Zealand) food safety bodies. In these analyses, all of the spices tested were found to contain detectable levels of heavy metals. The case study of turmeric is highlighted in the context of its recent popularity because of the therapeutic effects of curcumin, one of three major curcuminoids; the recent food safety recall in the US due to lead contamination; the surveillance measures to ensure consumer safety; and the relevance of country of origin in world spice trade.

**Conclusions:** As interest in the beneficial nutrients and bioactive non-nutrients in spices increases, the requirement for safety testing becomes critical. Dietary intake assessments, and exposure assessments, should always include both benefits and risks.

**Keywords:** spices, contaminants, food safety, exposure assessment, turmeric

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CRUCIFEROUS VEGETABLE INTAKE AND LUNG CANCER RISK: A PROSPECTIVE STUDY AND A META-ANALYSIS

(1)Mori, Nagisa; (2)Shimazu, Taichi; (1)Nozue, Miho; (2)Sawada, Norie;

(2)Iwasaki, Motoki; (3)Takachi, Ribeka; (1)Sunami, Ayaka; (4)Ishihara, Junko; (5)Sobue, Tomotaka; (6)Tsugane, Shoichiro.

(1)PhD. Epidemiology and Prevention Group. Center for Public Health Sciences. National Cancer Center. Tokyo. Japan.; (2)MD. PhD. Epidemiology and Prevention Group. Center for Public Health Sciences. National Cancer Center. Tokyo. Japan.;

(3)Department of Food Science and Nutrition. Faculty of Human Life and Environment. Nara Women's University. Nara. Japan.;

(4)Division of Nutrition Science. Graduate School of Sagami Women's University. Kanagawa. Japan.; (5)Department of Environmental Medicine and Population Sciences. Graduate School of Medicine. Osaka University. Osaka. Japan.; (6)MD. DMSc. Epidemiology and Prevention Group. Center for Public Health Sciences. National Cancer Center. Tokyo. Japan.

**Background and objectives:** Cruciferous vegetables, a rich source of isothiocyanates, have been reported to lower the risk of lung cancer. However, evidence from prospective observations of populations with relatively high intake of cruciferous vegetables is sparse. We examined the association between cruciferous vegetable intake and lung cancer risk in a large-scale, population-based, prospective study in Japan.

**Methods:** We studied 82,330 participants aged 45-74 years. Participants responded to a questionnaire that included 138 food items. The association between cruciferous vegetable intake and lung cancer incidence was assessed using the Cox proportional-hazard regression model. Furthermore, we carried out a meta-analysis of all prospective studies.

**Results:** After 14.9 years of follow-up, a total of 1499 subjects were diagnosed with lung cancer. After the deletion of early-diagnosed cancer, we observed a significant inverse association between cruciferous vegetable intake and lung cancer risk among male current nonsmokers: multivariate HR (95% CI): 0.49 (0.27, 0.87), P for trend=0.04 for never smokers, and 0.59 (0.35, 0.99), P for trend=0.10 for past smokers. No association was noted in male current smokers and female never smokers.

**Conclusions:** The study suggests that cruciferous vegetable intake may be associated with reduction in lung cancer risk among male current nonsmokers.

**Keywords:** cruciferous vegetables, isothiocyanate, lung cancer, prospective study, Japan

**Conflict of Interest Disclosure:** M Inoue is the beneficiary of a financial contribution from the AXA Research Fund as chair holder of the AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo. The AXA Research Fund had no role in the design, data, collection, analysis, or interpretation. Other authors declare no other conflict of interest.

**Further collaborators:**

Shizuka Sasazuki (MD. PhD. Epidemiology and Prevention Group. Center for Public Health Sciences. National Cancer Center. Tokyo. Japan.)

Michihiro Mutoh (MD. PhD. Epidemiology and Prevention Group. Center for Public Health Sciences. National Cancer Center. Tokyo. Japan.)

Taiki Yamaji (MD. PhD. Epidemiology and Prevention Group. Center for Public Health Sciences. National Cancer Center. Tokyo. Japan.)

Manami Inoue (MD. PhD. Graduate School of Medicine. The University of Tokyo. Tokyo. Japan. the JPHC Study Group.

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QUALITY OF FOOD CARRIED OUT OF HOME BY ADULTS IN THE SANTOS CITY - SÃO PAULO (SP)

(1)Albano, Renata Doratioto; (2)De Oliveira, Carolina; (2)Dos Santos, Tayná; (3)Marqueze, Elaine Cristina.

(1)PhD Professor in Public Health Nutrition Area. Center for Applied Social Sciences and Health. Catholic University of Santos (UniSantos). Brazil; (2)Nutritionist. Center for Applied Social Sciences and Health. Catholic University of Santos (UniSantos). Brazil.; (3)PhD. Professor in School of Public Health. Catholic University of Santos (UniSantos). Brazil.

**Background and objectives:** Out-of-home meals are a trend in today's society and may be associated with unhealthy eating habits. In this study, the objective was to evaluate the consumption and quality of food carried out outside the home by adults, as well as to verify the association between sociodemographic aspects, health, nutritional status and characteristics of meals outside the home.

**Methods:** Cross-sectional study in a convenience sample with 100 adults (20-59 years old) attending a Shopping Center in Santos/SP (Ethics Committee protocol number 1.028.804 in April 2015). Sociodemographic information and health conditions (ed-
largely underpinned by adverse dietary intake. Little is known about the environmental-level factors that shape diet quality in this geographically isolated population group. Therefore, this study aimed to identify modifiable environmental level factors associated with features of dietary intake that underpin cardio-metabolic disease risk in this population group.

**Methods:** Community-level store food and beverage purchasing data collected over 49 weeks throughout 2012 were linked with social, built and physical environmental dimension data for up to 20 remote Indigenous Australian communities in the Northern Territory. Descriptive analyses were performed to investigate associations between modifiable environmental factors and diet quality.

**Results:** At the community level, percent of dwellings needing extra bedroom/s was negatively associated with protein intake (Pearson correlation; r=-0.64, p=0.02) and sugar-sweetened beverage intake (r=-0.55, p<0.05). Mean Indigenous household income was negatively associated with protein intake (r=-0.57, p=0.04). Indigenous unemployment was negatively associated with sugar-sweetened beverage intake (r=-0.62, p=0.02). Distance to a neighbouring store was negatively associated with discretionary food intake (r=-0.45, p<0.05) and sugar-sweetened beverage intake (r=-0.61, p<0.01).

**Conclusions:** In the first study of its kind, several modifiable environmental factors appear to be associated with adverse diet quality in geographically isolated communities.

**Keywords:** Indigenous health, spatial epidemiology, nutrition, cardio-metabolic disease

and physical activity were collected by validated questionnaires. Investigated indices for describing glucose homeostasis included fasting plasma glucose (FPG), fasting plasma insulin, glycated hemoglobin (HbA1c), the homeostatic model assessment-insulin resistance (HOMA2-IR) and odds of pre-diabetes (impaired glucose tolerance and (or) impaired fasting glucose). Waist circumstance (WC), height and weight were measured, and the last two were used to calculate body mass index (BMI). Data were analyzed by multivariable regression models.

**Results:** The average serum 25(OH)D was 22.66 ng/ml, and percentages of vitamin D deficiency (25(OH)D < 20 ng/ml) and insufficiency (20 ≤25(OH)D ≤30 ng/ml) were 47.61% and 32.17%, respectively. Serum 25(OH)D was inversely associated with fasting insulin (p=0.0007), HbA1c (p=0.0001) and HOMA2-IR (p=0.0007), but not with FPG, after adjusting for age, gender, personal monthly income, smoking status, energy intake, physical activity and WC. Furthermore, higher serum 25(OH)D level was a protective factor of pre-diabetes, the estimates of odds ratio (OR) comparing the highest vs. the lowest tertile of serum 25(OH)D were 0.68 (95% CI: 0.47-0.99) after adjusting for the confounders mentioned above.

**Conclusions:** Our results support that a higher serum 25(OH)D level is associated with decreased risk of pre-diabetes by mechanism likely tied to effects on insulin sensitivity in Chinese population.

**Keywords:** Vitamin D, 25(OH)D, Glucose homeostasis

**Further collaborators:** All phases of this study were supported by research grant from the National Nature Science Foundation of China (No.81472976).

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## SERUM 25(OH)D CONCENTRATIONS ARE ASSOCIATED WITH GLUCOSE HOMEOSTASIS AMONG ADULTS IN SOUTHWEST CHINA

(1)Danting, Li; (1)Xue, Hongmei; (1)Liang, Yi; (2)Chen, Mengxue; (1)Quan, Liming; (3)Zhao, Li; (4)Gong, Yunhui; (5)Cheng, Guo.

(1)MD. West China School of Public Health. Sichuan University. Chengdu. China.; (2)BSc. West China School of Public Health. Sichuan University. Chengdu. China.; (3)MD. West China Research Center for Rural Health Development, Sichuan University Huaxi Medical Center. Sichuan University. Chengdu. China; (4)MD, PhD. Department of Obstetrics and Gynecology, West China Second University Hospital. Sichuan University. Chengdu. China.; (5)PhD. West China School of Public Health. Sichuan University. Chengdu. China.

**Background and objectives:** Recent epidemiological studies have suggested inverse associations between vitamin D status and metabolic diseases including type 2 diabetes. However, the role of vitamin D in glucose metabolism remains inconclusive. We aimed to examine whether a higher serum 25-hydroxy vitamin D (25(OH)D) was associated with a more favorable glucose homeostasis among adults in Southwest China.

**Methods:** Serum 25(OH)D was detected in a cross-sectional sample of 920 non-diabetic adults (62.61% women) aged 25-65 years recruited from Southwest China. Data on dietary intake

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## OBESITY PARADOX IN THE OLDEST OLD: EVIDENCE FROM A CHINESE COMMUNITY-BASED PERSPECTIVE COHORT STUDY

(1)Lyu, Yuebin; (2)Gao, Xiang; (3)Yin, Zhao-Xue; (4)Chen, Huashuai;

(3)Luo, Jie-Si; (5)Brasher, Melanie; (6)Kraus, Virginia; (7)Zeng, Yi; (8)Zhang, Juan; (9)Shi, Xiao-Ming.

(1)M.D.. National Institute of Environmental Health. Chinese Center for Disease Control and Prevention. China; (2)M.D., Ph.D.. Nutritional Epidemiology Lab. Pennsylvania State University. USA; (3)M.D. Division of Non-Communicable Disease Control and Community Health. Chinese Center for Disease Control and Prevention. China; (4)M.D., Ph.D. Center for the study of Aging and Human Development and the Geriatric Division of School of Medicine. Duke University. USA; (5)Ph.D.. Department of Sociology and Anthropology. University of Rhode Island. USA; (6)M.D., Ph.D. Duke Molecular Physiology Institute and Division of Rheumatology. Duke University School of Medicine. USA; (7)Center for Study of Healthy Aging and Development Studies. Peking University. China; (8)School of Public Health. Peking Union Medical College. China; (9)M.D., Ph.D.. National Institute of Environmental Health. Chinese Center for Disease Control and Prevention. China.

