PROMOTING NUTRITION AND HYGIENE FOR ORPHANS AND VULNERABLE CHILDREN IN THROUGHOUT CHILDHOOD IN NIGERIA

(1)Cunningham, Andrew; (2)Granger, Kristina; (3)Mburu-de-wagt, Anne; (4)Rogers, Bridget; (5)Koniz-Booher, Peggy.

(1)MPH. SBCC Project Officer. SPRING Project. JSI. United States.;

(2)MPH. SBCC Manager. SPRING Project. Manoff Group. United States.; (3)PhD. Independent consultant. India.; (4)MPH. Senior Project Officer. SPRING Project. JSI. United States.; (5)MPS. SBCC Team Lead. SPRING Project. JSI. United States.

**Background and objectives:** Out of Nigeria's 69 million children, an estimated 17.5 million are considered orphans and vulnerable children (OVCs), of which 7.3 million are orphaned by HIV/AIDS. Communities often face challenges when trying to feed and care for these children and meet particular needs due to their OVC status. In 2015, The USAID-funded Strengthening Partnerships, Results: **Methods:** SPRING conducted a landscape analysis to identify priority nutrition practices, existing nutrition materials and curricula, and other interventions across Nigeria for the early childhood (2-5), middle childhood (6-11), and adolescent (13-17) age groups. Data were collected via a combination of desk review and surveys conducted with 63 civil society organizations (CSOs) working with OVCs. SPRING used the findings to design a training package with key nutrition information for use by CSOs associated with Kids' Clubs and early child development (ECD) centers. SPRING concept tested selected activities from the package in four communities in the Federal Capital Territory with teachers and children from each age group.

**Results:** The resulting training package builds the nutrition capacity of CSO staff and volunteers working with OVCs. It includes four modules that use highly engaging and participatory activities for all three age groups and colorful graphic training aids to highlight nutrition concepts. In September 2016, SPRING conducted a training of trainers (implementing partners and donors) to build a pool of 26 master trainers. Each of the five OVC partners is now able to cascade the trainings across CSOs and communities in which they work; one partner has already adopted this package for use in northern Nigeria.

**Conclusions:** This package incorporates developmentally appropriate lessons about food and nutrition using language, concepts, and instruction techniques tailored to each age group. In addition to OVC partners in Nigeria who are cascading this curriculum for their communities, Ministry of Education representatives were specifically included in the TOT to facilitate the incorporation of activities from this package into their existing curricula.

**Keywords:** ECD, OVC, training, curriculum, education

BACK TO BASICS FOR BETTER BREASTFEED-
ING: FINDINGS FROM THREE REGIONS OF THE
WORLD

(1)Galloway, Rae; (2)Assabri, Ali Mohamed; (3)Cooper, Chelsea;

(4)Creed-Kanashiro, Hilary; (5)Picado, Irene.

(1)M.S. Nutritionist. Consultant. USA.; (2)M.D. Department of Community Medicine. University of Sana'a. Sana'a. Republic of Yemen; (3)MPH. Maternal and Child Survival Program. Washington D.C. USA.; (4)Lead Investigator. Institute of Investigation in Nutrition. Lima. Peru; (5)Nutrition Consultant. Tegucigalpa. Honduras.

**Background and objectives:** Given its benefits, exclusive breastfeeding (EBF) remains low in many countries. Studies in three in countries in Africa, Asia, and the Middle East were conducted to determine coverage of EBF in the first 6 months and the reasons for non-EBF.

**Methods:** In-depth interviews (IDIs) about breastfeeding were conducted with mothers of children<2 years in Lao People's Democratic Republic (PDR) in 2001 (67 mothers), Malawi in 2009 (100 mothers), and in Yemen in 2013-14 (32 mothers). Breastfeeding practices also were observed in homes. IDIs with key informants (KIs) (fathers, grandmothers, health workers) also identified barriers to EBF.

**Results:** In Yemen, only one child<2 years had been exclusively breastfed. In Malawi, nearly half of babies<6 months were exclusively breastfed while in Lao PDR, one-third of babies had been exclusively breastfed until 4-6 months. EBF varied by region and ethnic group only in Lao PDR.

The major reasons for non-EBF, reported by mothers and KIs, was that breastmilk was insufficient or mothers had to return to work. While there was knowledge about the benefits of EBF in all countries, there was less knowledge about (and fewer observations of) optimal breastfeeding practices. The perception about breastmilk insufficiency, triggered by babies crying after breastfeeding or too much, led to the introduction of breastmilk substitutes and/or food. Inadequate practices co-existed with perceptions of insufficiency and included late initiation of breastfeeding; giving pre-lacteal feeds; withholding colostrum; incorrect positioning; breastfeeding for short durations or infrequently; breastfeeding from only one breast per feed; mothers returning to work; and lack of knowledge about how to increase breastmilk production. A few mothers and key informants said the cause of insufficiency was that mothers' diets were inadequate.

**Conclusions:** To successfully breastfeed in the first six months, nutrition programs need to get back to basics and give mothers adequate information about and support and time to breastfeed. Detailed information is needed by mothers and their families about all the practices required to ensure optimal breastfeeding. Agricultural and income-generating programs need to be nutrition-sensitive by giving mothers the time and support to breastfeed.

**Keywords:** breastfeeding, breastmilk, practices, barriers, education
# IDENTIFICATION OF FACTORS ASSOCIATED WITH NUTRITIONAL RISK AND MALNUTRITION FOR USE IN COMPREHENSIVE GERIATRIC ASSESSMENT - CGA BY CORRESPONDENCE ANALYSIS

**Background and objectives:** Background: Comprehensive Geriatric Assessment (CGA) is a tool used to early identify health problems (medical, psychosocial, and functional limitations) of a frail older person. Nutritional screening is an important component of the CGA that can provides an indication of a patient's nutritional risk. Objective: The study aimed to identify the factors associated with nutritional risk and malnutrition, using the Comprehensive Geriatric Assessment.

**Methods:** This is a cross-sectional study with systematic random sample. A total of 233 older adults patients (aged 60 years or older) attending the Rehabilitation Screening of the Center for the Elderly Reference in the north area of São Paulo (CRI-Norte) (Centro de Referência do Idoso da Zona Norte). Initially, Chi-square and Fisher's exact tests were performed to identify variables associated with nutritional risk and malnutrition, treated as a single variable. For these analysis, it was adopted a level of significance of 5%. Multiple Correspondence Analysis (MCA) were used to identify the association between nutritional risk and malnutrition and the co-variables of the study: weight loss, altered appetite, decrease intake, physical difficulty to buy food, self-health assessment and nutritional self-assessment. MCA is a technique used to analyze the pattern of relationships of several categorical dependent variables, aiming to reduce large sets of variables into smaller sets of components that summarize the information contained in the data.

**Results:** Based on the Multiple Correspondence Analysis, nutritional risk and malnutrition were correlated with unintentional weight loss, decrease appetite, decrease food intake, receiving physical help for to buy food, poor and regular self-health assessment, and nutritional self-assessment low-weight.

**Conclusion:** Through the joint relationship between nutritional risk and malnutrition and the identified variables, it is suggested the development and validation of a nutritional screening tool for the early identification of risks. This instrument will be important for the optimization of the time and appropriate referral of the elderly to the nutritional attention essential for the recovery and maintenance of the health and quality of life of this population.

**Keywords:** nutritional risks, aging, malnutrition, nutrition-assessment.

# EPIDEMIOLOGY OF ANEMIA IN CHILDREN, ADOLESCENT GIRLS AND WOMEN OF REPRODUCITIVE AGE IN BHUTAN

**Background and objectives:** In Bhutan, anemia has declined but remains a public health concern. Globally, causes include iron or other micronutrient deficiencies, helminths or genetic disorders. We estimated prevalence and identify risk factors of anemia in children, adolescent girls and women in Bhutan.

**Methods:** In a 2015 national survey, hemoglobin was measured in 1,083 children 6-59 months, 1,103 adolescent girls 10-19 years, 118 gravida and 3,234 non-pregnant women 15-49 years. We calculated anemia prevalence adjusted for altitude and survey design using life-stage-specific cutoffs. Predictors of hemoglobin and anemia were evaluated in unadjusted and survey-adjusted multivariable regression models.

**Results:** Anemia affected 42%, 32%, 36% and 28% in children, adolescents, non-pregnant and pregnant women, respectively. Children 24-59 mo were at lower risk [OR (95% CI): 0.4 (0.3-0.7) than 6-11 mo olds, as were girls [0.7 (0.5-0.9)] versus boys. Stunted and overweight children were at higher risk [1.5 (1.1-2.1) and 3.7 (1.4-9.5), respectively] than normal height/weight children. Child feeding practices were not associated with anemia. Adolescent and adult women's risk was lower in the East [0.7 (0.5-1.0) and 0.7 (0.5-0.8)] than West region. Older adolescents (15-19 yrs) were at higher risk than 10-14 yr olds [1.5 (1.1-2.2)]. A protective odds was observed for adolescents in households consuming animal foods 1-6 versus zero, but also, paradoxically, ≥7 times per week. Among non-pregnant women, risk was higher at 30-39 and 40-49 years [1.2 (1.0-1.6) and 1.4 (1.0-1.8), respectively], versus 20-29 yrs. Primary versus no schooling was protective [0.7 (0.6-0.9)], as was being married [0.4 (0.3-0.6)] versus unmarried and having a child <5 yr [0.8 (0.6-1.0)] versus not. Beginning antenatal care (ANC) in the first trimester may have put pregnant women at lower risk [0.4 (0.1-1.1)]. In survey design-adjusted regressions, point estimates were unchanged but most CIs contained 1.

**Conclusions:** Age, region, socioeconomic status and possibly diet pose diverse risk associations with anemia in Bhutanese children and women. National ANC coverage including IFA supplementation may have reduced anemia among pregnant women.

<footnote>(1)Marques de Sousa, Mariana Izabel; (2)de Aquino, Rita de Cássia;</footnote>

<footnote>(2)Nogueira Previdelli, Agatha; (3)Império de Freitas, Tatiana; (4)de Jesus dos Santos, Amanda.</footnote>

<footnote>(1)MSc. Nutritionist. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil;</footnote>

<footnote>(2)PhD. Professor. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil.; (3)MSc.</footnote>

<footnote>Professor. Universidade Cruzeiro do Sul. São Paulo. Brazil.; (4)MSc Student. Nutritionist. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu. São Paulo. Brazil.</footnote>

<footnote>(1)Campbell, Rebecca; (2)Aguayo, Victor; (3)Kang, Yunhee; (4)Dzed, Laigden; (5)Joshi, Vandana; (6)Waid, Jillian; (7)Haselow, Nancy; (8)West, Jr., Keith.</footnote>

<footnote>(1)PhD. Postdoctoral Fellow. Johns Hopkins Bloomberg School of Public Health. USA.; (2)PhD. Associate Director. Chief Nutrition Program Division. UNICEF. USA.; (3)PhD. International Health. Johns Hopkins Bloomberg School of Public Health. USA.;</footnote>

<footnote>(4)Ministry of Health. Government of Bhutan. Bhutan.; (5)MBBS. MPH. Chief Health Nutrition and WASH section. UNICEF Bhutan. Bhutan.; (6)Director. Research, Learning, and Evaluation. Helen Keller International. Bangladesh.; (7)Vice President. Asia-Pacific. Helen Keller International. Cambodia.; (8)DrPH. Professor.</footnote>

<footnote>International Health. Johns Hopkins Bloomberg School of Public Health. USA.</footnote>
en; scaling supplementation for other demographic groups may reduce anemia further, though other potential causes (e.g., thalassemias) should also be investigated.