**Background and objectives:** Current international and national guidelines for body mass index (BMI) and waist circum-
ference (WC) were recommended to all adults aged 18 or older. However, the optimal BMI and WC in the oldest old (aged 80 or older) were poorly known. The present study was to investigate the relationship of BMI and WC with all-cause mortality in a large prospective community-based cohort study in the oldest old.

**Methods:** A total of 4361 Chinese oldest old (mean age 91.8) participated in this study. BMI and WC were measured at baseline and all-cause mortality was calculated over a 3-year period from 2011 to 2014. The BMI and WC were used as continuous variables and as categorized variables by recommendations or by tertiles. In both genders, additive Cox proportional hazards models and Cox proportional hazards models were used to explore and assess the association with adjustment for covariates.

**Results:** During 3 years of follow-up, 1795 participants died, and the overall all-cause mortality was 41.2%. Compared to underweight participants (BMI<18.5 kg/m2), the hazard ratios (HRs) for all-cause mortality were lower in normal weight participants (BMI:18.5-24.0 kg/m2) and overweight or obese participants (BMI≥24.0 kg/m2), were 0.71(0.60-0.83) and 0.60(0.47-0.76) for men, and 0.80(0.70-0.91) and 0.79(0.64-0.96) for women. Similarly, the HRs were lower in participants with abdominal obesity, were 0.76(0.65-0.89) for men and 0.78(0.69-0.88) for women. Compared to the upper BMI tertile, the middle and lower tertile of BMI and WC increased the risk of mortality. For men, the HRs were 1.23(1.02-1.48) and 1.53(1.28-1.82) for middle and lower BMI, 1.21(1.01-1.46) and 1.41(1.18-1.69) for middle and lower WC. For women, the HRs were 1.21(1.03-1.41) and 1.35(1.15-1.58) for middle and lower BMI, 1.35(1.15-1.58) and 1.55(1.32-1.81) for middle and lower WC. These findings were robust or more significant in further sensitive analyses.

**Conclusions:** In Chinese oldest old, both higher BMI and higher WC predict better survival in both genders. This study lends further support for the opinion that current international and national recommendations for the oldest old should be revised, and reminds the importance in providing Asian-specific and gender-specific guidelines for optimal BMI and WC in this age group.

**Keywords:** body mass index; waist circumference; mortality; obesity paradox; oldest old.

# THE SOUTH AFRICAN SALT STORY: WHERE ARE WE AND WHERE ARE WE HEADING?

(1)Swanepoel, Bianca; (2)Schutte, Aletta; (3)Steyn, Krisela; (4)Wentzel-Viljoen, Edelweiss.

(1)PhD. Nutrition Lecturer. Department of Life and Consumer Sciences. University of South Africa. Centre of Excellence for Nutrition. North West University.; (2)PhD. Physiologist. Hypertension in Africa Research Team (HART). North-West University. South Africa. MRC Unit for Hypertension and Cardiovascular Disease. North-West University. South Africa; (3)MSc. MD. Chronic Disease Initiative for Africa (CDIA). Department of Medicine. Faculty of Health Sciences. University of Cape Town. South Africa; (4)PhD. Dietician. Nutritionist. Centre of Excellence for Nutrition (CEN).North-West University. South Africa. MRC Unit for Hypertension and Cardiovascular Disease. North-West University. South Africa.

**Background and objectives:** The mortality and morbidity burden caused by hypertension are preventable and therefore, efforts need to be taken to address this burden. Excess dietary sodium intake is associated with increased blood pressure and the reduction thereof is considered as one of the best investments for public health. As a first step the South African (SA) government has implemented a mandatory regulation (R.214) pertaining to the reduction of sodium in foodstuffs as part of a wider sodium reduction strategy. Monitoring of different aspects of such a strategy is crucial to establish effectiveness and was the main aim. Objectives included (i) establishing baseline sodium and potassium excretion; (ii) investigating appropriate monitoring methods in terms of sodium intake and (iii) to evaluate sodium content in foodstuffs set out in R.214.

**Methods:** We collected 24-hour urine samples and spot urine samples from three population groups i.e. White, Black and Indians in SA. Sodium and potassium were analysed. Three formulas were used to estimate sodium excretion i.e. Kawasaki, Tanaka and INTERSALT. To evaluate the sodium content of foodstuffs we randomly selected ten food products from each of the categories and measured the sodium through atomic absorption spectrometer.

**Results:** In total, 692 and 681 24-hour and spot urine collections were collected. Median sodium and potassium excretion was 122.9 and 33.5mmol/day, and median salt intake was 7.2g/d. The majority (92.8%) of the population did not meet the recommended potassium intake per day and 65.6% consumed more than 6g/d of salt. The Kawasaki and Tanaka formula showed significantly higher (p≤0.001) estimated sodium values than the measured 24 hour excretion in the whole population (5677.79mg/d and 4235.05mg/d vs. 3279.19mg/d). The majority of the food products tested complied with the 2016 targets (72%) and 42% with the 2019 targets.

**Conclusions:** These findings support the SA government's sodium reduction legislation. Estimated sodium excretion from the three formulas should be used with caution. The sodium content in foodstuffs provides valuable information with regard to monitoring and evaluation. SA is doing well in terms of the strategy but a lot still needs to be done.

**Keywords:** Sodium, Potassium, Hypertension, Regulation, South Africa
# WHAT FOODS WERE INSUFFICIENT AFTER THE GREAT EAST JAPAN EARTHQUAKE?

(1)Tsuboyama-kasaoka, Nobuyo; (2)Ishikawa-Takata, Kazuko;

(3)Shimoura, Yoshiyuki.

(1)National Institute of Health and Nutrition. National Institutes of Biomedical Innovation, Health and Nutrition. Japan;

(2)National Institute of Health and Nutrition. National Institutes of Biomedical Innovation, Health and Nutrition. Japan;

(3)Committee of Japan Dietetic Association-Disaster Assistance Team (JDA-DAT). The Japan Dietetic Association. Japan.

**Background and objectives:** To aid in preparation for future disaster and disaster response programs, we looked at what was needed in successive phases after the Great East Japan Earthquake Disaster by exploring what shortages there were in food supplies.

**Methods:** Which included a question requesting detail on the "shortages of food and supplies needed in the affected areas," was mailed to 1,991 members of dietetic associations in Iwate, Miyagi, and Fukushima Prefectures. Of the 435 responses received (response rate: 21.8%), the 303 that contained responses to that question were used for the analysis. Supply shortages were tallied for four successive phases after the earthquake (within 3 days, 4 days to 1 month, 1 month to 2 months and 3 months to 6 months after the Great East Japan Earthquake).

**Results:** During the first month after the disaster struck, the shortages of supplies in the disaster areas were the greatest, with shortages of ordinary foods and foods for special dietary uses being especially severe. Regarding ordinary foods, there were many instances of shortages of water, food sources of protein, and sources of vitamins and minerals. Regarding foods for special dietary uses, there were conspicuous shortages of foods for vulnerable disaster victims.

**Conclusions:** We suggest that in order to fill the gaps between the foods needed in a particular phase and the supplies provided, in addition to a national-level disaster response plan to supply food that meets the needs of disaster victims, a system is needed to ensure the delivery of foods needed by vulnerable populations.

**Keywords:** food shortage, disaster nutrition, Great East Japan Earthquake, vulnerable

**Conflict of Interest Disclosure:** This study was supported by the Japan Dietetic Association and founded by the Japanese Society of Nutrition and Dietetic.

# IS THERE A PREFERENCE FOR HEAVIER BODY SIZES FOR WOMEN LIVING IN AFRICA? EVIDENCE FROM A SYSTEMATIC REVIEW OF EVIDENCE SPANNING OVER 30 YEARS

(1)Pradeilles, Rebecca; (2)Olaitan, Oluwabukola; (3)Cohen, Emmanuel;

(4)Araba Osei-Kwasi, Hibbah; (5)Holdsworth, Michelle.

(1)BSc, MSc, PhD. Research Fellow in Global Health Nutrition. Department of Population Health. London School of Hygiene and Tropical Medicine. London. UK & Public Health Section. School of Health and Related Research. University of Sheffield. Sheffield. UK; (2)MBChb, MPH. Medical doctor. Public Health Section. School of Health and Related Research. University of Sheffield. Sheffield. UK; (3)BSc, MSc, PhD. Postdoctoral research fellow. Developmental Pathways for Health Research Unit. University of the Witwatersrand. Johannesburg. South Africa & UMI-CNRS 3189. Environment, Health, Societies. Faculty of Medicine. Marseille. France; (4)BSc, MSc, PhD student. Public Health Section. School of Health and Related Research. University of Sheffield. Sheffield. UK.; (5)BSc, MSc, PhD. Professor of Public Health. Public Health Section. School of Health and Related Research. University of Sheffield. Sheffield. UK.

**Background and objectives:** Overweight and obesity are increasing in Africa, particularly amongst women. The widespread belief that there is a cultural preference for heavier body sizes for African women may be a contributing factor to this growing problem. Hence, we assessed body size preferences for African women and the factors influencing these.

**Methods:** A mixed-methods systematic review spanning over the past 30 years was conducted. Comprehensive searches were undertaken on Medline, CINHAL, ASSIA, Web of Science and PsycINFO. Reference list searching and contact with experts in the field were also used to identify relevant studies. Studies conducted in Africa composed of Black or Arab females and/or males aged ten and above were included, providing they assessed participants preferred body size for females and/or factors influencing preferences. A sequential-explanatory approach was used to integrate quantitative and qualitative data.

**Results:** Fifty-one studies from 15 countries were included in the final synthesis: 37 quantitative, four qualitative and four mixed-methods. Most studies reported a preference for body sizes within the normal or overweight body mass index category. Appearance, health, wellbeing, fear of negative treatment within the community, social standing, acculturative stress and fatalistic attitudes towards body size were found to influence African women's body size ideals.

**Conclusions:** Obesity remains an important public health issue with a high prevalence amongst African women. It is generally assumed that larger body sizes are preferred for African women, however the evidence synthesised in this review found that overall a body size that is normal or overweight (to a lesser extent) in medical terms is preferred for African women. Numerous factors were found to influence body size preferences for African women. For example, women were aware of obesity's associated health risks,
and were willing to lose weight to improve their health. These perceived health risks were overshadowed by the community's negative perceptions towards weight loss and thinness, which are associated with HIV in some contexts and subsequently negative treatment by the community. A preference for normal or overweight body sizes among African women means that cultural norms are not an obstacle for preventing obesity in African women.

**Keywords:** body size, women, Africa, review, mixed-methods

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PROMOTING SUSTAINABLE FOOD SYSTEMS FOR GOOD NUTRITION AND HEALTH IN THE MEDITERRANEAN REGION: A CONCEPTUAL FRAMEWORK FROM THE MEDINA STUDY GROUP

(1)Verger, Eric; (2)Perignon, Marlène; (2)Amiot-Carlin, Marie Josephpe.

(1)PhD. Nutritional Epidemiologist. Unité Mixte de Recherche 204 Nutrition et Alimentation des Populations aux Suds (UMR NUTRIPASS). Institut de Recherche pour le Développement (IRD). France.; (2)PhD. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.