**Keywords:** Anemia, risk factors, Bhutan

(1)Kimani-Murage, Elizabeth; (2)Wanjohi, Milka; (3)Kamande, Eva;

(2)Macharia, Teresa; (4)Muiruri, Juliana; (5)Samburu, Betty; (6)Kiige, Laura;

(7)Musoke, Rachel; (8)Amundson, Kimberly; (9)Israel-Ballard, Kiersten.

(1)PhD. Research Scientist.African Population and Health Research Center. Kenya; (2)BSc. Research Officer. Health Program. African Population and Health Research Center. Kenya.; (3)MSc. Research Officer. Health Program. African Population and Health Research Center. Kenya.; (4)BSc. Human Milk Banks Coordinator. Maternal and Child Health and Nutrition Program. PATH. Kenya.; (5)MSc. Program Manager.Maternal Infant and Young Child Nutrition. Nutrition and Dietetics Unit. Ministry of Health. Kenya.; (6)Msc. Nutrition Specialist. Maternal Infant and Young Child Nutrition and HIV/Aids. UNICEF. Kenya.; (7)PhD. Pediatrician. Departments of Pediatric. University of Nairobi. Nairobi. Kenya.; (8)MSc.Program officer. Maternal and Child Health and Nutrition. PATH. USA.; (9)PhD. Technical Officer. Maternal and Child Health and Nutrition Global program. PATH. USA.

**Background and objectives:** Kenya has a high burden of neonatal deaths (22/1,000 live births). Breastfeeding is among the most effective interventions for reducing infant mortality but some babies lack access to breastmilk due to mother's sickness, unavailability, or death. World Health Organization recommends Donor Human Milk (DHM) as the best alternative, for vulnerable infants without access to mother's own milk (MOM). However, Kenya has not implemented the best practice of providing safe DHM from Human Milk Banks (HMB), for children without access to MOM. This study aims to establish the perceptions and acceptability of donating and using DHM and the perceived barriers and facilitators in establishing HMBs.

**Methods:** The study was conducted in Nairobi.Quantitative interviews were conducted in three health facilities with 980 mothers of children under 3 years. Qualitative interviews included 17 focus group discussions, 29 key informant interviews and 25 in-depth interviews, with mothers, fathers, and other community members, health professionals and policy makers. Descriptive analysis of quantitative data was done in STATA 13 software while qualitative interviews were transcribed verbatim, coded using NVIVO and analyzed thematically.

**Results:** HMBs and use of DHM were new concepts to over 70% of the mothers. Majority of the participants had a positive attitude towards donating breastmilk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM on their own children (56%). The main concerns on donating and use of DHM were personal dislike, fear of diseases including HIV, hygiene concerns and cultural beliefs.Testing DHM for contamination, Sterilizing DHM and the processing equipment, enhancing personal hygiene were recommended to ensure DHM safety. Community education and involvement in the establishment of HMBs, multidisciplinary approach and assurance on the safety and quality of the DHM were proposed as important ways of enhancing the acceptability and successful establishment of the HMBs.

**Conclusions:** The Findings show potential feasibility of establishing HMBs in Kenya, and are useful in HMB's guidelines development and informing future actions towards establishment of HMB in Kenya, as a strategy to promote optimal child health and nutrition.

**Further collaborators**

Gladys Mugambi. MSc. Head of Human Human Nutrition and Dietetics Unit.Ministry of Health. Kenya.

Allan Govoga. BSc. Program Officer. Newborn Child and Adolescent Health Unit. Ministry of Health. Kenya.

Lucy Gathigi.Msc.Monitering and Evaluation Manager.Nutrition and Dietetics Unit.Ministry of Health. Kenya.

Thomas Ngwiri. MD. Head of Clinical Services Program.Gertrude's Children's Hospital. Nairobi.Kenya.

Waithera Mirie. PhD. Lecturer.School of Nursing. University of Nairobi. Kenya.

Paula Griffiths. PhD. Reader in Biosocial Science and Programme Director. Human Biology. Centre for Global Health and Human Development. School of Sport Exercise and Health Sciences. Loughborough University. United Kingdom.

Richard Lilford. PhD. Professor of Public Health. University of Warwick. United Kingdom.

Nyovani Madise.PhD. Associate Dean (Research). Faculty of Social and Human Sciences University of Southampton. United Kingdom.

Stephen McGarvey. PhD. Director. International Health Institute. Brown University. USA.

(1)Sal, Francisco; (2)Salazar Burgos, Ramiro; (3)Lacunza, Betina;

(4)Fernandez, Noelia; (5)Caballero, Valeria; (6)Filgueira, Josefina;

(7)Diaz, Yanina; (8)Ale, Marcelo.

(1)Nutricionist. Saint Tomas of Aquino University of North. Argentina; (2)Nutritionist. Conicet. National University of Tucumán. Argentina.; (3)PhD. Psychology. Conicet. National University of Tucumán. Argentina; (4)Nutritionist. Saint Thomas of Aquino University of North. Argentina; (5)Psychology. National University of Tucumán. Argentina; (6)Nutritionist. Si.Pro.Sa. (Sistema Provincial de Salud). Argentina.; (7)Psychology. Saint Thomas of Aquino University of North. Argentina.

**Background and objectives:** Literature indicates that socioeconomic disparities affect health, due to a reduced presence of physical, ecological and psychosocial protective resources.

The objective was to evaluate the relationship between nutritional status, eating habits and salutogenic environment indicators in rural Tucuman adolescents.
**Methods:** Anthropometric Measurements (Weight, Height, BMI) according to WHO criteria.

Structured questionnaire of Food Habits with descriptive rat-
ing scale of 5 categories (designed for this study).

Structured questionnaire of salugenic environment indicators (presence of tap water, waste collection and presence of sewers). The environment was considered salugenic when the respondent had at least one of these indicators.

Sample: 167 adolescents students of low and medium socioec-
onomic level between 11 and 18 years (57% were women), from
rural schools of the province of Tucumán. It was stratified into 2
subgroups: Clinical group (over weight) and Control group (regu-
lar weight). There is no incidental type probabilistic.

**Results:** The clinical group presented a greater absence of salu-
genic environmental indicators than the control group (24% vs. 21%).

Comparing the clinical and control groups with eating habits,
the control group represented a higher consumption in the catego-
ries of “always and always” protective foods (fruits, vegetables, dairy
products and eggs) and hypercaloric (sweets, ice cream, chocolates).
The clinical group had a lower consumption of protective foods.

Relating eating habits and indicators of the salugenic environ-
ment, it was found that in the categories “never and almost never”
the consumption of healthy foods (beef, fish, eggs, fruits, vegeta-
bles and dairy products) the percentages were higher in people
who did not present Indicators of salugenic environment than in
their peers who responded to have at least one indicator (Fish 39%
vs. 29%, vegetables 31% vs. 11% and milk 54% vs. 28%).

Regarding the consumption of hypercaloric foods (sweets, ice cream, chocolates and soft drinks), a greater proportion of “always / almost always” responses were observed among adolescents with not salugenic environment indicators in this food group (81 Vs. 45%, 50% vs. 28%, 61% vs. 35%).

**Conclusions:** Rural adolescents belonging to less salugenic en-
vironments reported higher consumption of hypercaloric foods.
These data are relevant for the design of interdisciplinary intervention
strategies focused on food and surrounding ecological contexts.

**Keywords:** Nutritional status, eating habits indicators of salu-
genic environment

(1)Bedford, Juliet; (2)Johnson, Ginger; (3)Jones, Theresa; (4)Gercama, Ingrid; (5)Vandyke, Hanneke; (6)Halati, Siti; (7)Aburmishan, Dina; (8)Oliva, Maritza; (9)Bose, Indira; (10)Kiess, Lynnda.

(1)DPhil. Anthropologist. Anthrologica. UK.; (2)PhD. Anthropologist. Anthrologica. USA.; (3)ClinicPsyD. Anthrologica. Kenya.; (4)MSc. Anthropologist. Sierra Leone.; (5)MS MALD. Nutritionist. Nutrition Unit. World Food Programme. Cambodia.; (6)MPH. Nutritionist. Programme Unit. World Food Programme. Uganda.; (7)MPH. Nutritionist. Analysis Trends and Innovation Unit. World Food Programme. Kenya.; (8)MPH. Nutritionist. World Food Programme. Guatemala.; (9)MPH. Office of Nutrition. World Good Programme. Italy.; (10)MPH. Office of Nutrition. World Good Programme. USA.

**Background and objectives:** Addressing the nutritional needs of adolescent girls is a key step towards achieving SDG 2, Target 2.2, ending malnutrition by 2030. This formative study provides a landscape analysis of adolescent programming in four high priority countries (Kenya, Uganda, Cambodia and Guatemala) and presents new empirical data on perceptions and experiences of adolescents regarding nutrition and engagement platforms particularly aimed at reaching the most vulnerable.

**Methods:** The collaborative study was conducted in three phases. First, a country landscape analysis of adolescent programming categorized the focus, timeframe and location of interventions, target group (age, ethnicity, gender), modes of engagement, and key programme implementer(s). Second, formative qualitative research using participatory creative methodologies elicited perspectives, experiences and suggestions from adolescents and their communities. Third, data was synthesized to provide evidence to improve the design of nutrition-specific and nutrition-sensitive interventions for adolescents across different contexts. Adolescents participated from a range of communities including food insecure pastoralists, rural agriculturalists, settled refugees, remote ethnic minorities, and urban and slum communities.

**Results:** Final results will be available by June. Initial stakehold-
er mapping indicated a wide range of government, non-governmen-
tal and private sector engagement with adolescents, with different
policy and operational environments influencing the focus of inter-
ventions and modes of engagement. Preliminary analysis highlight-
ed that the concept of 'adolescence' is varied, that nutrition is one
of several key areas of intervention alongside education, sexual re-
productive health, gender-based violence and employment oppor-
tunities. Thematic synthesis across the four countries will identify
points of convergence and divergence in engaging with adolescents
in different contexts and operational environments.

**Conclusions:** Increasing the visibility, priority and engage-
ment of adolescents is critical. Evidence can be operationalized
to develop adolescent friendly, context specific interventions and
appropriate modes of engagement that can positively influence
health- and nutrition-related behavior, and encourage the timely
utilization of services by adolescents.
**Keywords:** Adolescents

Girls

Formative research

Qualitative

Participatory

Gloria Aguilar

Ximena Rose Marie Zayas Cáceres

Lourdes Maria Regina Elizeche Serra

Eliana Araceli Cantero Grissetti

Tamara Elizabeth Vidal Britos

Andrea Patricia Reyes García

144/1936

VALUATION OF NUTRITIONAL STATUS BY AN-
THROPOMETRIC METHODS AND BIOELECTRIC
IMPEDANCE IN SCHOOLSCHILDREN'S AND AD-
OLESCENTS OF PUBLIC AND PRIVATE SCHOOLS
IN THE CENTRAL DEPARTMENT

(1)Torres Giménez, María Elida; (2)Sanabria, Marta; (3)Meza Miranda, Eliana.

(1)Nutritionist. Paraguay.; (2)MSc. Doctor. Cathedra and Pediatric service. Faculty of Medical Sciences. National University of Asuncion. Paraguay; (3)PhD. Nutritionist. Teaching researcher. Multidisciplinary Center for Technological Research. National University of Asuncion. Paraguay.

**Background and objectives:** The nutritional status allows to focus groups of risk that present deficiencies and excesses. Child malnutrition is a public health problem in Paraguay. There are few national publications on body composition therefore a descriptive observational research with analytical component was designed to determine the nutritional status and body composition in school-children and adolescents attending Public and Private Educational Institutions of the Central Department.