**Background and objectives:** Countries of the Mediterranean region are undergoing different stages of nutritional transition affecting the health of inhabitants, while facing massive alteration of the environment (climate change, water scarcity, soil erosion, biodiversity loss and urbanization). The increasing demand of water in agriculture, the capacities to maintain local food production and the growing dependence on food imports are interconnected challenges to ensure food security and good nutrition in the Mediterranean region. The objective is to present the conceptual framework and methodologies developed by the MEDINA-Study Group for rethinking food systems to sustain consumption and production.

**Methods:** Based on its multidisciplinary expertise in nutrition, food science, agronomy and economy, the MEDINA-Study Group identified the relevant parameters for including in a conceptual framework that was developed for research activities in South of France and Tunisia, two contrasted areas in regards to the Diet-Agriculture-Environment Nexus.

**Results:** The conceptual framework consists of an array of elements of the food systems (from consumption to production) and scales (individual, household and national levels). We prioritized the following parameters: adherence to the Mediterranean diet pyramid and nutrient recommendations, nutritional value of foods and local recipes, nutritional potential of local agroecosystems, women's empowerment in agriculture, multiple environmental indicators of the food systems, and food trade and dependence on food imports. The proposed methodologies consist in: (1) modeling at different scales the dietary changes to optimize food consumption-production without increasing environmental impact, (2) translating the identified changes into action proposals,

(3) testing the acceptability and feasibility by multi-stakeholders, and (4) co-building guidelines to orientate sustainable food choices and production.

**Conclusions:** To ensure sustainable food systems in the Mediterranean region, the MEDINA-Study Group identified other perspectives to implement the initially-build framework, such as the nutrient bioavailability, the exposure to contaminants and active substances used in agriculture, and social indicators to contribute designing ambitious agricultural, food and health policies and prioritizing actions. Acknowledgement: Medina-Study is funded by the French Research Agency (ANR-12-TMED-0004).

**Keywords:** Food systems; Sustainability; Mediterranean region; Conceptual framework.

**Further collaborators:**

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

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ANAEMIA AND NUTRITIONAL STATUS IN POPULATION OF SALTA CITY. CROSS-SECTIONAL STUDY.ARGENTINA 2017

(1)Patricia Carolina, Rivas; (2)Susana Judith, Gotthelf.

(1)MSc Biochemistry. Epidemiological Research Department. National Center for Nutricional Research. ANLIS. Argentina;

(2)MSc Doctor. Epidemiological Research Department. National Center for Nutricional Research. ANLIS. Argentina.

**Background and objectives:** Iron deficiency anemia is a nutritional disease of high prevalence especially in developing countries. In the city of Salta, malnutrition coexists with an increase in overweight and obesity. The objective of this study was to determine the prevalence of anaemia and its relationship with nutritional status in children, adolescents and adults in the city of Salta.

**Methods:** Cross-sectional study, secondary database (Salta Nutritional Survey 2014). Stratified two-stage sample. Variables: sex, age, anaemia (Hemoglobin level measurements were adjusted for altitudes and the cut-off points for anaemia based on WHO 2011); Nutritional status BMI (WHO z score tables in children and adolescents): normal >-2 <+1, malnutrition ≤-2, overweight ≥+1, obesity ≥+2. Adults: malnutrition <18.5; normal ≥18.5 <25; overweight ≥25 and <30; obesity ≥30. Short stature (≤-2 z score height WHO). Analysis: Frequency distribution (chi2, Fisher), mean comparison (ANOVA), level of significance p <0.05. EXCEL, SPSS V18, WHO softwares Anthro V.1.0.4 Plus, programs were used.
**Results:** A total of 147 children aged 6-59 months, 170 aged 5-11 years, 70 children aged 12-14 years and 533 ≥ 15 years old, of both sexes were evaluated. The overall prevalence of anaemia was 7%, the groups most affected were children 6-59 months (12.9%) and ≥ 15 years (8.3%, significant difference by sex). Mild anaemia was found in 78.1%, moderate in 20.3% and severe in 1.6% of the anaemic population. The 47.5% of children aged 6-59 months with anaemia and 56.8% of ≥ 15 years with anaemia were overweight/obese. There was no association between nutritional status and short stature with the prevalence of anaemia. Mean values of hemoglobin were: 12,18mg/dl ±1.09 (6-59m); 13,39mg/dl ±0.74 (5-5-11 ys); 13.93±0.85(12-14 ys) and 13.91mg/dl±1,44 (≥15 ys) Mean values of weight and height were significantly lower in anemic children aged 6-59 months.

**Conclusions:** Although low prevalence of anemia was observed in all age groups, it remains a relevant public health problem, which also affects those with overweight and obesity.

**Keywords:** anaemia, nutritional status, children, adolescents, adults.

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TWO-YEAR SUSTAINED IMPACTS OF LARGE-SCALE SOCIAL AND BEHAVIOR CHANGE COMMUNICATION INTERVENTIONS TO IMPROVE INFANT AND YOUNG CHILD FEEDING IN BANGLADESH

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

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

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

**Background and objectives:** Achieving sustained improvements in infant and young child feeding (IYCF) likely requires continued implementation of effective interventions and sus-

tained enabling social norms. From 2010-2104, Alive & Thrive (A&T) provided intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) at large-scale in Bangladesh, with demonstrated impact on IYCF practices. Since 2014, geographically expanded implementation was continued by national partners, with support from other donors. In 2016, we assessed sustained impacts of the IPC + MM + CM interventions in intensive compared with non-intensive areas (standard nutrition counseling + less-intensive MM + CM) on intervention exposure and IYCF knowledge and practices.

**Methods:** We used a cluster-randomized design with repeated cross-sectional surveys at baseline (2010, n=2,188), endline (2014, n=2,001), and follow-up (2016, n=2,400) in the same communities, among households with children 0-23.9 months of age. Within-group differences over time were tested using regression models, and differences between groups in changes between baseline and follow-up were tested using difference-in-difference estimates (DDE), adjusting for geographic clustering, child age, and gender.

**Results:** In intensive areas, exposure to IPC decreased between endline and follow-up but remained high (77.2% for home visits by community health workers); exposure to CM activities decreased significantly (29.3% to 3.6% for video shows). Exposure to MM at follow-up was moderate (22.9-54.4% across 7 TV spots). There was no expanded exposure to interventions in non-intensive areas. Most IYCF indicators in intensive areas declined from endline to follow-up, but remained higher than at baseline. Larger improvements in intensive areas between baseline and follow-up remained for early initiation of breastfeeding (BF), exclusive BF, timely introduction of foods, and consumption of iron-rich food (DDE: 16.6, 17.0, 16.6, and 11.8 percentage points, respectively). Differential impact in BF knowledge remained between baseline and follow-up (DDE: 0.4 points); complementary feeding knowledge increased similarly in both groups.

**Conclusions:** Continued IPC exposure and sustained impacts on IYCF practices in intensive areas in 2016 indicate lasting benefits from A&T's interventions through existing delivery systems. Remaining gaps indicate that sustained delivery of behavior change interventions will be needed to support appropriate IYCF practices.

**Keywords:** Bangladesh, breastfeeding, complementary feeding, infant and young child feeding, sustainability

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

**Further collaborators:**

Silvia Alayon, MS. Nutrition and Monitoring Advisor. Alive & Thrive. FHI 360. Washington, D.C., USA.
ASSOCIATION BETWEEN LEVELS OF IRON IN GROUNDWATER AND IRON STORES IN WOMEN IN KAMPONG CHHNANG PROVINCE, CAMBODIA

(1)Rappaport, Aviva; (2)Chai, Tze Lin; (3)Green, Tim; (4)Karakochuk, Crystal.

(1)MSc. Nutritionist. University of British Columbia; (2)BSc. Nutritionist. Helen Keller International. Cambodia; (3)PhD. Nutritionist. South Australian Health and Medical Research Institute. Australia.; (4)PhD. Nutritionist. University of British Columbia. Canada.

**Background and objectives:** Groundwater has been shown to be high in iron in some areas in Cambodia. However, little is known about the bioavailability of the iron and the potential contribution to iron stores. Further, household biosand and ceramic filters have been shown to remove 95-99% of the iron in groundwater. Our objective was to determine if levels of groundwater iron from household wells were associated with serum ferritin concentrations among women in rural Cambodia.

**Methods:** Water samples were collected from 80 households in Kampong Chhnang Province, Cambodia. Information on the type of household well and use of a water filtration system was collected, as iron concentrations may differ by well type and whether or not the water was filtered before consumption. Fasting venous blood samples were collected for analysis of serum ferritin, serum transferrin receptor (sTfR), C-reactive protein (CRP), and α-1 acid glycoprotein (AGP) using a sandwich ELISA. Serum ferritin was adjusted for CRP>5mg/L and AGP>1g/L. Median serum ferritin concentrations are presented for women who used ground well water with and without a filtration system, and for women who used ring well water with and without a filtration system.

**Results:** Overall, 50% of households had a ground well and 50% had a ring well. Mean ± SD groundwater iron was higher (1265 ± 2632 µg/L) than ring well water iron (423 ± 375 µg/L). More than half of the water samples (n=48) were above the 2011 WHO drinking water standards for iron (300 µg/L). More women with a ground well (n=17) used a water filter as compared to those who had a ring well (n=4). Median (IQR) serum ferritin concentrations were highest among women who used ground well and ring well water without filtration 53 (20,95) µg/L and 57 (23,91) µg/L, respectively. Those who used a filtration system had lower median (IQR) serum ferritin concentrations for both the ground well and ring well source 29 (17,57) µg/L and 23 (8,58) µg/L, respectively.

**Conclusions:** Women who used a filter had lower median ferritin concentration. Despite this, little is known about the bioavailability of iron.

**Keywords:** iron deficiency, serum ferritin, groundwater, ring well water, anemia

TEENEGERS’ PERCEIVED QUALITY OF LIFE AND LIFESTYLE: A CROSS-SECTIONAL STUDY IN POLISH STUDENTS FROM LESS-URBANIZED REGIONS. THE POLYSES PROJECT

(1)Dlugosz, Anna; (2)Wadolowska, Lidia.

(1)PhD. Institute of Health. University of Economy. Bydgoszcz. Poland; (2)Full Professor. Faculty of Food Science. University of Warmia and Mazury in Olsztyn. Poland.

**Background and objectives:** Teenagers’ health is positively linked to many factors of lifestyle [1]. Less-urbanized regions create specific conditions for living, including lifestyle. The association between quality of life and lifestyle of Polish teenagers living in less-urbanized regions is not well understood.

**Objective:** To assess association between teenagers’ perceived quality of life and lifestyle.

**Methods:** The study involved 576 students 13-18 years old who lived in small towns and villages in less-urbanized regions of Poland. Students were chosen in a two-step random selection. Closed questions were applied to characterize lifestyle. High-active lifestyle (everyday performance with high activity outside school) and sedentary lifestyle (TV watching or computer games at least 4 hours/day) were determined. Quality of life perception was assessed by the SF-36 questionnaire (The Short Form Health Survey) with 36 items [2]. Using the alfa-Cronbacha 20 items were selected to describe teenagers’ quality of life. The Cluster Analysis (k-means method) was used to identify quality of life clusters. The association between clusters and lifestyle was verified by logistic regression, with adjustment for gender, age and socioeconomic status.