**Methods:** A Sampling probabilistic, stratified, random study was conducted on 494 school children and adolescents between 6 to 17 years old attended public and private educational institutions in the Central Department during 2016. Anthropometric indicators were evaluated according to the current WHO growth curves.

**Results:** 50% of the sample was male. It was found 22.3% of Overweight malnutrition and 13.2% of overweight and obesity, 88% of normal height. There is a positive correlation between BMI and waist circumference (WC). As for the muscular area of the arm, 21% of the female population is with low protein reserve, 60% with normal protein reserve and 19% with high protein reserve. On the other hand, in the men, 32.4% had low protein reserves, 44.1% had normal protein reserves and 23.5% had high protein reserves. In reference to the women fat area, 90.6% showed a normal energy reserve, while 9% showed a high energy reserve. As for males, 74.5% showed a normal energy reserve and 25.1% high energy reserve.

**Conclusions:** Overweigh malnutrition is high among school-
children in the Central Department. The percentage of fat mass
measured by impedanciometry does not exceed the limit that is
25% for men and 30% for women. There is a positive correlation
between BMI and WC.

**Keywords:** nutritional Valuation, body composition, schoolschildren's, adolescents, malnutrition.

**Further collaborators**

Viviana Raquel Salomon de Torres

144/1938

DIETARY INTAKE AND BIOCHEMICAL PARAM-
ETERS RELATED TO BONE HEALTH IN WOMEN
OVER 65 YEARS OLD IN THE BUENOS AIRES
CITY, ARGENTINA

(1)Brito, Graciela Mabel; (2)Somoza, Julia; (3)Oliveri, Beatriz; (4)López, Laura Beatriz.

(1)BSc. Nutritionist. Escuela de Nutrición. Universidad de Buenos Aires. Argentina. Laboratorio de Enfermedades Metabólicas Óseas. Instituto de Inmunología Genética y Metabolismo (INIGEM) CONICET-UBA. Argentina.; (2)Laboratory Technician. Laboratorio de Enfermedades Metabólicas Óseas. Instituto de Inmunología Genética y Metabolismo (INIGEM) CONICET-UBA. Argentina.; (3)PhD. Medicine. Laboratorio de Enfermedades Metabólicas Óseas. Instituto de Inmunología Genética y Metabolismo (INIGEM) CONICET-UBA. Argentina.; (4)PhD. Nutritionist. Escuela de Nutrición. Universidad de Buenos Aires. Argentina.

**Background and objectives:** Both nutritional status and bone health influence elderly's health and quality of life. The aim of this study was to evaluate: the relationship between the nutritional status of vitamin D (VD) and biochemical markers of bone turnover; the relationship between the intake of Calcium (Ca), protein, VD and vitamin K (VK) and bone formation and resorption markers; the relationship between total osteocalcin (OC) and undercarboxylated osteocalcin (uOC) to VK intake and bone remodeling parameters.

**Methods:** 102 healthy women were evaluated, with age: (X±SD) 71±5 years, BMI 28.7±3.8 kg/m2. A validated food frequency questionnaire was used to asses' dietary intake. Serum 25 hydroxyvitamin D (25OHD), crossslaps (sCTX), bone alkaline phosphatase (BAP), calcium (sCas), phosphorus (sP), OC y unOC were determined in blood samples and calcium/creatinine ratio (uCa/uCr) in 24-hour urine samples.

Data were analyzed applying descriptive statistics, Kolmogoro-
rov-Smirnov, Mann-Whitney and Pearson or Spearman correla-
tion. Linear regression models were used to analyze the relation-
ship between numerical variables.

**Results:** Calcium, VK and VD intakes were lower than the rec-
ommended doses 79%, 33.7% and 100% of population respectively.
Median protein intake was 1.03 g/kg body weight/d, with 100% re-
porting intakes higher than the recommended. Vitamin D insuffi-
ciency affected 32.7% of women and deficiency 55.9%, higher levels
of sCTX were observed in those women with lower 25OHD levels.
There were significant (p<0.02) correlations between 25OHD and
sCa, sP, uCa/uCr and Ca intake. OC correlated directly with the
bone resorption marker: sCTX (p<0.0001), but not with the for-
mation parameters. In contrast, the unOC showed an inverse cor-
relation with BAP, no correlation with sCTX and was related with VK intake (p<0.0001). OC levels were lower in the deficiency and insufficient VD groups and were related to sCTX levels (p<0.0001).

**Conclusions:** The intake pattern was high in protein, and deficient in calcium, VD and VK. Poor vitamin D status affected 93% of women, with an increase in bone remodeling observed in severe deficiency. The ucOC was related to VK intake, so it could be considered an adequate indicator of its nutritional status, while OC and its relation to sCTX would reflect the increase in bone remodeling.

**Keywords:** Elderly, bone health, intake, nutritional status

144/1957

A BABY FRIENDLY COMMUNITY INITIATIVE IN KENYA: HARNESSING THE POTENTIAL OF THE COMMUNITY HEALTH STRATEGY IN ENHANCING MATERNAL AND CHILD NUTRITIONAL AND HEALTH STATUS IN RURAL KENYA

(1)Gatheru, Peter; (2)Kimani-Murage, Elizabeth; (3)Kimiywe, Judith;

(4)Wekesah, Frederick; (5)Muhia, Nelson; (6)Wanjohi, Milka; (7)Samburu, Betty.

(1)BA. Research Officer. Health Challenges and Systems. African Population and Health Research Center. Kenya.; (2)PhD. Research Scientist. Health Program. African Population and Health Research Center. Kenya.; (3)PhD. Nutrition. Assistant Professor. Department of Food, Nutrition and Dietetics. Kenyatta University. Kenya.; (4)MSc. Epidemiologist. Health Challenges and Systems Program. African Population & Health Research Center. Kenya.; (5)BA. Economist. Health Challenges and Systems Program. African Population & Health Research Center. Kenya.; (6)BSc. Research Officer. Health Challenges and Systems Program. African Population and Health Research Center. Kenya.; (7)MSc. Program Manager. Maternal Infant and Young Child Nutrition. Nutrition and Dietetics Unit. Ministry of Health. Kenya.

**Background and objectives:** Background:The Baby Friendly Community Initiative (BFCI) is a multifaceted program for the promotion of optimal breastfeeding and maternal, infant and young child nutrition practices in the community. BFCI extends the care provided at the health facility through the Baby Friendly Hospital Initiative (BFHI) to the community, while providing the mothers and their babies a comprehensive support system to improve breastfeeding practices and other maternal, infant and young child nutrition practices at the community level thereby bridging the gap between health facilities and the community.

**Objectives:** We present the design and implementation of the BFCI in rural Kenya, while highlighting its contribution to the improvement of maternal and child nutritional and health status. BFCI leverages on the community health strategy, a program established by the government of Kenya in 2007, and one that uses the vast network of community health volunteers to promote health care at the community level.

**Methods:** The BFCI is implemented within the community health strategy. The community units, which includes the com-

munity health volunteers (CHVs) and the community health committees (CHC) are sensitized on appropriate and optimal maternal, infant and young child nutrition practices. The CHVs are empowered and facilitated by knowledge and materials to provide home based counselling to pregnant women and breastfeeding mothers on maternal, infant and young child nutrition practices.

**Results:** The BFCI program in the rural community in Koibatek sub County, Baringo County engages about 260 CHVs, in 13 community units. From August 2015 to December 2016, CHVs have been actively involved in home visits and counselling of pregnant and breastfeeding women and their families in the community. BFCI also includes introduction of sustainable income generating activities, formation of community mother support groups which includes men and other community members as they influence feeding practices at household level.

**Conclusions:** Ultimately, we hope that the BFCI will: (i) strengthen the capacity for CHVs and the community members regarding MIYCN at community level; (ii) improve nutrition, health and survival of children substantially; and (iii) inform the design and implementation of ongoing and future interventions while advancing knowledge among the research community locally and internationally.

**Keywords:** Baby Friendly Community Initiative, breastfeeding

**Further collaborators:** Koibatek Sub County Health Management Team

144/1960

RELATIONSHIP BETWEEN CHOLINE METABOLITES AND DEVELOPMENTAL OUTCOMES IN HEALTHY TODDLERS AT 24 MONTHS-OF-AGE

(1)Wiedeman, Alejandra Wiedeman; (2)Chau, Cecil; (3)Grunau, Ruth;

(4)McCarthy, Deanna; (5)Yurko-Mauro, Karin; (3)Innis, Sheila; (3)Devlin, Angela M.

(1)PhD candidate. Department of Pediatrics. University of British Columbia and BC Children's Hospital Research Institute. Vancouver. Canada.; (2)MSc. Department of Pediatrics. University of British Columbia and BC Children's Hospital Research Institute. Vancouver. Canada.; (3)PhD. Department of Pediatrics. University of British Columbia and BC Children's Hospital Research Institute. Vancouver. Canada.; (4)RD. DSM Nutritional Products. Columbia. MD. USA.; (5)PhD. DSM Nutritional Products. Columbia. MD. USA.

**Background and objectives:** Choline is an essential nutrient that plays an important role in growth and development and is the precursor of acetylcholine, phosphatidylcholine, and the methyl donor betaine. There is limited data on choline status of infants and toddlers and the potential relationship to neurodevelopmental outcomes. The objective of this study was to assess choline status in healthy toddlers at 12 and 24 months-of-age and to determine relationships to neurodevelopment.

**Methods:** Participants were part of a prospective longitudinal double blind controlled study of arachidonic acid (ARA) and docosahexaenoic acid (DHA) supplementation of toddlers between 12 and 24 months-of-age (24 months). Plasma free cho-
line, betaine, and dimethylglycine concentrations were quantified by liquid chromatography tandem mass spectrometry at baseline (13.4±0.9 months-of-age; mean±SD) and 24 months; developmental outcomes were assessed by the Bayley Scales of Infant and Toddler Development 3rd Ed (Bayley-III) Cognitive and Language composites, and Beery-Buktenica Developmental Test of Visual-Motor Integration (5th Edition) (Beery) at 24 months. Relationships between choline metabolites and developmental outcomes at 24 months were determined by separate general linear models adjusted for sex, supplement group, maternal nonverbal intelligence (TONI-3), and baseline concentrations.

**Results:** At baseline (n=122) plasma free choline, betaine, and dimethylglycine concentrations [median (IQR)] were 9.8 (8.1-12.3), 36.2 (30.8-47.7), and 3.7 (2.9-2.8) µmol/L, respectively. Plasma free choline, betaine, and dimethylglycine concentrations at 24 months (n=103) were 8.1 (6.9-9.5), 37.5 (31.2-45.0), and 2.9 (2.3-3.6) µmol/L, respectively. The DHA/ARA supplement had no effect on plasma choline metabolites at 24 months but plasma free choline and dimethylglycine concentrations were lower (P<0.001) at 24 months compared to baseline. Plasma betaine concentrations were positively associated with Bayley III Language composite scores (B=59.4, P=0.002) at 24 months but no relationships were found with the Bayley III Cognitive or Beery scores. No associations between plasma free choline or dimethylglycine and neurodevelopment tests were observed.

**Conclusions:** This finding suggests a positive relationship between plasma betaine concentrations and language development in healthy toddlers at 24 months-of-age. Additional work is required to investigate this relationship further and to delineate choline metabolism in toddlers and its role in neurodevelopment.