**Results:** Two clusters differentiating with respect to quality of life in mental context, but not in physical context, were found. They were labelled: better mental quality of life (MQoL; 41% of the sample), worse MQoL (59%). Teenagers with better MQoL compared to worse MQoL were significantly less often nervous, depressed, sad, exhausted and tired. Teenagers with better MQoL compared to worse MQoL (odds ratio OR=1.00) were less likely to have high-active lifestyle (crude OR=0.83; 95% confidence interval 95%CI:0.72,0.96; adjusted OR=0.84; 95%CI:0.72,0.97). No significant association was found between sedentary lifestyle and quality of life clusters.

**Conclusions:** Conclusion: Worse mental quality of life was widespread among Polish teenagers from less-urbanized region. We revealed negative association between high-active lifestyle and mental quality of life. Next study are necessary to explain our findings and not compliance with previous ones.

**References:** [1] Carson V et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab, 2016,41:S240-S265. [2] Tylka J, Piotrowicz R. Quality of life SF-36 questionnaire – the Polish version. Kardiol Pol, 2009,67:1166-1169.

**Keywords:** activity, adolescent, lifestyle, quality of life, sedentary lifestyle

**Conflict of Interest Disclosure:** None. Research relating to this abstract was funded by Polish Ministry of Science and Higher Education – NCN project no. N N312 215336.
(1)Tumas, Natalia; (2)Scuzzi, Graciela; (3)Rodríguez Junyent, Constanza; (4)Crivelli, Verónica; (4)Galli, María Sofía; (4)Siufi Dagum, Yazmín; (5)Pou, Sonia Alejandra.

(1)PhD. Nutritionist. Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS). Universidad Nacional de Córdoba. CONICET. Carrera de Nutrición. Facultad de Medicina. Universidad Católica de Córdoba. Argentina.; (2)MSc. Nutritionist. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba y Universidad Católica de Córdoba. Argentina.; (3)PhD Student. Nutritionist. Carrera de Nutrición. Facultad de Medicina Universidad Católica de Córdoba. Argentina.; (4)BSc Student. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.; (5)PhD. Nutritionist. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba. CONICET. Facultad de Ciencias Médicas. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.

**Background and objectives:** Argentine society is in transition with significant sociodemographic and economic gaps. Such heterogeneous living conditions could generate inequality in the population's access to health services, education and food, all of which affects its health and nutrition. The aim of this work was to identify social inequalities according to unmet basic needs (UBN) in the distribution of nutritional transition (NT) indicators in Argentina, in the period of 2005-2013

**Methods:** Multi-group, ecological study (24 geographical units: 23 provinces and the Autonomous City of Buenos Aires). NT indicators were selected (in three analysis dimensions: nutritional state, physical activity, and food intake) obtained from secondary sources of information (official surveys and census data). The mean of each NT indicator was calculated according to the distribution of provinces by quartile of the indicator "proportion of households with UBN" (2010). A mean differences test was conducted between the provinces belonging to the upper and lower quartiles. In addition, the concentration index was calculated for each NT indicator according to the proportion of households with UBN using the EPIDAT version 3.1 software package.

**Results:** The prevalence of low height in children (p=0.003) and anemia (p=0.054) were greater in the provinces belonging to the upper quartile of UBN (over 15.27% of households with UBN), while the prevalence of childhood obesity, the frequent consumption of salt, and the use of computers was greater (p<0.05) in the provinces of the first quartile (that is, those in a better relative situation according to UBN, with fewer than 7.95% poor households). Meanwhile, the concentration index evidenced that the indicators showing greater social inequality were the consumption of salt, the prevalence of anemia, and the use of computers.

**Conclusions:** There are social inequalities in the distribution of NT indicators in Argentina. The results of this work could contribute to define equitable nutritional policies.

**Keywords:** nutritional transition, social inequality, social epidemiology, Argentina.

(1)Asghari, Golaleh; (2)Yuzbashian, Emad; (3)Mirmiran, Parvin; (4)Azizi, Fereidoun.

(1)PhD. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran; (2)MSc. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran; (3)PhD. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran; (4)MD. Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran.

**Background and objectives:** We aimed to investigate the association of dietary total antioxidant capacity (TAC) with incidence of CKD in subjects with dysglycemia.

**Methods:** We followed-up 1179 subjects with dysglycemia from the Tehran Lipid and Glucose Study (TLGS) for 3 years, who were initially free of CKD. Dietary intakes of TAC, vitamin C, vitamin E, and β-carotene were assessed by a food-frequency questionnaire at the baseline. Dietary TAC was estimated using the oxygen radical absorbance capacity method. Estimated glomerular filtration rate (eGFR) was calculated, using the Modification of Diet in Renal Disease Study equation and CKD was defined as eGFR <60mL/min/1.73m2. Odds ratios (ORs) using multivariable logistic regression were reported for the association of incident CKD with dietary TAC.

**Results:** A total of 197 (16.7%) cases of incident CKD were recorded after 3 years of follow-up. After adjustment for age, sex, smoking, physical activity, body mass index, hypertension, and total energy intake, the top tertile of dietary TAC, compared to the bottom was associated with 39% (95% confidence interval (CI) = 0.61 0.40-0.93) lower risk of incident CKD (P for trend=0.025). Furthermore, the highest tertile of vitamin C intake, compared to the lowest, the risk of incident CKD was decreased (OR: 0.60; 95% CI: 0.38-0.93, P trend: 0.023). Intakes of vitamin E and β-carotene were not significantly associated with incident CKD risk.

**Conclusions:** Our findings suggest diets high in TAC are associated with a lower risk of incident CKD among subjects with hyperglycemia after 3 years of follow-up.

**Keywords:** Total antioxidant capacity; incident CKD, vitamin C, free radical, oxidative stress

**Further collaborators:**

The authors would like to thank Ms. Behnaz Mahmoodi.
# EVIDENCE BASED RECOMMENDATIONS TO IMPROVE THE LAW IN MEXICO TO RESTRICT UNHEALTHY FOOD ADVERTISING TO CHILDREN ON TELEVISION

(1)Bahena, Liliana; (2)Rincon-Gallardo, Sofía; (2)Tolentino Mayo, María Lizbeth; (3)Vandevijvere, Stefanie; (3)Barquera, Simon.

(1)Md. Nutritionist. National Institute Of Public Health; (2)Msc.; (3)Phd.

**Background and objectives:** In Mexico, government regulations to restrict food and beverages(F&B) advertising to children on screens during selected hours were implemented in mid-2014. The aim of the study is to compare the Mexican F&B regulation guidelines on TV with international and evidence based criteria.

**Methods:** Total of 1,140 hours were recorded over three years (2013,2014&2015) from four-free-to-air television channels with the highest national audience ratings over six randomly selected days from 6:25am-10:15pm. Each advertisement was analyzed following the International Network for Food and Obesity/non-communicable diseases Research Monitoring and Action Support (INFORMAS) type of program category, Nielsen definition of children peak times,and three nutrient profile models criteria (WHO Europe 2015;OPS 2016,Mexican regulation(MR).

**Results:** From the 6,785 F&B identified ads, 76.7% were aimed at children, and at least 50.2% of the F&B display ads contain a persuasive technique. After the MR came on channels 5 and 7(children's channels) decrease of 7% and 2.8% of F&B ads (p <0.001) were found.The soap opera shows an increase between 2014-2015 of 3% in F&B advertising and series and a 1.7% was shown(p <0.001). Contrary, children's programs showed a decrease 6.2%(p <0.001).

During the peak viewing time(PV) on 2013, 23.5 F&B per hour were advertised compared to 22.2 F&B ads in 2015.Chocolate and confectionery ads rates decreased from 2.1 to 1 ads per hour, while an increase of breakfast cereals from 1.4 to 2.1 ads/hr were observed.The nutritional quality of products aimed at children in PV.Specifically, during 2015 the MR allowed advertising during of 55.2% of total products, however WHO of 23.2%, and PAHO only allowed 5.6% of the products advertised in the Mexican TV.

Week-days at regulated times, F&B highest advertising(3.5 F&B ads unhealthy/hr) comes in unregulated hours.

**Conclusions:** Most of the F&B ads are targeted to children and includes a persuasive technique of attraction, which needs to be considering into the MR. Increase/migration to other types of programs that children do watch. MR need to consider more extensive time schedules and all program types, particularly those aimed at general audiences.Encourage Mexican government to take into account evidence based criteria to improve the current regulation to protect children.

**Keywords:** television-advertising, policy, children, food and beverages

# THE ADVERTISING OF FOOD AND BEVERAGES ON MEXICAN TELEVISION: THE TECHNIQUES OF ATTRACTION SHAPPING CONSUMPTION HABITS IN SCHOOL CHILDREN

(1)Bahena, Liliana; (2)Tolentino Mayo, María Lizbeth; (3)Barquera, Simon; (3)Rivera, Juan.

(1)Md. Education. National Institute of Public Health; (2)Msc; (3)Phd.

**Background and objectives:** The National Health and Nutrition Surveys in Mexico show that between 1999 and 2012, the combined prevalence of overweight and obesity in children between 5-11 years of age, increased from 26.9% to 34.4%. México implemented guidelines governing advertising of F&B to children on screens were implemented in mid-2014.

**Methods:** A total of 780 hours of television programming were recorded from the four major television channels in Mexico from 6:25am-10:15pm, the December 2014 To April 2015. Each advertisement was analyzed following the International Network for Food and Obesity/non-communicable diseases Research Monitoring and Action Support (INFORMAS) type of program category, F&B advertisements were identified into three major groups: Core and Healthy Food Categories, Non-Core and Unhealthy Food Categories (NUFC) and Miscellaneous. For the analysis, programming was divided as peak viewing periods (PV) and non-peak viewing periods for children (NPV). The presence of visual, promotional, associative and audio techniques was analyzed. During the same time period, a survey among 10-12 year old children was conducted to understand the relationship between television viewing habits and brand recognition of advertised F&B products.

**Results:** Of the recorded hours, 390 belong to PV, and the rest to NPV. From the total number of advertisements, 3766 were F&B advertisements, comprising 12.4%. An average of 23.5 ads per hour, were of F&B. The most dominant group of F&B advertisements observed during PV was NUFC (67.3%). Most of NUFC advertisements were observed during soap operas (41.7%), followed by comedies (14.5%), movies (14.1%), and cartoons (10%). A total of 64% of F&B advertisements screened during PV utilized persuasion techniques. Survey results demonstrated that the majority of children could identify characteristics of products advertised; 97% could identify products with its television character and 73.8% could identify a product with its slogan.

**Conclusions:** The children are still largely exposed to NUFC advertisements during PV, even with the new Guidelines. It should also be noted that children are still exposed during unregulated programming. An overwhelming majority of F&B advertisements used persuasive techniques during PV.

**Keywords:** television-advertising, children, eating habits
## FOOD PROCESSING CATEGORIES RELATING TO DIET QUALITY IN THE NURSES HEALTH STUDY

(1)Rossato, Sinara L; (2)Yuan, Changzheng; (3)Sampson, Laura; (4)Fung, Teresa T; (5)Willett, Walter C.

(1)Harvard T.H.Chan School of Public Health; (2)PhD. Research fellow. Department of Nutrition. Harvard T.H. Chan School of Public Health. Boston. United States; (3)RD. Nutritionist. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital. Harvard Medical School. Boston. United States; (4)PhD. Professor. Department of Nutrition. Harvard T.H. Chan School of Public Health. Boston. United States; (5)MD. PhDr. Professor. Department of Nutrition. Harvard T.H. Chan School of Public Health. Boston. United States.

**Background and objectives:** High intake of ultra-processed foods has been related to an unhealthy nutrient profile; however, the relationship between food-processing categories (FPC) with diet-quality has yet to be assessed. To assess the relationship between intake of foods classified into four FPC and diet-quality.

**Methods:** This was a cross-sectional analysis of 52,976 women from the Nurses' Health Study. Diet was assessed with FFQ in 2006, and food intake was classified into four FPC: unprocessed, moderately, processed, and ultra-processed FPC calculated in grams and percentage of energy. We computed the following diet-quality scores for each woman: Dietary Approach to Stop Hypertension (DASH-score) and the Alternative Health Eating Index-2010 (AHEI-2010). The associations between FPCs with diet-quality was evaluated using Spearman correlation coefficients and generalized linear models adjusted for energy, age, smoking, BMI, and physical activity.

**Results:** In the adjusted analysis adjusted, DASH-score was 21 and the AHEI-2010 was 45 for women in the first quintile of un-processed FPC. In comparison to the first quintile, DASH-score and AHEI-2010 were 4.7 and 7.5 higher in women in the fifth of unprocessed FPC in grams. DASH-score and AHEI-2010 were lower in women in the fifth quintile of % of energy from ultra-processed FPC (22 and 47) than in the first (25 and 50). We found modest correlations between the unprocessed FPC and the DASH-score and the AHEI-2010 for both, grams (r=0.39 and r=0.21) and percentage of energy (r=0.43 and r=0.30). Negative correlations were seen between ultra-processed FPC and the DASH and AHEI-2010 as percentage of energy (r=-0.38 and r=-0.26) and as grams (r=-0.15 and r=-0.13). Intake of unprocessed FPC in percentage of energy was negatively correlated with ultra-processed FPC (r=-0.78).

**Conclusions:** Eating unprocessed foods had a positive impact on diet quality scores, which was more significant than the negative impact of consuming ultra-processed foods.

**Keywords:** food processing categories, ultra-processed foods, food processing, diet quality.

## RELATIONSHIP AMONG BONE MINERAL DENSITY, ADIPOSITY, AND PHYSICAL ACTIVITY IN MEXICAN WOMEN

(1)Ramos Ibañez, Norma; (2)Ilse Ivonne, Larraguivel-Ruiz; (3)Karina, Caballero-Cabrera; (4)Luis, Ortiz-Hernandez.

(1)PhD. Nutritionist. Department of Health Care. Autonoma Metropolitana University. Mexico; (2)Nutritionist. Department of Health care. Autonoma Metropolitana University. Mexico.;
(3)Nutritionist. Department of Health care. Autonoma Metropolitana University. Mexico; (4)PhD. Nutritionist. Department of Health care. Autonoma Metropolitana University. Mexico.

**Background and objectives:** It has considered that in females low intake of calcium and physical inactivity could influence on reduction of the bone mineral density (BMD) and developing osteoporosis later. The aim of this study was to determine the relationship between BMD and nutritional status, body fat, nutrient intake, physical activity, alcohol consumption, and smoking in women from an urban area of Mexico.

**Methods:** The volunteers were 201 women aged 27 to 55 years old from Mexico City and Mexico State. BMD was assessed with dual energy X-ray absorptiometry (Hologic densitometer, model DiscoveryWi) in lumbar spine and femur neck. Nutritional status was evaluated with body mass index (BMI) and waist circumference. The percentage of body fat was obtained with bioelectrical impedance (Inbody 720). The intake of calcium, phosphorous, vitamin D and sodium was assessed with a food frequency questionnaire. The time spent in moderate and vigorous physical activities daily, alcohol consumption, and smoking were also assessed by questionnaire.

**Results:** Menopause was present in 14.7% of females. Low BMD was found in 24% of participants. It was showed a high prevalence of total adiposity (76.9%) and in abdomen (88.8%). Calcium and vitamin D intakes were deficient in most of them. The 64% did not spend enough time to moderate and vigorous physical activities. The alcohol consumption in the last 3 months was of 35.7% and 65.1% reported to smoke. Linear models of regression showed that BMI, body fat percentage, waist circumference, physical activity, and menopause were related to BMD. A high body fat percentage and frequent physical activity were associated with less probability to present low BMD.

**Conclusions:** In a sample of Mexican urban women the adiposity and physical activity were factors related to BDM.

**Keywords:** Bone mineral density, women, adiposity, physical activity.
PHYSICAL FITNESS PERCEPTION IS ASSOCIATED WITH NUTRITIONAL STATUS AND ACTUAL PHYSICAL FITNESS IN ADOLESCENTS

(1)Ramos Ibañez, Norma; (2)Cesar Ivan, Ayala-Guzman; (3)Luis, Ortiz-Hernandez.

(1)PhD. Nutritionist. Department of Health Care. Autonoma Metropolitana University. Mexico; (2)Nutritionist. Department of Health Care. Autonoma Metropolitana University. Mexico;

(3)PhD. Nutritionist. Department of Health Care. Autonoma Metropolitana University. Mexico.

**Background and objectives:** Although physical fitness (PF) is associated with better health outcomes, its direct assessment sometimes in not feasible; therefore surrogates of actual PF are necessary. The aim of this study was to analyze the association between the perception of PF with nutritional status and actual PF in adolescents.

**Methods:** The participants were 319 boys and girls aged 10 to 15 years from Mexico City. Nutritional status with evaluated with body mass index (BMI)-for-age and waist circumference-for-age. Body fat was estimated with Slaughter equation. Each component of PF (aerobic capacity, muscular strength and endurance, and flexibility) was assessed with FITNESSGRAM tests. International Fitness Scale (IFIS) was applied to evaluate the perception of PF.

**Results:** It was observed a high frequency in inadequate aerobic capacity (48.8%), in low strength of trunk, arms and abdomen (60.7%, 63.9% and 42.5% respectively) and flexibility of trunk and legs (68.7%). Most of adolescents did perceive themselves with a good PF (aerobic capacity: 85.2%, muscular strength: 90.5, flexibility: 74.1%, velocity/agility: 89.6% and general PF: 92.7%). Adolescents with a high adiposity had a low aerobic capacity, muscular strength and flexibility and perceived themselves with inadequate PF. Adolescents that perceived themselves with a good general PF had an adequate aerobic capacity and strength of abdomen and arm. A good perception of aerobic capacity and muscular strength was related with an adequate aerobic capacity and strength of abdomen and arms. The level agreement between FITNESSGRAM battery and IFIS was fair (K= 0.37, p<0.05) between perception of aerobic capacity and actual aerobic capacity and there was a poor agreement in the others components of PF perception and the tests of PF.

**Conclusions:** Adolescents perceived themselves with better PF compared than actual PF. Nutritional status influence on the perception and actual PF. It was showed a poor agreement between both methods of assessment PF.

**Keywords:** Perception of physical fitness, physical fitness, adolescents,

THE POTENTIAL OF A HUMAN RIGHTS APPROACH FOR ACCELERATING THE IMPLEMENTATION OF COMPREHENSIVE RESTRICTIONS ON THE MARKETING OF UNHEALTHY FOODS AND NON-ALCOHOLIC BEVERAGES TO CHILDREN

(1)Granheim, Sabrina; (2)Vandevijvere, Stefanie; (3)Torheim, Liv Elin.

(1)Nutritionist. Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences. Oslo. Norway; (2)Senior Research Fellow. School of Population Health. University of Auckland. Auckland. New Zealand; (3)Professor. Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences. Oslo. Norway.

**Background and objectives:** Overweight and obesity in children is increasing at the global level, particularly in low- and middle-income countries. Among the causes for this increase is the marketing of unhealthy food and beverage products, which affects children's food preferences, purchasing requests and consumption patterns. The need to address harmful marketing to children has been recognized by the World Health Organization, with Member States having agreed in 2010 to implement a set of recommendations to restrict such practices. Concurrently, there is an increasing understanding of unhealthy food and malnutrition as human rights concerns. This study explores the potential of existing human rights instruments for accelerating the implementation of comprehensive restrictions to reduce harmful marketing of unhealthy foods and beverages to children.

**Methods:** A review of legally and non-legally binding human rights instruments was conducted, including the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of the Child, the Guiding Principles for Business and Human Rights and a series of General Comments as components of existing human rights frameworks.

**Results:** Legally and non-legally binding human rights instruments offer important opportunities to strengthen and accelerate state implementation of restrictions on marketing of unhealthy food and beverage products to children. Four relevant themes were identified in existing human rights instruments: 1) the best interest of the child should be considered above all other interests; 2) the rights to health and adequate food cannot be realized without supportive healthy environments; 3) children should be protected from economic exploitation; and 4) the persuasive marketing of unhealthy food and beverage products is explicitly recognized as a threat to the rights to food and health.

**Conclusions:** In conclusion, existing human rights instruments could be harnessed to advance public health measures to restrict the marketing of unhealthy foods and beverage products to children. Policy-makers and advocates should draw from these instruments and refer to State's obligations within international and domestic human rights law to strengthen their efforts to restrict harmful marketing practices to children.

**Keywords:** right to food, right to health, nutrition, marketing, unhealthy foods, public health
# MALNUTRITION IN ALL ITS FORMS AND SOCIO-ECONOMIC DISPARITIES IN GUATEMALA

(1)Mazariegos, Monica; (1)Kroker-Lobos, Maria F; (2)Ramirez-Zea, Manuel.

(1)Researcher. INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC). Institute of Nutrition of Central America and Panama (INCAP). Guatemala.; (2)Director. INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC). Institute of Nutrition of Central America and Panama (INCAP). Guatemala.

**Background and objectives:** The complex interplay of social, economic, and political determinants of malnutrition results in substantial disparities. Identification of population groups at higher risk of malnutrition will inform public health policy and aid in the design of appropriately targeted interventions. Therefore, our objective was to reveal disparities of malnutrition in all its forms by socioeconomic status (SES) in children, adolescents and women of reproductive age (WRA) in Guatemala.

**Methods:** We used the 2008 National Maternal and Child Health Survey conducted in Guatemala. We estimated the prevalence (95%CI) for underweight/thinness, stunting/short stature, overweight/obesity in children <5 y (n=10,645), adolescents (15-19 y) (n=2,894), and WRA (20-49 y) (n=13,925). Then we evaluated whether the prevalence of malnutrition differed according to tertiles of SES. Disparities are shown as the ratio of low to high-SES tertile.

**Results:** Wasting/thinness prevalence among children, adolescents, and WRA was low (<1%) and was no significantly different among SES. Stunting/short stature prevalence was 48.0% (45.8,50.2) among children, 51.1% (48.4,53.8) among adolescents, and 29.0% (27.5,30.1) among WRA. The prevalence of stunting in these age groups was 3.1, 1.9, and 3.0 times significantly higher in the poorest SES tertile than in the richest tertile, respectively. Anemia prevalence was 49.2% (47.1,51.3) among children, 25.1% (22.7,27.7) among adolescents, and 29% (27.5,30.1) among WRA. The prevalence of anemia was 1.3, 1.8 and 1.7 times significantly higher in the poorest SES tertile than in the richest tertile, respectively. Overweight/obesity prevalence was 6.0% (5.3,6.6) among children, 21.3% (19.3,23.4) among adolescents and 57.8% (56.5,59.2) among WRA. Overweight/obesity prevalence in WRA was 1.4 significantly higher in the richest SES tertile than in the poorest tertile.