**Keywords:** Choline, betaine, development, toddlers, long chain polyunsaturated fatty acids

obesity, as dietary patterns and eating habits are often formed in childhood, and persist through adolescence into adulthood. Parents can be seen as 'agents of change' in the recognition and treatment of childhood obesity. However, they usually fail to recognize their child excessive weight. The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated to underestimation.

**Methods:** Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of two-to-eight-year-old children (n=976) completed a self-reported questionnaire about their perception of child weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, we estimated the Kappa coefficient, and to investigate associations between parental underestimation and independent variables, we calculated chi-square tests, followed by multiple logistic regression model, considering p≤0.05 for statistical significance.

**Results:** Overall, 48.05% of the parents incorrectly classified their child's weight; more particularly, 45.08% underestimated their child's weight status. Logistic regression demonstrated that children with higher body mass index (OR=2.03; p<0.001) and boys (OR=1.70; p<0.001) were more likely to have their weight status underestimated by parents. The poor agreement of parent's perception and child's weight status was also confirmed by the Kappa coefficient (0.038).

**Conclusions:** Clinical practitioners should focus their interventions on these children to assist parents to correctly evaluate their child weight status. The awareness of parents about a weight problem in children is essential towards the prevention and treatment of childhood obesity, and healthy lifestyles.

**Keywords:** Weight perception; pediatric obesity; parent-child relations; overweight; child.

144/1961

## FACTORS ASSOCIATED WITH PARENT'S UNDERESTIMATION OF CHILD'S WEIGHT STATUS: A STUDY IN BRAZIL

(1)Amaral Mais, Laís; (2)Warkentin, Sarah; (3)Dias de Oliveira Latorre, Maria do Rosário; (4)Carnell, Susan; (5)de Aguiar Carrazoed Taddei, José Augusto.

(1)MSc. Nutritionist. Discipline of Nutrology. Department of Pediatrics. Federal University of São Paulo. Brazil; (2)MSc. Nutritionist. Discipline of Nutrology. Department of Pediatrics. Federal University of São Paulo. Brazil.; (3)PhD. Statistician. School of Public Health. Department of Epidemiology. University of São Paulo. Brazil.; (4)PhD. Psychologist. Division of Child & Adolescent Psychiatry. Department of Psychiatry and Behavioral Sciences. Johns Hopkins University School of Medicine. United States of America.; (5)PhD. Epidemiologist. Discipline of Nutrology. Federal University of São Paulo (UNIFESP). Department of Pediatrics. Brazil.

**Background and objectives:** Childhood overweight is a recognized public health problem, including in Brazil. Early intervention is critical in the prevention and treatment of overweight and

144/1968

## STRENGTHENING OF THE ESSENTIAL NUTRITION ACTIONS (ENA), AT THE PRIMARY LEVEL HEALTH SERVICES ON 30 MUNICIPALITIES OF THE WESTERN HIGHLANDS FROM GUATEMALA

(1)Alfaro, Norma; (2)Corado, Ana; (3)Arroyo, Gustavo; (3)Perez, Wilton.

(1)MSc. Department of Development of Human Resources. Institute of Nutrition of Central America and Panama. Guatemala.;

(2)Nutritionist. Department of Development of Human Resources. Institute of Nutrition of Central America and Panama. Guatemala;

(3)PhD. Department of Monitoring and Evaluation. Institute of Nutrition of Central America and Panama. Guatemala.

**Background and objectives:** Guatemala is ranked as the sixth country worldwide and the first in Latin America with the highest prevalence of stunting in children less than five years old. Data shows a national prevalence of 46.5% in 2014-2015, mostly focused on the population located at the western highlands of the country. In order to contribute to the Government's efforts to battle this
problem a project based on interventions to address mother-child
health and nutrition during the first 1,000-day window of oppor-
tunity, which efficacy has been widely recognized, and also based
on the Normative Framework of the Ministry of Health (MOH)
for the primary level of attention was promoted. This study aims to
strengthen the capabilities of the primary level health workers at 30
municipalities of the western highlands from Guatemala, to provide
nutrition actions to reduce stunting in Guatemala.

**Methods:** A project based on the analysis of needs and conditions of the environment was generated, which started with the collaborative work among the international cooperation, INCAP and the MOH on its different levels of organization and implementation, afterwards the curricula of the program supported by the MOH and the methodology of implementation were designed, including the training addressed to trainers. The topics included were: nutrition of the pregnant woman, breastfeeding, complementary feeding and feeding of a sick child, water, hygiene and sanitation, growth monitoring and promotion and effective counseling. The topic of self-esteem was included in order to promote the appreciation of the human resource as an agent of change. A process of monitoring and evaluation was applied.

**Results:** The model was carried out in two cohorts, which trained 97 trainers, 1,163 health workers. An 18% of increase on knowledge acquired was reached. Educational printed and multimedia materials were created. The collaborative work at all levels, favored the positioning of the topic related to the first 1,000-day window of opportunity at the MOH and the transference of the program.

**Conclusions:** The feasibility, realignment and interinstitutional coordination were essential for the achievement of results and will be key for sustainability.

**Keywords:** Forming and training, stunting, 1,000-day window of opportunity, essential nutrition actions.

erature. While accurately assessing adiposity can be expensive and invasive, waist circumference (WC) adjusted for total body weight is a cost-effective and useful maker of body fat distribution. The aim of this study was to determine the association between height trajectories during the preschool years and WC in late childhood.

**Methods:** Study participants were a sub-sample that partic-
ipated in the 8-10 y follow-up of the POSGRAD study, a dou-
ble-blind, randomized, placebo-controlled trial of prenatal DHA
supplementation. Sex-specific height latent class trajectories were
derived from 11 measures of height from birth to 5 years of age.
MPlus version 7.3 was used in the derivation of trajectories using
latent class growth analysis. At ages 8-10, WC (to the nearest 1
mm) was measured at the smallest horizontal circumference be-
tween the costal margin and the iliac crests. Multivariable linear
regression models were used to determine the relationship be-
tween growth trajectory classes and WC in late childhood. Covar-
iates included in the analysis were current body weight (kg), SES
(low, medium and high), parity and maternal schooling. Regres-
sion analyses were conducted using STATA 14.

**Results:** We included 281 boys and 255 girls. Two height classes were determined for girls [low (58%), high (42%)] and three for boys [low (17%), medium (51%) and high (32%)]. In boys, relative to the intermediate growth class, the high trajectory class had lower waist circumference in late childhood $\beta$ = -1.15 cm 95% CI (-2.27 - -0.03) after controlling for covariates, while no significant associations were found the low trajectory class. For girls, the high class had lower waist circumference relative to the low class, $\beta$= -1.06 cm, 95%CI (-1.93 - -0.20).

**Conclusions:** In this study, children who followed the higher growth trajectory through 5 years of age, had lower waist circumference in late childhood. This suggests that children with shorter stature during the first 5 years of life are at a higher risk of becoming overweight or obese.

**Keywords:** child nutrition, latent class growth analysis, height, waist circumference, BIA, Anthropometry

**Further collaborators**

Supported by NIH grants HD-043099, HD-058818 and Grant
Sectorial CONACYT 202062

144/1982

HEIGHT TRAJECTORIES AND WAIST CIRCUM-
FERENCE IN LATE CHILDHOOD OF MEXICAN
CHILDREN

**Background and objectives:** The relationship between fast early growth and adiposity has been of particular interest in the lit-

<footnote>(1)Barrios, Pamela L.; (2)Rivera, Juan; (3)Garcia-Feregrino, Raquel;</footnote>

<footnote>(4)Barraza-Villarreal, Albino; (4)Romieu, Isabelle; (5)Gonzalez-Casanova, Ines; (5)Stein, Aryeh,; (5)Ramakrishnan, Usha; (6)Hoffman, Daniel J.</footnote>

<footnote>(1)MSc. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.; (2)PhD. Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (3)MSc. Health and Nutrition Research Center. National Institute of Public Health. Mexico.;
(4)Population Health Research Center. National Institute of Public Health. Mexico.; (5)PhD. Hubert Department of Global Health. Rollins School of Public Health. Emory University. United States.;
(6)PhD. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.</footnote>
# EFFECTS OF TWO FORMS OF DAILY PREVENTIVE ZINC AND THERAPEUTIC ZINC SUPPLEMENTATION FOR DIARRHEA ON GROWTH AND ACQUISITION OF DEVELOPMENTAL MILESTONES IN RURAL LAOTIAN CHILDREN: A RANDOMIZED TRIAL

(¹)Barffour, Maxwell A; (²)Hinnouho, Guy-Marino; (³)Kounnavong, Sengchanh; (⁴)Wessells, K. Ryan; (³)Ratsavong, Kethmany;

(³)Bounheuang, Bangone; (³)Chanhthavong, Bigphone; (⁴)Arnold, Charles D.; (⁵)Brown, Ken; (¹)Hess, Sonja.

(¹)PhD. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA;

(²)MD-PhD. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA;

(³)MD. National Institute of Public Health. Vientiane. Lao People's Democratic Republic (PDR); (⁴)M.S. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA; (⁵)MD. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. CA. USA and Bill & Melinda Gates Foundation. Seattle. WA. USA.

**Background and objectives:** Evidence is needed on the optimal strategy for delivering zinc to improve growth and other zinc-related functional health outcomes in children. In this double-blind, placebo-controlled, randomized trial, we determined the impact of providing daily preventive zinc tablets (7 mg/d), daily multiple micronutrient powder sachets (containing 10 mg zinc, 6 mg iron and 13 other micronutrients), therapeutic zinc supplements for diarrhea treatment (20 mg/d for 10 days) or daily placebo powder, on growth and acquisition of motor and language developmental milestones in young children in rural Lao PDR.

**Methods:** 3433 children 6-23 months old at enrollment were randomized to one of four intervention groups and followed weekly for ~9 months. Weight and length were assessed at baseline and endline, 32-40 weeks later. Motor milestones (crawling, sitting without support, standing with assistance, standing alone, walking with assistance, walking alone, running, eating, drinking and waving) and language acquisition were assessed weekly by caregiver report and monthly by observation. We compared final height-for-age, weight-for-age, and weight-for-height z-scores, and stunting, underweight and wasting prevalence, and age of acquisition of developmental milestones among the 4 groups using linear or logistic regression (anthropometric outcomes) and cox proportional hazard models (milestone acquisition), controlling for age and baseline values. Intervention groups are still masked.

**Results:** Groups were comparable regarding age, anthropometric scores and attained milestones at baseline. Mean age at baseline was 14.2 ± 5.1 mo; and there was a high prevalence of stunting (37.9%), underweight (26.0%) and wasting (7.9%). We observed a marginally significant treatment effect on the prevalence of final stunting (34.8-41.2% across the groups), wasting (3.8-6.6%) and underweight (22.3-24.9%). There were no between-group differences in final anthropometric indices. We observed a significant treatment effect on reported or observed onset of crawling, sitting

without support, standing with assistance, standing alone and walking with assistance but not on other milestones.

**Conclusions:** Endline stunting, wasting and underweight were marginally different and onset of crawling, sitting without support, standing with assistance, standing alone, and walking with assistance differed significantly by treatment group after ~9 months of supplementation. Specific pairwise differences will be identified when codes are revealed.

**Keywords:** Zinc supplementation strategy, growth, developmental milestones

**Conflict of Interest Disclosure:** KHB works for the Bill & Melinda Gates Foundation, which provided part of the financial support. The spouse of SYH works for the Bill & Melinda Gates Foundation. KRW and SYH received non-monetary support from Nutriset SAS. None of the other authors have a conflict of interest to declare.