**Conclusions:** Stunting and anemia affected the poorest two to three times more than the richest SES tertile. In contrast, only in WRA overweight/obesity was higher among the richest SES tertile. These results highlight the disparities in Guatemala and the need for targeted interventions.

**Keywords:** malnutrition, socioeconomic status, disparities, nutrition policy

# METHODOLOGICAL ASPECTS OF NEW WEB-BASED TECHNOLOGIES FOR ASSESSING DIETARY INTAKE IN CHILDREN AND ADOLESCENTS

(1)Perazi, Fernanda; (2)Altenburg de Assis, Maria Alice; (2)Gracieli Kunradi Vieira, Francilene; (3)Jeremias Pereira, Luciana; (2)Faria Di Pietro, Patrícia; (2)de Fragas Hinnig, Patricia.

(1)Fernanda Machado Perazi. Nutricionista. Programa de Pós-graduação em Nutrição. Universidade Federal de Santa Catarina. Brazil; (2)PhD. Professor. Postgraduade Program in Nutrition. Universidade Federal de Santa Catarina. Brazil.; (3)Nutritionist. Postgraduade Program in Nutrition. Universidade Federal de Santa Catarina. Brazil.

**Background and objectives:** New web-based technologies have been developed in order to contribute for the improvement of dietary intake evaluation of children and adolescents. To review the characteristics of studies that developed web-based questionnaires for assessing dietary intake in children and adolescents.

**Methods:** questionnaires for assessing dietary intake in children and adolescents. Methods: **Results:** Twelve web-based questionnaires were found. Eight of them were developed for children and adolescents from European countries, two in Brazil, and two in the United States (n=2). Regarding the population age, 58.3% of the questionnaires were developed for children aged 7 to 10. Only one questionnaire developed in Brazil evaluated the qualitative dietary intake. All questionnaires were based on 24-hour recall from the previous day and were self-administered. Four instruments provided an Avatar to assist the respondent with completing the questionnaire, and five presented six eating events. Most of the questionnaires (90.9%) had images or photographs of portions size in order to assist the quantity of food reported. Of the 12 studies, 11 published results of validity and 2 of reproducibility. Regarding the reference methods for validity, half of the studies used direct observation. The percentage of agreement between the test questionnaire and the reference method ranged from 37% to 90%. Intrusion rates (false positives) ranged from 5% to 35%, and omission rates (false negatives) from 3% to 35%.

**Conclusions:** There are still few published studies that have developed web-based questionnaires for assessing dietary in children and adolescents. There is a wide variation in the results of agreement when compared the web-based questionnaires with the reference method, and few studies presented results of reproducibility.

**Keywords:** dietary intake, children, adolescents, online, questionnaire.

**Further collaborators:**

Patrícia Faria Di Pietro PhD. Professor. Postgraduade Program in Nutrition. Universidade Federal de Santa Catarina. Brazil.
# THE ASSOCIATION OF DIETARY APPROACHES TO STOP HYPERTENSION WITH VISCERAL ADIPOSITY INDEX IN ADULTS: TEHRAN LIPID AND GLUCOSE STUDY

(1)Mirmiran, Parvin; (2)Yuzbashian, Emad; (1)Asghari, Golaleh; (3)Azizi, Fereidoun.

(1)PhD. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran; (2)MSc. Nutrition and Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran; (3)MD. Endocrine Research Center. Research Institute for Endocrine Sciences. Shahid Beheshti University of Medical Sciences. Tehran. Iran.

**Background and objectives:** Abdominal obesity is independently related to increased risk of metabolic and cardiovascular diseases and mortality rates. The effect of abdominal obesity on metabolic factors seems to be mainly mediated by the visceral adipose tissue (VAT) that might modify by dietary intakes. This study was conducted to examine the association of adherence to the Dietary Approaches to Stop Hypertension (DASH)-style diet and its components with prospective visceral adiposity index (VAI)-changes after 6.1 years of follow-up among an Iranian population.

**Methods:** We followed-up 1863 participants (50.5% women, mean age: 42.8years) of the Tehran Lipid and Glucose Study (TLGS) for 6.1years. Baseline diet was assessed using a valid and reliable 168-item food-frequency questionnaire. A DASH-style diet was calculated based on Folsom et al score. Linear regression was used to report for the association of VAI-change and logistic regression was used for calculating the odds of incident visceral adiposity dysfunction (VAD) with DASH-style diet score.

**Results:** The mean age of participants was 40.25y, and mean VAI was 1.85. After adjusted for age, sex, physical activity, smoking, and total energy intake, a unit increase in adherence to the DASH-style diet score was positively associated with changes in VAI (β: -0.098; P=0.009). Each increased in scores of vegetable and saturated fatty acid were associated with a 0.349, 0.287 decreased in VAI (p<0.05), respectively. Furthermore, subjects in the highest quartile of the DASH-style diet score had the lower risk of incident VAD in comparison to those in the lowest quartile (OR:0.72;95% CI:0.55-0.94).

**Conclusions:** Higher adherence to the DASH-style diet was associated with a lower change of VAI and risk of incident VAD among adults during 6.1 years of follow-up.

**Keywords:** DASH-style diet; Visceral Adiposity Index; Obesity; Dietary pattern

**Further collaborators:** Behnaz Mahmoodi

# BULLYING IN ADOLESCENCE: A MAJOR REASON TO PREVENT OBESITY

(1)Calvo, Soledad; (2)Bove, Maria Isabel.

(1)MSc. Nutritionist. Catholic University of Uruguay. Uruguay;

(2)PhD. Nutritionist. Catholic University of Uruguay. Uruguay.

**Background and objectives:** Interpersonal violence in teenagers is a public health problem that requires studies that delve into possible determinants. Physical appearance can predispose to intimidation experiences. Research indicates that obesity promotes discriminatory behaviours that affect the psychosocial development of young people.

To investigate the connection between obesity and bullying related to physical appearance in adolescents from Uruguay, Argentina and Chile.

**Methods:** It has been made a cross-sectional and descriptive study with an analytical component of the Global School Health Survey of Uruguay (2012), Argentina (2012) and Chile (2013); (30.845 adolescents).

The variables were: sex, age, bullying related to physical appearance, overweight or obesity, family support, number of close friends, feeling alone and problems for sleeping.

To study the contribution of each risk factor, a multivariate analysis was performed through binary logistic regression. The chance was expressed as Odds Ratios with a 95% confidence interval. All tests were considered statistically significant with a level α < 0.05.

**Results:** About 23.8% (95% CI: 23.3-24.3%) of teenagers admitted to having been bullied at least once in the last month. Argentina occupied the first place in this problematic, followed by Uruguay and finally Chile. About 27.9% (CI 95%, 27.3-28.5%) of teenagers were overweight (overweight 21.6% and obesity was 6.3%). In Chile, this figure ascended to 41.8% (95% CI, 31.4-44.4%), being the country with the highest prevalence (p<0.001). Obesity predominated in the males of the three countries (p<0.001). Bullying was more prevalent among adolescents under 15 years (p<0.001); among teenagers with poor parental support (p<0.001), among young people with little or no close friends (p<0.001), and among those who presented overweight (p=0.005) or obesity (p=0.1). The most frequent form of aggression was the jokes and within them the ones related to the physical aspect. It was observed that adolescents with obesity are more prone to bullying, they are more than twice as likely to be bullied (OR: 2.44, 95% CI 1.94-3.08).

**Conclusions:** Approximately 20% of adolescents in the region are victims of bullying.

The main form of aggression between peers is the physical appearance teasing.

Obesity turns out to be the greatest risk for this type of bullying.

**Keywords:** Adolescence. Bullying. Intimidation. Obesity

**Further collaborators:** Calvo, Soledad; Bove, Isabel
# THE RELATION OF NEIGHBORHOOD ENVIRONMENT CHARACTERISTICS WITH ANTHROPO-METRIC INDICES AND ACTIVITY IN TWO IRANI-AN ETHNIC GROUPS LIVING IN NORTH-WEST OF IRAN

Rezazadeh, Arezoo; Omidvar, Nasrin; Eini-Zinab, Hassan.

Department of Community Nutrition. National Nutrition and Food Technology Research Institute. Faculty of Nutrition and Food Technology. Shahid Beheshti University of Medical Sciences and Health Services. Iran.

**Background and objectives:** Features of living environments may contribute to weight and activity status. This study aimed to assess the relation of neighborhood environment with anthropometric indices and activity in Azeris (as major ethnic group) and Kurds (as minor ethnic group) living in Urmia city, North West of Iran.

**Methods:** In this cross-sectional study, 723 participants (427 women and 296 men) aged 20–64 year old, from two ethnic groups (445 Azeri Turk and 278 Kurd) were selected through a combination of cluster, random and systematic sampling methods from 38 neighborhoods. Neighborhood characteristics was obtained by using a validated 22-items neighborhood and health observational checklist. Weight and height and waist circumference (WC) were measured using standard methods and Body Mass Index (BMI) was calculated. Activity level was measured by a validated long form International physical activity questionnaire (IPAQ). Principal component analysis was used to define dominant neighborhood environment. The relation between anthropometric indices and activity with neighborhood characteristics was analyzed by multiple linear regression. P<0.05 was considered as significant level.

**Results:** Three common neighborhood environments were defined: "newly built and affluent", "Centrally located neighborhood with high access to social services" and "marginally located neighborhoods". Higher percent of Azeri group were settled in higher tertiles of "Modern-high quality" and "Central-high access "neighborhoods. In Azeri vs. Kurd ethnic group, the mean ± SD of BMI, WC and physical activity was 27.9±5.7 vs. 26.9±5.8 kg.m2, 93.5±13.8 vs. 91.7±13.0 cm and 5619±7723 vs. 8052±9637 MET/ hour/week, respectively. In total participants, after adjustment for age, gender, marital status, SES and energy intake those living in higher tertile of "Central-high access" neighborhoods had higher WC and lower physical activity level. In Azeri Turk ethnic group, living at the highest tertile of Modern-high quality neighborhoods was significantly related with higher BMI. In Kurd ethnic group, those living in "marginally located neighborhoods" had higher physical activity.

**Conclusions:** Findings suggest that living in high quality neighborhoods and belonging to the major and affluent ethnic group was related with higher BMI however, living in low quality neighborhoods located in marginal part of city was related with higher activity level in minor ethnic group.

**Keywords:** neighborhood characteristics, anthropometric indices, activity, ethnicity, Iran.

# EXAMINING FOOD ENVIRONMENT POLICY IMPLEMENTATION IN CANADA: ADAPTING THE FOOD-EPI TOOL AND PROCESS TO THE CANADIAN CONTEXT

**Background and objectives:** Globally, food environment policies play a critical role in improving diet and related non-communicable diseases (NCDs). This study aimed to identify food environment policies in different policy domains in Canada to improve the food environment and address high rates of obesity and NCDs.

**Methods:** This study employed the Healthy Food Environment Policy Index (Food-EPI), developed by International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) to measure the extent of implementation of food environment policies by governments globally. The index examines 7 policy domains (composition, labelling, promotion, prices, provision, trade, and retail) and 6 infrastructure support domains (leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, and health-in-all-policies). An inventory of current policy implementation was collated and verified by government stakeholders for accuracy. Policies were examined at national and provincial/territorial level (13 jurisdictions). Ratings were conducted by more than 70 non-governmental experts to assess the level of implementation compared to international benchmarks for 47 indicators on a scale from 1 (less than 20% implementation) to 5 (80–100% implementation). Federal policies were rated in 3 workshops in Vancouver and Toronto in May/June 2017, while provincial/territorial policies were rated using an on-line process. Concrete areas for action at the federal and provincial/territorial level were discussed and prioritized at the in-person workshops.

**Results:** Overall, there was no evidence of national or provincial implementation in 6 of 23 policy indicators. National and provincial policies were identified for food composition and labelling domains, while pricing policies were only implemented nationally. Policy regarding unhealthy food marketing and nutrition standards in school settings, public settings such as recreation centres and private sector settings were primarily provincial in nature. No actions relating to food retail or zoning policy or taxing unhealthy foods were identified. Ratings by experts and priority areas for action will be discussed.

**Conclusions:** There are gaps in food environment policy in Canada at the federal and provincial level. Prioritizing actions to improve the food environment has significant potential to influ-

<footnote>(1)Vanderlee, Lana; (2)Karbasy, Kimiya; (3)Vandevijvere, Stefanie;</footnote>

<footnote>(4)Swinburn, Boyd; (5)L'Abbé, Mary.</footnote>

<footnote>(1)PhD. Department of Nutritional Sciences. University of Toronto. Canada.; (2)BSc. MSc student. Department of Nutritional Sciences. University of Toronto. Canada.; (3)PhD. Senior Research Fellow Global Health, Food Policy, Obesity and NCD prevention. University of Auckland. New Zealand.; (4)MBChB. MD. FRACP. Professor of Population Nutrition and Global Health. University of Auckland. New Zealand.; (5)PhD. Earle W. McHenry Professor and Chair. Department of Nutritional Sciences. University of Toronto. Canada.</footnote>
ence the diet of Canadians, with downstream influences on rates of obesity and NCDs.

**Keywords:** Food environment, food policy, obesity prevention

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STUDY OF ADULT-TYPE PRIMARY HYPOLACTASIA IN TERMS OF THE GEOGRAPHICAL AND ETHNIC FACTORS: CASE OF MOROCCAN AND SUB-SAHARAN POPULATIONS

Lebiad, Zineb; Bour, Abdellatif.

Laboratory of Biological Tests. Team of Food and Nutritional Transition [ETAN]. Faculty of Sciences of Kénitra. University Ibn Tofail Morocco.

**Background and objectives:** Background: Less known in Africa, yet very widespread in the world, Lactose intolerance is a digestive problem that testifies a deficit of lactose digesting enzyme, lactase, which leads to uncomfortable digestive symptoms.

**Context:** The prevalence of lactose intolerance varied from one region to another with an undeniable north-south gradient ranging from 5% in North Europe to 100% in some Asian countries.

**Objective:** The purpose of this article is to highlight the difference in the prevalence of adult type hypolactasia according to geographical space and ethnicity.

**Methods:** The survey was conducted in the city of Kenitra representing the North of Morocco and the city of Agadir representing the south of Morocco on the adult population and also among the sub-Saharan adults residing in Morocco. Lactose intolerance was assessed by the rate of glucose in blood before and 30 minutes after administration of an overload taking of lactose and also taking account of the subsequent digestive symptoms. Subjects were also asked to answer some questions about their milk consumption and their knowledge about lactose intolerance.

**Results:** The prevalence of adult-type primary hypolactasia was higher in the sub-Saharan population than in the Moroccan population, it varies significantly with age and may be influenced by milk consumption in adulthood but less by its consumption after weaning.

**Conclusions:** Lactose intolerance increases as we go towards the south, several genetic and environmental factors influence this divergence. The prevalence of lactose intolerance is very high among the studied population which requires the participation of the health authorities to raise awareness of the existence of lactose intolerance in order to improve their quality of life.

**Keywords:** Lactose, Intolerance, Lactase, Milk, Morocco.

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USING HEALTH EXAMINATION DATABASE TO STUDY PUBLIC HEALTH NUTRITION -- A DATA PROCESSING APPROACH

(1)Hsu, Chien-Yeh; (2)Rau, Hsiao-Hsien; (3)Chao, Jane.

(1)PhD. Department of Information Management. National Taipei University of Nursing and Health Sciences. Taipei. Taiwan.; (2)MSc. Graduate Institute of Biomedical Informatics. Taipei Medical University. Taipei. Taiwan.; (3)PhD. School of Nutrition and Health Sciences. Taipei Medical University. Taipei. Taiwan.

**Background and objectives:** With the rapid development of information technology, medical and health related personal data was generated very fast and diversely.

Since data collection became more and more easily, using data directly by screening, integration, processing and analyzing is a suitable approach for studying public health nutrition. A data processing procedure used to support research purpose is essential.

**Methods:** In this study, a health examination database was integrated with several other databases including personal behavior questionnaire, personal health records and clinical laboratory dataset to form a research data warehouse by using SQL server. All the subjects signed the consent form to agree the data without personally identifiable information used for the purpose of academic research. A standard procedure was built to connect data from different data sets and retrieved automatically according to the research problems.

**Results:** An integrated health related database was built which contains health examination data, behavior data, personal health records and clinical laboratory data. The researchers can set inclusion and exclusion criteria and query the data across from different datasets. This provides a very easy and efficient way for the researchers to obtain correct and clean data. Further data analysis can be done by using variety of statistical tools.

**Conclusions:** Data driving approach has been applied in many different research areas to obtain statistical inferences. The data warehouse built in this study is useful to do value-added applications such as finding the association between dietary patterns and metabolic and cardiovascular diseases, identifying the risk factors for building disease prediction/prevention models in public health nutrition, and applying to personalized health care.

**Keywords:** Personal Health Records, Public Health Nutrition, Data Warehouse, Data Analyzing, Data processing, Meaningful Use of PHR

**Further collaborators:**

Health Examination Companies, Health Insurance companies, public health researchers.
THE FIRST INFORMAS NATIONAL FOOD ENVI-
RONMENTS SURVEY IN NEW ZEALAND: A BLUE-
PRINT COUNTRY SCORECARD FOR MEASURING
PROGRESS ON CREATING HEALTHIER FOOD EN-
VIRONMENTS

(1)Vandevijvere, Stefanie; (2)D'Souza, Erica; (2)Mackay, Sally; (3)Buch, Tina; (4)Swinburn, Boyd.

(1)Senior Research Fellow. School of Population Health. The University of Auckland. Auckland. New Zealand.; (2)Phd student. School of Population Health. The University of Auckland. Auckland. New Zealand; (3)Nutritionist. School of Population Health. The University of Auckland. Auckland. New Zealand; (4)Professor. School of Population Health. The University of Auckland. Auckland. New Zealand.

**Background and objectives:** INFORMAS aims to benchmark food environments globally. We present results of the first-ever, comprehensive New Zealand (NZ) food environments study, the policies influencing those and a scorecard to measure progress over time and compared to other countries.

**Methods:** Implementation of priority national food environment policies, and strength and comprehensiveness of District Health Board (DHB) and school nutrition policies were assessed. Food environments were measured in 819 schools, 204 supermarkets, 1500 takeaway outlets, 28 hospitals, 70 sport centres and all school zones. Food swamps, areas with high relative density of unhealthy outlets, were identified, and food marketing to children on television, websites, magazines, packages and social media and in and around schools was measured. The proportion of packaged foods in supermarkets carrying health-related claims and promotions, and the cost differential between healthy and current diets were calculated.

**Results:** Implementation gaps exist for 75% of recommended national policies. Comprehensiveness and strength of policies are higher for DHBs than schools. About 75% of hospitals, 60% of schools and 44% of sport centres are sugary drink free. The average ratio of cumulative linear shelf length for healthy versus unhealthy foods is 0.42 and the average proportion of junk food free endcaps and check-outs is 47.0 and 14.7 in supermarkets. Nation-wide, one-third of census areas are food swamps with the highest number in most deprived areas. Median road distance to the closest convenience store from urban schools is higher for the least (617 m) versus the most deprived (521 m) schools. Food marketing to children through all media is predominantly for unhealthy foods. About 83% of less healthy packaged foods carry at least one nutrition claim. It is possible to consume a healthy diet at the same cost as current NZ diets, but the majority of healthy household menus are significantly more expensive than current household menus.

**Conclusions:** NZ food environments, especially children's environments, are largely unhealthy, and policy implementation is low. Effective policies, particularly on food marketing, healthy food in schools and food prices need to be implemented. NZ's healthy food environment scorecard will be updated regularly and benchmarked against other countries globally.

**Keywords:** food environments, benchmarking, monitoring, nutrition policies

INTRODUCTION OF GUAVA IN SUPPLEMENTARY
NUTRITION MEAL PROVISIONED FOR 24-60MO
CHILDREN BY INTEGRATED CHILD DEVELOP-
MENT SCHEME (ICDS) IMPROVES IRON STATUS
OF BENEFICIARIES

(1)Roy Choudhury, Dripta; (2)Fernandez Rao, Sylvia; (3)Balakrishna, Nagalla; (4)K. Vijaya, Radhakrishna; (5)Ghosh, Sudip; (6)Nair, K. Madhavan.

(1)MSc. Senior Research Fellow. Division of Molecular Biology. National Institute of Nutrition. Hyderabad. India; (2)PhD. Scientist C. Behavioural Science Unit. National Institute of Nutrition. Hyderabad. India; (3)PhD. Scientist E. Division of Biostatistics. National Institute of Nutrition. Hyderabad. India; (4)MBBS. DCH. Retired Scientist E. Clinical Division. National Institute of Nutrition. Hyderabad. India; (5)PhD. Scientist E. Division of Molecular Biology. National Institute of Nutrition. Hyderabad. India; (6)PhD. Retired Scientist F and Head. Micronutrient Research Group. National Institute of Nutrition. Hyderabad. India.

**Background and objectives:** Simultaneous intake of guava with rice-based meal enhanced iron bioavailability by more than 100% among Indian adolescents. Hence, a RCT was done to establish the impact of regular inclusion of guava in a nutrition sensitive platform for strategy adoption.

**Methods:** In India, Supplementary Nutrition Programme (SNP) provides hot cooked meal to 24-60mo children under ICDS through its operational unit, 'Anganwadi Centers' (AWCs). A three-arm cluster-RCT (CTRI/2014/09/004983) integrated with SNP was designed with passive control cucumber group (minimal vitamin C), active control banana group (minimal vitamin C, high soluble fiber) and experimental guava group (high vitamin C and soluble fiber) to receive 25g of each fruit based on 1RDA of vitamin C (40mg) present in the guava portion. Written consent from parents and permission from government departments were obtained. Participants (n=261) having Hb>8g/dL with no chronic diseases/severe malnutrition were recruited from 28 AWC-clusters in rural area of Nalgonda district, Telangana State. Participants were dewormed with albendazole. Randomization was followed at village level. Fruits were supplied by a local vendor throughout study period for 6 days/week for 21 weeks. Compliance was supervised at AWC. 2mL blood samples were collected at baseline and endline to assess haemoglobin (Hb), plasma ferritin (PF), soluble-transferrin receptor (sTfR), c-reactive protein (CRP), hepcidin, IL-6, plasma vitamin B12 and folate. Ferritin was corrected for CRP values>5mg/L by multiplying with 0.67. Linear Mixed Model was used for group comparison adjusting the cluster effect. Endpoint group comparison was analyzed by adjusting the baseline as covariate if found significant (p<0.05).