**Further collaborators** : Dalaphone Sitthideth (MD. National Institute of Public Health, Vientiane, Lao People's Democratic Republic (PDR))

(Khanpaseuth Sengnam) MD. National Institute of Public Health, Vientiane, Lao People's Democratic Republic (PDR)

# TIMELY COUNSELLING AS A STRATEGY TO IMROVE AGE APPROPRIATE INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES AMONG MOTHERS FROM URBAN SLUMS OF VADODARA

(¹)Chandorkar, Suneeta; (²)Patil, Priyanka.

(¹)PhD. Nutritionist. Department of Foods and Nutrition. The Maharaja Sayjirao University of Baroda. Vadodara; (²)MSc. Department of Foods and Nutrition. The Maharaja Sayjirao University of Baroda. Vadodara.

**Background and objectives:** Good nutrition during first 1000 days of life can give a good head start to a child to achieve his/ her physical and cognitive potential. Therefore, the present study aimed at capacity building of health functionaries to improve Infant and Young Child Feeding (IYCF) practices among mothers of urban slums of Vadodara.

**Methods:** Counselling regarding age appropriate IYCF practices was provided to pregnant women in last trimester and lactating mothers (N=57) by Anganwadi Workers (AWWs; service provider under ICDS government nutrition health program), doctors and nurses for 3 months once every month. The pregnant women formed the intervention group 1, younger lactating women (4-6 months) formed the intervention group 2 and older lactating women (7-9 months) formed the intervention group 3. Perceptions and practices of mothers were assessed at baseline and post intervention.

**Results:** Sixty five percent of the mothers in intervention group 1 initiated breastfeeding within 1 hour after birth and 96% fed colostrum to the child. Intervention group 2- Exclusive breastfeeding practices were good and majority of the mothers knew about correct age of introduction of complementary foods but percep-
tions regarding quality, quantity and frequency of feeding comple-
mentary foods were poor. Post intervention 85% of the mothers
fed solid, semi solid or mushy foods along with breast milk. Inter-
vention group 3- The rates of feeding appropriate quality, quantity
and frequency of complementary foods were average at baseline in
children 7-9 months. Forty three percent of the mothers fed 3 or
more food groups at baseline while the same increased to 86% at
the end of intervention. Forty three percent of the mothers started
feeding adequate quantity of food after intervention. Knowledge
and attendance of mothers at mamta day and annaprashan day
(nutrition days celebrated under ICDS) were poor at baseline and
marginal improvement was observed after intervention.

**Conclusions:** Counselling by AWWs and doctors was found to bring about improvement in age appropriate IYCF practices in intervention group 2 and 3. Timely counselling on age appropriate feeding practices can bring about significant improvement in adoption of age appropriate IYCF practices.

**Keywords:** 1000 days, age appropriate IYCF practices, complementary feeding

144/1997

EFFECT OF MULTIPLE MICRONUTRIENT SUP-
PLEMENTATION IN LACTATING WOMEN ON
INFANT GROWTH AND MORBIDITY: A DOU-
BLE-BLIND RANDOMIZED CONTROLLED TRIAL
IN RURAL BURKINA FASO

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

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

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

**Methods:** In a randomized controlled trial in rural Burkina Faso, 1426 pregnancies were allocated to daily supplementation

with either UNIMMAP (intervention) or IFA (control) for three
months after delivery. In total, 1296 mothers with live births were
enrolled in the study. Daily tablet intake was directly observed by
trained community workers. Anthropometry, morbidity and he-
moglobin concentration of infants were measured monthly until
the first birthday.

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

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

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

144/2001

EARLY LIFE HEIGHT TRAJECTORIES AND LATE
CHILDHOOD ADIPOSITY IN MEXICAN CHILDREN

(1)Barrios, Pamela L.; (2)Rivera, Juan; (3)Garcia-Feregrino, Raquel;

(4)Barraza-Villarreal, Albino; (5)Romieu, Isabelle; (6)Gonzalez-Casanova,

Ines; (6)Stein, Aryeh.; (6)Ramakrishnan, Usha; (7)Hoffman, Daniel J.

(1)MSc. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States;

(2)Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (3)MSc. Health and Nutrition Research Center.

National Institute of Public Health. Mexico.; (4)PhD. Population Health Research Center. National Institute of Public Health.

Mexico.; (5)Population Health Research Center. National Institute of Public Health. Mexico.; (6)PhD. Hubert Department of Global Health.

Rollins School of Public Health. Emory University. United States.;

(7)PhD. Department of Nutritional Sciences. New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.

**Background and objectives:** In Mexico, childhood obesity is a major public health concern, with a current prevalence of 34.4 % in school-aged children classified as overweight or obese. Previous research suggests that poor growth during early childhood may increase the risk of obesity, but others have reported that the rate of growth is more important than size at birth or early nutritional status. Therefore, the objective of this study was to determine if distinct trajectories of growth are associated with body fat mass (FM) in late childhood.
**Methods:** Study participants were a sub-sample that partic-
ipated in the 8-10 y follow up of the POSGRAD study, a dou-
ble-blind, randomized, placebo-controlled trial of prenatal DHA
supplementation. Sex-specific height latent class trajectories were
derived from 11 measures of height from birth to 5 years of age us-
ing MPlus v.7.3. Body composition and anthropometric measures
were obtained between ages 8-10 years. Body composition was
estimated using validated equations for Mexican children based
on the measures from a tetrapolar bioimpedance analyzer (Imped-
imed DF50). Multivariate linear regression was used to determine
the relationship between growth trajectory classes and FM (kg)
in late childhood, controlling for current body weight (kg), SES
(low, med and high), parity and maternal education. All statistical
analyses were conducted with STATA 14.

**Results:** 255 girls and 281 boys and were included. Two height latent classes were identified in girls [low (58%) and high (42%)] and three classes in boys [low (17%), medium (51%) and high (32%)]. Mean FM in girls (high and low) and boys (high, medium, low) per class were 12.66 kg and 8.99 kg and 10.76 kg, 8.97 kg and 8.39 kg, respectively. In girls, there were no significant associations between classes and FM. In boys, relative to the intermediate growth class, the low class had higher FM $\beta$ = 0.69 kg, 95% CI (0.26 - 1.11) and the high class had lower FM in late childhood $\beta$ = -0.40 kg, (-0.76 - -0.05).

**Conclusions:** Among boys, more rapid growth in early child-
hood is associated with lower adiposity in late childhood com-
pared to children who grew slower.

**Keywords:** child nutrition, latent class growth analysis, height, fat mass, BIA

**Further collaborators:** Supported by NIH grants HD-043099, HD-058818 and Grant Sectorial CONACYT 202062

We aimed to investigate the long-term influence of maternal obe-
sity and gestational diabetes (GD) during pregnancy on their chil-
dren diet up to 6 years of life.

**Methods:** 119 children participating in the PREOBE study, born to overweight (n=16), obese (n=15), GD (n=35), and healthy normal weight pregnant women (n=53) were included in the present analysis. Children dietary intake was recorded using three days 24h dietary record (2 working days and 1 weekend day). Quantification of nutrient intake by each child was performed by using the DIAL nutritional software. MANCOVA were performed using SPSS version 23.0, and the results were adjusted for confounding factors (maternal age, weight gain during pregnancy, maternal education and family status). Bonferroni corrected post hoc comparisons were used to identify significant group differences.

**Results:** Children born to GD mothers showed higher levels of fatty acids and trans- fatty acids intake than those born to normal weight (p=0,013 and p=0,006;respectively) and overweight mothers (p=0,026 and p=0,008;respectively). Children born to GD mothers showed higher levels of monounsaturated fatty acids (MUFA)-cis than those born to normal weight (p=0,034) and MUFA-trans respect to those born to normal weight and overweight mothers (p=0,031 and p=0,013;respectively). The intake of polyunsaturated fatty acids-trans were higher in children born to GD mothers than in those born to normal weight or overweight mothers (p=0,005 and p=0,002;respectively).

**Conclusions:** At 6 years of age, children born to mothers who developed GD show an inadequate dietary intake of trans fatty acids from manufactured foods. Diabetic pregnant women are included by routine in medical and nutritional programs to prevent undesirable problems during pregnancy and on their offspring, and furthermore after this intervention, an improvement of their eating habits is usually expected. However, the present results reflect the turn back to poor eating habits in the diabetic mothers which are translated into their offspring up to school age. The consequences of this fact are unknown. Behavioural programs are needed to maintain healthy eating habits in the mothers and children.

**Keywords:** Gestational diabetes, Diet, trans fatty acids

**Conflict of Interest Disclosure:** Supported by the Andalu-
sian Government, Economy, Science and Innovation Ministry
(PREOBE Excellence Project Ref. P06-CTS-02341), the Span-
ish Ministry of Economy and Competitiveness. Ref. BFU2012-
40254-C03-01and Ref. SAF2015-69265-C2-2-R.MyNewGut, GA:
613979. DynaHEALTH, GA: 633595.

**Further collaborators:** PREOBE Research Group.

144/2003

THE DEVELOPMENT OF GESTATIONAL DIABETES
IS LINKED TO HIGHER INTAKE OF TRANS FATTY
ACIDS IN THEIR CHILDREN AT 6 YEARS OLD. A
FOLLOW-UP FROM THE PREOBE COHORT

(1)Torres-Espínola, Francisco José; (2)Arias, Miriam; (2)Escudero Marín, Mireia; (3)Campos, Daniel; (4)Pérez-García, Miguel; (5)Campoy, Cristina.

(1)PhD. Psychologist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (2)MSc. Nutritionist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (3)MSc. Degree in Physical Activity and Sports Science. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (4)PhD. Psychologist. Mind, Brain and Behavior Research Centre (CIMCYC). University of Granada. Spain.; (5)MD. Pediatrician. Department of Paediatrics. University of Granada. Spain.

**Background and objectives:** Maternal diet and nutritional status are powerful determinants of development in utero and the first years of life. Women from disadvantaged groups tend to have the poorest quality diets which are translated into their offspring.
## MAIN SOURCES OF INFORMATION ON INFANT FEEDING, AND THEIR APPRAISAL, AMONG SOMALI AND IRAQI MOTHERS RESIDING IN NORTHERN WAY - A MIXED-METHODS STUDY

(1)Grewal, Navnit Kaur; (1)Terragni, Laura; (2)Torheim, Liv Elin.

(1)PhD. Department of Health, Nutrition and Management.
Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences. Norway.; (2)PhD. Professor. Department of Health, Nutrition and Management. Faculty of Health Sciences. Oslo and Akershus University College of Applied Sciences. Norway.

**Background and objectives:** Child health centers have a unique opportunity to support infant nutrition. However, studies suggest there can be communication barriers between health centers and immigrant mothers. The objective of the present study was to describe the main sources of information regarding infant nutrition, and how they have been evaluated, among Somali and Iraqi mothers residing in Norway.

**Methods:** Two rounds of surveys and qualitative interviews were carried out in the Oslo region in 2013-2014 among Somali and Iraqi mothers with infants aged 6 and 12 months. At infant's age 6 month, 187 mothers participated in the questionnaire-based survey and 29 in qualitative, in-depth interviews. At age 12 months, 166 mothers participated in the survey and 30 in qualitative interviews.

**Results:** Both in the 6- and 12-month surveys, the main source of information on infant nutrition was the child health center, received by more than 90% of the mothers. At infant's age 6 months, more Somali (97%) than Iraqi mothers (86%) evaluated the information received at the health center as useful. Information received from family members was the second most important source of information, at both 6 and 12 months. At 12 months, slightly more mothers (83%) rated the information from the family as useful, as compared with information received from the health station (80%). Qualitative interviews revealed that the mothers trusted the public health nurses. Some found it challenging to balance the information from the different sources. The mothers missed information that was adapted to their language and culture. Around 60% of the mothers wanted more information on infant and child nutrition.

**Conclusions:** The child health center is the main source for information on infant nutrition among Somali and Iraqi mothers in Norway. The information should be culturally adapted and more informative about feeding of toddlers.

**Keywords:** Infant feeding, nutrition information, immigrants, Norway

**Further collaborators:** The study is a collaboration between Fafo Research Foundation; Oslo and Akershus University College; University of Oslo; Norwegian Center for Migration and Minority Health and Oslo University Hospital. The study has been financed by the Norwegian Research Council.

## MATERNAL DIET WITH ELEVATED FOLIC ACID AND LOW VITAMIN B12 CONCENTRATIONS INCREASES THE METABOLIC RISK IN MICE (C57BL/6)

Castaño, Erika; Ronco, Ana María.

Professor. Institute of Nutrition and Food Technology Doctor
Fernando Monckeberg Barros. INTA. University of Chile. Chile.

**Background and objectives:** Folates and vitamin B12 (B12) are essential during pregnancy to ensure adequate fetal and placental development. Several countries have implemented public policies of food fortification and supplementation with folic acid (FA), but not with B12. Potential side effects for the mother and offspring of high FA/ low B12 consumption during pregnancy are unknown. The aim of this work was to determine whether maternal diets containing high levels of FA and low B12 increase oxidative stress markers in maternal livers and placentas.

**Methods:** Female mice (C57BL/6, age 8 weeks) were fed with diets containing high FA (8mg/Kg) and low B12 (0.5mg/Kg) diet (T) and with normal diet (C) 60 days before, during (20 days) and 21 days after pregnancy. A group (n=13) was scheduled for caesarean and another group (n=8) grew up until 60 days of age with same prenatal diet. Oxidative stress was assessed measuring TBARS in maternal livers and in placentas. Offspring weight was registered after weaning (21 days of age) and fasting glycemia was determined at 60 days of age.

**Results:** TBARS (MDA equivalents µM/mg protein) in T were higher in both, livers (10.5±2.4 vs 6.38±1.3, p=0.0082) and placenta (20.2±5.2 vs 14.2±2.4; p=0.0275) compared to C. Offspring weight at weaning was higher in T compared to C, in both, males (13±3 vs 8±1, p=0.0188) and females (12±2 vs 9±2, p=0.0227). Fasting blood glucose levels (mg/dL) at 60 days of age were higher in T vs. C only in males (153 ± 23 vs 116 ±30).

**Conclusions:** Maternal diets containing high levels of FA and low B12 before, during and after gestation may increase the risk of metabolic alterations in mothers and their offspring, in the short and long term; as evidenced by an increase in oxidative stress in the liver and placenta, in weaning weight, and in fasting blood glucose levels at 60 days of age.

**Keywords:** Folic acid, vitamin b12, oxidative stress, placenta, fetal programming.

**Further collaborators**

Funding: Fondo Nacional de Ciencia y Tecnología (FONDECYT N° 1130188) Gobierno de Chile.

Beca Stekel, INTA, U de Chile.
# CONTRIBUTION OF COMPLEMENTARY FOODS TO ENERGY AND NUTRIENT INTAKES AMONG CHILDREN LIVING IN THE URBAN SLUMS OF MUMBAI, INDIA

(1)Venkatramanan, Sudha; (2)Udipi, Shobha A; (3)Ghugre, Padmini;

(4)Huey, Samantha; (5)Powis, Laura; (6)Finkelstein, Julia; (7)Haas, Jere D.; (8)Mehta, Saur.

(1)PhD. Postdoctoral Research Associate. Division of Nutritional Sciences. Cornell University. United States; (2)PhD. Professor and Head. Department of Food Science and Nutrition. SNDT Women's University. India.; (3)PhD. Associate Professor. Department of Food Science and Nutrition. SNDT Women's University. India.; (4)BSc. Doctoral Candidate. Division of Nutritional Sciences. Cornell University. United States.; (5)BS. Research Assistant. Division of Nutritional Sciences. Cornell University. United States.; (6)ScD. Assistant Professor. Division of Nutritional Sciences. Cornell University. United States.; (7)PhD. Emeritus Professor. Division of Nutritional Sciences. Cornell University. United States.; (8)MBBS. ScD. Associate Professor. Division of Nutritional Sciences. Cornell University. United States.

**Background and objectives:** This cross-sectional study was conducted in preparation for a randomized controlled feeding trial assessing the efficacy of iron-biofortified pearl millet based complementary foods in improving child health outcomes. The main objective of the present study was to characterize dietary intake and their appropriateness based on the Indian recommended dietary allowances (RDAs) in urban slums of Mumbai, India.

**Methods:** Study participants were children aged eight to 22 months (n=106). Children's dietary data was collected using 24-hour dietary recall (administered to mothers). Nutrient intakes were calculated using CS Dietary System and compared with the Indian RDAs per day for children.

**Results:** Mean intake of complementary foods was 260 ± 231 g per day. Daily energy intake was less than the RDA for complementary foods in 53% (6 to 12 months, RDA=276 kcal/d) and 89% (12 to 24 months, RDA=714 kcal/d) of children. Protein intake from complementary foods accounted for 81% (6-12 months, RDA=14 g/d) and 88% (12-24 months, RDA=16 g/d) of the total RDA. Iron, zinc, vitamin B-12, and vitamin A intakes were inadequate in more than 90% of children. Dietary iron intake from complementary foods was 24% (6 to 12 months, RDA=5 g/d) and 17% (12 to 24 months, RDA=9g/d) of the Indian RDA. Zinc intake from complementary foods contributed to 10% of the RDA (12 to 24 months, RDA=5 g/d). Vitamin B-12 intake contributed to only 1% of the total RDA (12 to 24 months, RDA=0.2-1 g/d). Vitamin A intake provided 4% and 5% of RDA in the children from both the age groups. Seventy-two percent (n=76) of children consumed animal source foods including whole milk, eggs, yogurt, and chicken.

**Conclusions:** Our results demonstrate the widespread prevalence of inadequate energy and nutrient intake from complementary foods among children in Mumbai. Implementation of effective and sustainable nutritional interventions is essential to

ameliorate nutritional deficiencies in such vulnerable populations (ClinicalTrials.gov ID: NCT02233764).

**Keywords:** Energy intake, complementary foods, nutritional status, iron, zinc

**Conflict of Interest Disclosure:** Saurabh Mehta is an unpaid board member for a diagnostic start-up company focused on developing point-of-care assays for nutritional status, informed by his research as a faculty member at Cornell University. All other authors report no conflict of interest.

# GESTATIONAL WEIGHT GAIN AND NUTRITION-AL STATUS AT MID-PREGNANCY IN BRAZILIAN AMAZON

(1)Barreto Malta, Maíra; (2)Barreto Malta, Maíra; (3)Campos, Chiara Alzineth Silva; (4)Neves, Paulo Augusto Ribeiro; (5)Lourenço, Bárbara Hatzlhoffer; (6)Castro, Marcia; (2)Cardoso, Marly Augusto; (7)MINA-Brazil Working Group

(1)PhD. Nutritionist. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil;

(2)PhD. Nutritionist. Departmento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil;

(3)Nutritionist. Departmento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil; (4)MS. Nutritionist. Departmento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil; (5)PhD. Nutritionist. Departmento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo. Brazil; (6)PhD. Department of Global Health and Population. Harvard T.H. Chan School of Public Health. Boston. MA. United States; (7)Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo. Brazil.

**Background and objectives:** Weight gain during pregnancy is a prognostic factor for maternal and child health and its inadequacy is associated with undesirable outcomes for both. The present study aims to evaluate the relation between gestational weight gain and anemia, vitamin A insufficiency, and blood pressure in the third trimester of pregnancy.

**Methods:** Prospective study in the urban area of Cruzeiro do Sul, Acre state, Western Brazilian Amazon. Women up to 20 weeks of pregnancy (by last menstrual period) attending primary health care units were enrolled in this study (n = 457). Weight gain between the second and third trimesters was classified as insufficient, adequate and excessive according to pre-pregnancy body mass index, using the guidelines of Instituto de Medicine (2009). Outcomes of interest in the third gestational trimester were: anemia (Hb <110 g/dL), vitamin A insufficiency (retinol <1.05 µmol/L) and blood pressure levels (continuous variable, in mmHg). Multiple Poisson regression models with robust variance adjusted for age, schooling and use of micronutrient supplements were performed using Stata software 14.0, p <0.05.
**Results:** Prevalence ratios (PR, 95% CI) for anemia among pregnant women with insufficient (n=85) weight gain was 0.41 (0.18, 0.93) when compared to those with adequate weight gain (n=102). For vitamin A insufficiency, PR was higher among pregnant women with insufficient weight gain (2.85, 95% CI: 1.55, 5.24) and excessive (1.53; 95% CI: 0.84, 2.74) when compared to those with adequate weight gain. Pregnant women with excessive weight gain presented higher mean systolic blood pressure (111.1, 95% CI: 109.9, 112.2) than those with insufficient weight gain (107.5, 95% CI: 105.4, 109.6) and adequate weight gain (106.2; 95% CI: 104.3, 108.2).

**Conclusions:** This is the first study in the Western Brazilian Amazon to evaluate the association between inadequate gestational weight gain and nutritional status and blood pressure levels during pregnancy. Insufficient gestational weight gain was associated with poorer vitamin A nutritional status, while excessive weight gain was associated with higher blood pressure levels. Findings highlight the importance of promoting adequate gestational weight to improve maternal nutritional status and maintain blood pressure in appropriate levels.

**Keywords:** vitamin A; anemia; pregnancy; nutritional status; epidemiologic factors

**Further collaborators**

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

144/2031

WOMEN'S EMPOWERMENT: PATHWAYS TO-
WARDS MATERNAL AND CHILD NUTRITIONAL
OUTCOMES

**Background and objectives:** Women's empowerment (WE) is a key determinant of nutritional status of women and children. In this paper we examine the role of several domains of WE and the pathways by which they influence child nutritional status (CNS).

**Methods:** We used nationally representative data from the Demographic and Health Survey (2011-2015) for married women with children under five in East Africa (Ethiopia, Kenya, Rwanda, Tanzania, and Uganda) (n=42,721). Our key outcome, CNS was operationalized through anemia, height-for-age-z score (HAZ), and body mass index (BMI). Based on our previous work, we used three domains of WE as our primary exposure variable: human/ social assets, justification of wife-beating, and household deci- sion-making. We used measured variable path analysis to estimate

the strength of a priori hypothesized biological and behavioral pathways from WE to CNS. For the biological pathway, the medi-ating variable was women's nutritional status (WNS) including anemia, underweight, and BMI. The behavioral pathway includ- ed infant and young child feeding (IYCF) practices measured by breastfeeding and timely introduction of complementary foods. Analysis reported with standardized coefficients and was further adjusted for maternal and household characteristics.

**Results:** In Ethiopia, the direct association of WE and CNS was significant for the household decision-making domain, with higher empowerment being positively associated with better CNS (beta=0.64; p<0.001). For the biological pathway, higher WE was positively related to WNS for each domain of empowerment (assets: beta=0.40; p<0.005; beatings: beta=0.12; p<0.001; decision-mak- ing: beta=0.38; p<0.001). Improved WNS was related to improved CNS (beta=0.54; p<0.001). Along the behavioral pathway, the as- sets domain was related to appropriate IYCF practices (beta=0.09; p<0.005). Improved IYCF was related to CNS (beta=0.10; p<0.005). Further examination of these relationships and pathways including analysis of data from the other four countries is ongoing.