**Results:** There were no group differences at baseline in growth, socio-economic status, age, gender and mother's education. Biochemical parameters were also comparable except for PF, B12 and IL-6. At endpoint, experimental group showed improved status compared to both passive and active control groups for Hb (p=0.001, 0.000), ferritin (p=0.000, 001) and sTfR (p=0.000,
0.000). There was no endpoint group difference for hepcidin, IL-6 and B12 except folate which was higher in experimental group only compared to active control group (p=0.032).

**Conclusions:** Inclusion of Guava in regular SNP meal can be an effective strategy to improve iron status of ICDS preschool beneficiaries.

**Keywords:** Guava, Iron Status, Supplementary Nutrition Meal, ICDS, Preschoolers

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### DEVELOPMENT OF A MULTI-SECTORAL SYSTEM TO ENFORCE A NATIONAL CODE ON MARKETING BREAST MILK SUBSTITUTES IN CAMBODIA

(1)Hou, Kroeun; (2)Prak, Sophonneary; (3)Aing, Hoksrun; (4)Green, Mackenzie; (5)Chai, Tze Lin; (6)Chum, Veasna.

(1)MPH. Deputy Country Director. Helen Keller International. Cambodia; (2)MD.MPH. Deputy Director. Maternal and Child Health Center. Ministry of Health. Cambodia; (3)Ph. Director. Department of Drugs and Food Safety. Ministry of Health. Cambodia; (4)Msc. ARCH Regional Coordinator. Helen Keller International; (5)Bsc. Research Specialist. Helen Hellen International. Cambodia; (6)Msc. ARCH National Coordinator. Helen Keller International. Cambodia.

**Background and objectives:** In 2005, Cambodia endorsed Sub-Decree 133 (SD133), a national code that regulates the marketing of breast milk substitutes (BMS). In 2014, research revealed that code violations were widespread and that there were no multi-sectoral mechanisms in place to enforce SD133. To monitor national code law, WHO recommends that the Ministries of Health set up an inter-ministerial monitoring team, composed of different ministries, agencies and departments that have a direct responsibility over the marketing, availability and promotion of relevant products.

**Methods:** Data on code violations and gaps in enforcement were used to advocate for an evidence-based plan to strengthen enforcement of SD133. Prior to August 2014, there was confusion over the roles of the four implementing ministries and no formal monitoring system, resulting in low reporting of code violations. Meetings and consultations were conducted with key stakeholders to discuss these issues. Policymakers including Officials from the Ministries of Health, Commerce, Information, and Industry and Handicraft, along with representatives from relevant UN Agencies and NGOs, collaborated to create a multi-sectoral supervisory mechanism to enforce the National Code regulating BMS in Cambodia.

**Results:** In August 2014, an Oversight Board (OB) was created to monitor and enforce SD133. This is co-led by the Ministry of Health and the Council for Agriculture and Rural Development; however, the four line Ministries are also represented by their Secretaries. The OB has two executive arms: (i) the Control Committee reviews marketing content regarding breast milk substitutes, and (ii) the Executive Working Group monitors and enforces compliance.

In 2015 the OB developed terms of reference and guidelines for the implementation of SD 133; which were adopted in December 2015. In 2016, the OB developed different monitoring checklists for the four line Ministries. Four provinces were selected to pilot test the system, develop implementation guidelines, and propose recommendations. Training included orientation on the national code and monitoring guidelines.

**Conclusions:** Cambodia's experience & lessons learned in establishing a multi-sectoral enforcement mechanism provide a valuable model for other countries wanting to establish similar systems to enforce code regulations.

**Keywords:** Breastfeeding, Policy, Multi-sectoral, Enforcement, Cambodia

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### SIGNIFICANT IMPROVEMENT IN SUPPLEMENTATION OF MEGA DOSE OF VITAMIN A TO UNDER FIVE CHILDREN IN INDIA

Gupta, Aakriti.

PhD Scholar. Department of Food and Nutrition. Lady Irwin College. Delhi University. India.

**Background and objectives:** Vitamin A deficiency (VAD) is associated with increased risk of mortality and morbidity amongst under five children (U5). VAD continues to be an important public health problem in India. A survey conducted in 2011-2012 indicated that 2.5% of U5 had VAD. A recent cochrane review revealed that the Vitamin A supplementation (VAS) should be continued for reduction in morbidity in U5.

The Vitamin A Supplementation Programme was given low priority by the Government of India during 1990-2005 which was reflected in the National Family Health Survey (NFHS)-III data which found that only 16.5% of the children received VAS during 2005.

**Methods:** The NFHS is a large-scale, multi-round survey which undertakes systematic and stratified sampling techniques to ensure inclusion of villages with different socioeconomic characteristics. The NFHS sample covers 99 percent of India's population living in each state. The survey provides state and national level data for India on IYCF practices, maternal and child health, reproductive health, nutrition, anaemia and food supplementation practices using the standard indicators.

An analysis of secondary data available from National Family Health Survey (NFHS)-III (2005-2006) and NFHS-IV (2015-2016) was conducted on the coverage of VAS amongst U5 in different states of the country.

**Results:** The coverage of VAS was found to increase from 16.5% to 60.2% amongst U5 over a decade (2005-2016). The increase in the VAS coverage was observed in the range of 20-66% in different states of the country. The states with the highest increase in the coverage of VAS were Sikkim (18% to 84%), Karnataka (14% to 79%), Chhattisgarh (9% to 70%), Goa (31% to 90%) and Gujarat (13% to 71%). The improvement in coverage of VAS amongst U5
could be attributed to the close monitoring and supervision by the
government and development partners.

**Conclusions:** The present study revealed that the Govern-
ment of India and development partners have strengthened the
VAS Programme in the country. There is a need of continued and
sustained efforts for achieving full coverage of VAS to prevent the
mortality and morbidity amongst U5.

**Keywords:** Vitamin A supplementation, vitamin A deficiency, Mega dose of Vitamin A

(ORs) and 95% confidence intervals (CIs) for coal-burning fluo-
rosis in the top quartiles (vs. the lowest quartiles) were 0.52 (0.33,
0.83) for α-carotene, 0.48 (0.31, 0.76) for β-carotene, 0.33 (0.20,
0.53) for lutein/zeaxanthin, 0.40 (0.25, 0.67) for lycopene, 1.40
(0.88, 2.24) for β-cryptoxanthin, 0.42 (0.26, 0.67) for total carot-
enoids, respectively.

**Conclusions:** Higher intake of carotenoids is independently associated with lower prevalence of coal burning fluorosis. Increasing consumption of carotenoids food may benefit the prevention of coal burning fluorosis in Guizhou.

**Keywords:** Carotenoids, Coal-burning fluorosis, Cross-sectional study

ASSOCIATION BETWEEN DIETARY CA-
ROTENOIDS AND FLUOROSIS IN CHINESE
COAL-BURNING FLUOROSIS AREA: A CROSS
SECTIONAL STUDY

(1)Liu, Jun; (2)Yang, Sheng; (2)Luo, Mingjiang.

(1)Ph.D Associated professor. Department of Nutrition and Food Hygiene. School of Public Health. Zunyi Medical University. China; (2)Postgraduate. Department of Nutrition and Food Hygiene. School of Public Health. Zunyi Medical University. China.

**Background and objectives:** Carotenoids are a group of di-
et-derived phytochemicals with antioxidant and anti-inflamma-
tory properties that have attracted substantial interest because of
their capacity to reduce the risks of relevant diseases. Epidemi-
ology and experiments have demonstrated that excessive fluoride
could lead to oxidative damage and oxidative stress was an impor-
tant mechanism of fluorosis. However, there has no epidemiology
studies reported the association between carotenoids and the coal
burning fluorosis. Thus, we investigated the relation of carotenoid
intake, to the prevalence of coal-burning fluorosis.

**Methods:** Subjects were required to be country resident for at least 5 years, aged between 20-75 years in Zhijin county, which is the most severe coal-burning fluorosis area in Guizhou. Face-to-face interviews were conducted to assess habitual dietary intakes using a 75-item food frequency questionnaire and various covariates by structured questionnaires. Dietary consumption of carotenoids, energy and other nutrients will be calculated according to the database of the China Food Composition and United States Department Of Agriculture.

**Results:** A total of 899 participants were involved and the prev-
alence of coal burning fluorosis was estimated to be 72.9% in this
cross-sectional study. In the univariate logistic regression analysis
showed significantly dose-dependent inverse correlations between
the prevalence of coal burning fluorosis and the intake of α-caro-
tene, β-carotene, lutein/zeaxanthin, lycopene and total carotenids
in all of the subjects (all P-trend:<0.001). But there was no asso-
cicatoin of the prevalence of fluorosis with β-cryptoxanthin. After
adjustment for sociodemographic characteristics, dietary factors
and other potential confounders, the associations were slightly at-
tenuated but remained significant for all (P-trend: <0.001–0.008)
except for β-cryptoxanthin (p=0.553). The adjusted odd ratios

A CLUSTER RANDOMISED CONTROL TRIAL OF
AN INTEGRATED AGRICULTURE-NUTRITION
PACKAGE TO IMPROVE CHILDREN'S DIETS
THROUGH COMMUNITY BASED CHILDCARE
CENTRES IN MALAWI

(1)Gelli, Aulo; (2)Roschnik, Natalie.

(1)Ph.D. Nutrition epidemiologist. Poverty, Health and Nutrition Division. International Food Policy Research Institute (IFPRI);

(2)MSc. Senior Research and Impact Advisor. Programme Policy and Quality. Hunger and Livelihood team. Save the Children.

**Background and objectives:** The Nutrition Embedded Eval-
uation Program Impact Evaluation (NEEP-IE) study is a cluster
randomised controlled trial designed to evaluate the impact of a
childcare centre-based integrated nutrition and agriculture inter-
vention on the diets, nutrition and development of young children
in Malawi. The intervention includes activities to improve nutri-
tious food production and training/behaviour change communi-
cation to improve food intake, care and hygiene practices.

**Methods:** Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either 1) a control group with communities with Save the Children supported CBCCs and parenting education; or 2) an intervention group where additional nutrition and agricultural support activities were provided to help communities provide nutritious meals in the preschools all year round. Primary outcomes at child level include dietary intake of children aged 3-6y (measured through 24-hour recall) and infant and young child feeding (IYCF) practices for children aged 0-24m. At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agriculture and nutrition pathways were measured. During this trial, we followed a mixed methods approach combining child-, household-, CBCC- and market-level surveys and assessments with in-depth interviews and focus group discussions with project stakeholders.

**Results:** The integrated agriculture and nutrition intervention improved dietary intake and dietary diversity for pre-school children and their younger siblings. Positive effects were also observed