**Conclusions:** These findings indicate that the direct and bio- logical pathways are more strongly associated with CNS than the behavioral pathway in Ethiopia. Further analysis will help deter- mine if these observations are generalizable across East Africa. Based on the relative contribution of the specific components of WE and pathways by which they influence CNS, appropriate in- terventions and programs that improve WE could be developed to improve CNS.

**Keywords:** Women's Empowerment; Nutritional Status; Mat- ernal & Child Health; East Africa

144/2066

LIFE-COURSE HEIGHT AND WEIGHT TRAJECTO-
RIES IN MEXICAN CHILDREN

**Background and objectives:** Growth during infancy is im-
portant for future health and overall well-being and rapid weight

<footnote>(1)Jones, Rebecca; (2)Ramakrishnan, Usha; (3)Yount, Kathryn M.;</footnote>

<footnote>(4)Miedema, Stephanie; (5)Haardoerfer, Regine; (2)Webb Girard, Aimee.</footnote>

<footnote>(1)MSPH. Doctoral Student. Nutrition and Health Sciences. Emory University. USA.; (2)PhD. Nutritionist. Hubert Department of Global Health. Emory University. USA.; (3)PhD. Sociologist. Hubert Department of Global Health. USA; (4)MA. Doctoral Student. Department of Sociology. Emory University. USA.;</footnote>

<footnote>(5)PhD. Statistician. Department of Behavioral Sciences and Health Education. Emory University. USA.</footnote>

<footnote>(1)Barrios, Pamela L.; (2)Rivera, Juan; (3)Garcia-Feregrino, Raquel;</footnote>

<footnote>(4)Barraza-Villarreal, Albino; (5)Romieu, Isabelle; (6)Gonzalez-Casanova, Ines; (6)Stein, Aryeh.; (6)Ramakrishnan, Usha; (7)Hoffman, Daniel J.</footnote>

<footnote>(1)MSc. Department of Nutritional Sciences, New Jersey Institute for Food, Nutrition, and Health. Rutgers University. United States.; (2)PhD. Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (3)MSc. Health and Nutrition Research Center. National Institute of Public Health. Mexico.; (4)PhD. Population Health Research Center. National Institute of Public Health. Mexico.; (5)MD. Population Health Research Center. National Institute of Public Health. Mexico.; (6)PhD. Hubert Department of Global Health, Rollins School of Public Health. Emory University. United States.; (7)PhD. Department of Nutritional Sciences, New Jersey Institute for Food, Nutrition, and Health, Rutgers University. United States.</footnote>
gain during childhood has been associated with adverse health effects in adulthood. Latent class growth analysis (LCGA) identifies heterogeneity of growth patterns in cohort subgroups whereas other modeling techniques assume a single underlying trajectory per population. In LCGA, similar individuals are grouped together on the basis of their growth characteristics. The aim of this study was to derive height and weight growth trajectories from birth to 5 years of age in Mexican children.

**Methods:** Study participants were a sub-sample that participated in the 8-10 y follow-up of the POSGRAD study, a double-blind, randomized, placebo-controlled trial designed to assess the effect of prenatal supplementation with DHA on offspring growth and development (281 boys, 255 girls). Sex-specific height and weight latent class trajectories were derived from 11 measures of height and weight from birth to 5 years of age. Analyses were conducted by using MPlus version 7.3 (Muthen &Muthen). Tests of class membership association between the latent classes formed by sex were carried out using Pearson's Chi Squared in STATA 14 and p<0.05 was considered significant.

**Results:** Two weight and height latent classes were identified in girls [height: low (58%) and high (42%), weight: low (67%) and high (33%)] and three classes in boys [height: low (17%), medium (51%) and high (32%), weight: low (30%), medium (52%) and high (19%)]. The 2-class models for girls and the 3-class models for boys had the highest entropy (sign of successful convergence), they were all above 0.79. Classes also had the highest posterior probabilities of candidate models suggesting high class separation, all above ~0.92. For both sexes, height latent class membership was associated to weight latent class membership (p<0.000).

**Conclusions:** Based on these results, distinct height and weight trajectories separate within the first months of life, suggesting that early life factors may play a role in this separation. There is also a high correlation of latent class membership in height and weight trajectories.

**Keywords:** child nutrition, latent class growth analysis, height, weight

**Further collaborators:** Supported by NIH grants HD-043099, HD-058818 and Grant Sectorial CONACYT 202062

**Background and objectives:** Interventions promoting optimal infant and young child nutrition could prevent a fifth of under five deaths in countries with high mortality. Effective strategies to improve infant and young child feeding practices are needed. This study aims to pilot implementation of the baby friendly community initiative (BFCI), a global initiative recommended by the WHO that is aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to exclusive breastfeeding in a rural setting in Kenya.

**Methods:** The study, employing a cluster-randomized trial design, was conducted in rural Kenya between 2014 and 2016. A total of 13 clusters, constituting community units within the government's community health strategy were randomized with six allocated to the intervention and seven to the control arm. A total of ~800 pregnant women and their respective children were recruited into the study. The mother-child pairs were followed up until the child was at least six months. The intervention involved regular counseling and support of mothers by trained community health volunteers and health professionals on maternal, infant and young child nutrition. Regular quantitative assessment of knowledge, attitudes, and practices on maternal, infant and young child nutrition was done. A qualitative exploration of the effect of the intervention was also done. The analysis involves assessment of the effectiveness of the intervention on the primary outcome (exclusive breastfeeding for six months).

**Results:** Preliminary results indicate potential effectiveness of the intervention on exclusive breastfeeding. Narratives indicate that the counseling of women enhanced their skills and competencies in breastfeeding including with regards to breast positioning and attachment which led to better breastfeeding practices. The analysis is ongoing.

<footnote>(1)Kimani-Murage, Elizabeth; (2)Kimiywe, Judith; (3)Wekesah, Frederick;</footnote>

<footnote>(4)Muriuki, Peter; (5)Wanjohi, Milka; (6)Samburu, Betty; (7)Kabue, Mark;</footnote>

<footnote>(8)Griffiths, Paula; (9)Madise, Nyovani; (10)McGarvey, Stephen.</footnote>

<footnote>(1)African Population and Health Research Center. Kenya;</footnote>

<footnote>(2)Professor. Department of Foods Nutrition and Dietetics. Kenyatta University Nutrition. Nairobi. Kenya; (3)Epidemiologist. Health Challenges and Systems. African Population and Health Research Center. Nairobi. Kenya; (4)Research Assistant Health Challenges and Systems. African Population and Health Research Center. Nairobi. Kenya; (5)Nutritionist. Health Challenges and Systems. African Population and Health Research Center. Nairobi. Kenya; (6)Nutritionist. Unit of Nutrition and Dietetics. Ministry of Health,. Nairobi. Kenya; (7)Epidemiologist. JHPIEGO. USA; (8)Professor. Centre for Global Health and Human Development; Loughborough University. Loughborough. UK; (9)Professor. Centre for Global Health. Population, Poverty, and Policy University of Southampton. Southampton. UK; (10)Professor. International Health Institute. Brown University. Providence. Rhode Island. USA.</footnote>
# THE ASSOCIATION BETWEEN ACTIVE TOBACCO USE DURING PREGNANCY AND GROWTH OUTCOMES OF CHILDREN UNDER FIVE YEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS

**Background and objectives:** Current research on infant and young child growth faltering, manifesting in the form of stunting, primarily focuses on nutrition-specific risk factors. However, less is known about the nutrition-sensitive risk factors of growth faltering, including exposures to harmful substances, such as tobacco use during pregnancy. The objective of the study is to investigate the relationship between active tobacco use among pregnant women and growth outcomes of children under five years globally through a systematic review and meta-analysis.

**Methods:** CABI Global Health, CINAHL, Embase, Global Index Medicus, PubMed, and Web of Science databases were searched to identify studies from 1980 to present on the association between active tobacco use during pregnancy and child growth. Studies that collected data on active tobacco use as either a binary measure, quantity, or frequency at any time during pregnancy based on self-reporting or biomarker assessment were included in the review. At least one of the following child growth outcomes was considered: small for gestational age (SGA), length/height, and head circumference. A meta-analysis using a random effects model was conducted for the association between active tobacco use and SGA.

**Results:** Of the 13,189 citations identified by the search strategy, 406 studies were included in the full text review and 213 studies were eligible for inclusion in the analysis: 42 cross-sectional, 77 prospective cohort, 41 retrospective cohort, 29 case-control, and 24 unclear study design. In total, 25,168,224 mother-child pairs were included measuring for SGA (121 studies), length/height (84 studies), and head circumference (75 studies). These studies were conducted in 43 countries, including low-, middle-, and high-income countries. Most commonly, tobacco use was defined by cigarette smoking measured by self reporting and/or cotinine levels. Active tobacco use during pregnancy is associated with significantly higher rates of SGA (pooled adjusted OR=1.96; 95% CI 1.71 to 2.23).

**Conclusions:** Active tobacco use during pregnancy is associated with impaired child growth among certain outcomes. Nutrition-sensitive risk factors such as tobacco use during pregnancy should be considered when implementing interventions to reduce child stunting.

**Keywords:** tobacco, pregnancy, stunting, growth, nutrition-sensitive

# THE NEED OF FOOD SUBSIDY PROGRAMS TO FULFILL NUTRIENT ADEQUACIES: THE CASE OF INDONESIA

**Background and objectives:** The Indonesian family-based conditional cash transfer (CCT) program or locally known as PKH/Program Keluarga Harapan) started in 2007, which target the bottom poorest 10 percent households. The program demanded pregnant and lactating mothers, as well as children under the age of five years attend health check-ups and school age children go to school. In addition, these families are entitled to a cash or 15 kg rice subsidy monthly. However, the two programs have had less effect on the improvement of the quantity and quality of food consumed.

**Methods:** The authors exercised calculation on the potential macronutrient adequacy of the cash received from both programs, which is amounting to approximately USD 12.00 per month.

**Results:** Assuming all the money is used to purchase rice, the money is not enough to provide 100% adequacy of energy and protein for pregnant and lactating women. There is still a gap of 6% for energy and 26% for protein for a pregnant woman or equivalent to one small plate of rice and two eggs daily. The gap for a lactating mother and her child age 7 to 11 month is 23% for energy and 40% for protein or equivalent to 2.5 plate rice and three eggs daily. The money, however, should be enough to provide food for a child age 4 to 6 years. The amount of money or food equivalent given to a family with a pregnant woman should be USD 13.00 monthly and for a lactating mother and her child USD 19.00.

**Conclusions:** Improvement of the programs should be made to guarantee nutritional need for the important first 1000-days-period.

**Keywords:** conditional cash transfer, nutrient adequacy, food subsidy, Indonesia

<footnote>(1)Quelhas, Diana; (2)Kompala, Chytanya; (3)Wittenbrink, Brittney;</footnote>

<footnote>(4)Han, Zhen; (5)Downs, Shauna; (6)Shapiro, Myra; (7)Parker, Megan;</footnote>

<footnote>(3)Kreis, Katharine; (8)Kraemer, Klaus; (9)Fanzo, Jessica.</footnote>

<footnote>(1)BSc. MPH. PhD. Nutrition Innovation. PATH. USA.; (2)BSc. MSPH. Nutrition Innovation. PATH. USA.; (3)BSc. MPH. Nutrition Innovation. PATH. USA.; (4)BSc. PhD. Nutrition Innovation. PATH. USA.; (5)BSc. MSc. PhD. Berman Institute of Bioethics. Johns Hopkins Bloomberg School of Public Health. USA.; (6)BA. MHS. PhD. Center for Human Nutrition. Department of International Health. Johns Hopkins Bloomberg School of Public Health. USA.; (7)BScH. MSc. PhD. Nutrition Innovation. PATH. USA.; (8)BSc. PhD. Johns Hopkins Bloomberg School of Public Health. USA. Sight and Life. Switzerland.; (9)BSc. PhD. Berman Institute of Bioethics. Johns Hopkins Bloomberg School of Public Health. USA.</footnote>

<footnote>(1)Usfar, Avita; (2)Catharina, Maria.</footnote>

<footnote>(1)Dr. Avita A. Usfar. Nutritionist. Sakanti Consulting. Jakarta. Indonesia.; (2)Maria Catharina, MSc. Nutritionist. Sakanti Consulting. Jakarta. Indonesia.</footnote>
# INTAKE OF DAIRY PRODUCTS REPORTED BY ELDERLY PEOPLE AND SOCIODEMOGRAPHIC AND CULTURAL VARIABLES - SABE SURVEY: HEALTH, WELLBEING AND AGING

**Background and objectives:** The feeding behavior may be related to sociodemographic and cultural variables. The elderly intake of dairy products has been considered unsatisfactory by some researchers and this behavior may be related to the living conditions influenced by sociodemographic and cultural variables. The aim of this study was to verify the association among elderly intake of dairy products and sociodemographic and cultural variables.

**Methods:** Cross-sectional study with elderly people (≥60 years), of both sex, from the SABE Survey: Health, Wellbeing and Aging, performed in 2000, in São Paulo/SP city. The variables were self-reported: intake of dairy products (<1x/day); sociodemographic: schooling by years (zero, 1-4, >4), sex (male or female), age group (60-74 or ≥75 years), marital status (married, single, divorced or widower) and company at home (accompanied and living alone); cultural (life in rural area during childhood or adolescence-yes/no); nationality (brazilian or foreign); religion (catholic, evangelical, others). It was used univariate logistic regression, Rao & Scott test (CI=95%;p<0,05) and Stata Version10.1 program.

**Results:** This research studied 2142 elderly people; 82% reported intake of dairy products ≥1x/day (60% female sex). It was verified positive association between the intake of dairy products <1x/day and: schooling = zero (OR=2,85;CI=1,85-4,40;p=0,000), schooling = 1-4 (OR=1,76;CI=1,17-2,66;p=0,007), life in rural area (OR=1,76;CI=1,27-2,44;p=0,001), male sex (OR=1,50;CI=1,16-1,93;p=0,002) and negative association with: age group ≥75 years (OR=0,63;CI=0,50-0,79;p=0,000) and foreign nationality (OR=0,35;CI=0,19-0,66;p=0,002).

**Conclusions:** The intake of dairy products was associated with sociodemographic and cultural variables such as schooling, life in rural area, sex, age group and nationality in this brazilian elderly population.

**Keywords:** Dairy products, feeding behavior, aged, aging

# EFFECT OF MATERNAL VITAMIN D SUPPLEMENTATION ON VITAMIN D METABOLITES AND MARKERS OF IMMUNE FUNCTION IN UMBILICAL CORD SERUM

**Background and objectives:** Low maternal vitamin D status has been associated with increased risk for asthma and autoimmune disease in the offspring. The hormone 1,25-dihydroxyvitamin D (1,25(OH)2D) regulates many inflammatory processes, but the pathways by which insufficient vitamin D during gestation may impact the developing immune system have not been elucidated. The aim of this study was to test the effects of maternal vitamin D supplementation on concentrations of vitamin D metabolites, inflammatory cytokines, and IgE in umbilical cord serum (UCS).

**Methods:** Pregnant adolescents (n=79) living in Rochester, NY received 200 IU or 2,000 IU of vitamin D3 daily (in addition to a standard prenatal supplement with 400 IU of vitamin D3) from (mean ± SD) 18 ± 5 weeks of gestation until delivery. Maternal serum and UCS were analyzed for 25(OH)D, 1,25(OH)2D, and 24,25(OH)2D using LC-MS/MS. UCS cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, TGF-β1, and TNF-α), IgE, and IgA (the negative control) were measured by immunoassays. Linear regression was used to test the effect of supplement group assignment on UCS vitamin D metabolites, cytokines, and IgE.

**Results:** The mothers were 17 ± 1 yrs of age at study entry. The majority (60%) identified as Black race, and 35% had serum 25(OH)D <20 ng/mL at delivery. UCS was obtained from 56 neonates at birth (39.5 ± 1.7 wks' gestation). The prevalence of UCS 25(OH)D <12 ng/mL was 39%. The 2,000 IU group had greater mean UCS 25(OH)D (β=4.6; p=0.02) and 24,25(OH)2D (β=0.42; p<0.01), but there was no effect of treatment group on UCS 1,25(OH)2D. Cytokines and IgE have been measured in 34 UCS samples. IL-6, IL-10, TGF-β1, TNF-α and IgE were detectable in the majority of UCS samples. The mean concentrations of these cytokines and IgE in UCS did not differ by supplement group.

**Conclusions:** Risk of vitamin D deficiency was prevalent in term neonates born to adolescents living at latitude 43°N. Daily supplementation with 2,000 IU compared with 200 IU of vitamin D3 increased UCS 25(OH)D and 24,25(OH)2D but had no effect on either UCS 1,25(OH)2D or (based on data available to date) select markers of immune function.

**Keywords:** perinatal nutrition, vitamin D, developmental origins, asthma, allergy

**Conflict of Interest Disclosure:** This work was supported by a Grant from The Gerber Foundation, the United States De-

<footnote>(1)Souza, Cláudia; (2)Marucci, Maria De Fátima; (3)Roediger, Manuela;</footnote>

<footnote>(3)França, Ana Paula; (4)Duarte, Yeda.</footnote>

<footnote>(1)MSc. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (2)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (3)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (4)PhD. Department of Nursing Medical-Surgical. School of Nursing. University of São Paulo. Brazil.</footnote>

<footnote>(1)Best, Cora; (2)Mehta, Saur; (3)Pressman, Eva; (3)Queenan, Ruth Anne;</footnote>

<footnote>(4)Cooper, Elizabeth; (5)O'Brien, Kimberly.</footnote>

<footnote>(1)MHS. PhD Candidate. Division of Nutritional Sciences. Cornell University. USA.; (2)MBBS. ScD. Division of Nutritional Sciences. Cornell University. USA.; (3)MD. Department of Obstetrics and Gynecology. University of Rochester School of Medicine. USA.; (4)CNM. EdD. Department of Obstetrics and Gynecology. University of Rochester School of Medicine. USA.; (5)PhD. Division of Nutritional Sciences. Cornell University. USA.</footnote>
partment of Agriculture under award 2011-03424, and the United States National Institutes of Health under award T32-DK007158. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health. SM is an unpaid board member for a diagnostic start up focused on measurement of nutritional biomarkers at the point-of-care utilizing the results from his research. The authors report no conflicts of interest.

144/2121

MOTHERS' VIEW ON BREASTFEEDING OF NEW-
BORNS ON A NEONATAL INTENSIVE CARE UNIT
(NICU) AT A HOSPITAL IN CURITIBA, BRAZIL

(1)Gebara, Telma; (2)Delfino, Bianca; (3)Tarzia, Andréa; (4)Mastella, Paula; (5)Santos, Silvana; (2)Thomaz, Ana Cláudia.

(1)BSc. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (2)BSc. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (3)PhD. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (4)PhD. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.; (5)MSc. Nutritionist. Department of Biological and Health Sciences. Tuiuti University of Parana. Brazil.

**Background and objectives:** Breastfeeding is the best natural strategy for bonding, affection, protection and nutrition for a child, as well as an important intervention to reduce infant morbidity and mortality. Exclusive breastfeeding is recommended by World Health Organization up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Some of the benefits that make breastfeeding feasible are the families engagement to support the mother during the breastfeeding period, the low cost, and the quality of life for mothers and their babies. Nevertheless, many mothers are not knowledgeable on the benefits of breastfeeding. The aim of this research was to analyze the perception of mothers regarding breastfeeding of inpatient newborns on a neonatal intensive care unit (NICU) in the city of Curitiba, Brazil.

**Methods:** A cross-sectional study (descriptive and observational) was conducted on a group of 10 mothers of newborns, during the months of August and September 2016. A questionnaire was applied and answered individually by each mother, without interference. Furthermore, the research project was approved by the Ethics Research Committee.

**Results:** Average age of mothers was 31.7 (± 4.71) years, and 60% were graduate or post-graduated. All the mothers (100%) answered that they received information about maternal education through various media, nurses and doctors, as well as family and friends. Half of them (50%) answered that mother can offer the milk to the baby in the first hour postpartum. Cultural level of the mothers is related to breastfeeding in a positive way, breastfeeding in the first hour after the birth of the baby is important for effective

breastfeeding, in addition to providing the strengthening of the
affective bonds between mothers and their babies.

**Conclusions:** It is important to recognize that knowledge building about the importance of exclusive breastfeeding is the result of a collective struggle, where quality health professionals should, besides providing adequate guidance, give greater safety to the mothers during breastfeeding.

**Keywords:** breastfeeding, nursing, breastfeeding promotion.

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POSTINFANCY GROWTH AND COGNITIVE PER-
FORMANCE IN EARLY ADOLESCENCE IN FOUR
LOW AND MIDDLE INCOME COUNTRIES: YOUNG
LIVES

(1)Kowalski, Alysse; (2)Georgiadis, Andreas; (3)Stein, Aryeh.

(1)PhD Student. Laney Graduate School. Emory University.
Atlanta. USA.; (2)PhD. Brunel Business School. College of Business,
Arts and Social Sciences. Brunel University London. London. UK.;
(3)PhD. Hubert Department of Global Health. Rollins School of
Public Health. Emory University. Atlanta. USA.

**Background and objectives:** Linear growth failure in the first 1000 days is associated with impaired child cognitive development. Using longitudinal data from four low and middle income countries we examined the strength of the pathways by which growth throughout childhood is associated with measures of cognitive performance.

**Methods:** Data come from the Young Lives study in Ethiopia (N=1275), India (N=1350), Peru (N=1402), and Vietnam (N=1594). Height was measured at participant age 1, 5, 8, and 12 y; height-for-age z-scores (HAZ) were calculated. Cognitive performance was assessed at age 12 y by the Peabody Picture Vocabulary Test and a mathematics test, which were adapted and standardized in each country. We used path analysis to examine associations between HAZ at each age and each test. We adjusted for covariates at the child, parent, household, and community levels.

**Results:** In all four countries, the total effect of HAZ at each age was positively associated with cognitive performance; 12 of 16 and 10 of 16 associations were statistically significant for vocabulary and mathematics scores, respectively. Collectively, total effects of HAZ explained modest proportions of the total variation in test scores; across countries, partial r2 ranged from 1.8% to 4.0% for vocabulary and 1.1% to 2.5% for mathematics. Across countries, the total effect of HAZ 1 y explained 0.1% to 1.3% and 0.1% to 0.9% of the total variation in vocabulary and mathematics scores, respectively, while HAZ 5, 8, and 12 y combined explained 1.0% to 3.9% and 0.9% to 2.0%, respectively. The relative magnitude of the HAZ associations with cognitive performance were comparable to those of maternal and paternal education, household expenditures, and ethnicity. The proportion of the total effect of HAZ at 1 y mediated through HAZ at older ages ranged from 55% to 100% across countries for vocabulary and 42% to 100% for mathematics.
**Conclusions:** HAZ was associated with increased cognitive performance at age 12 y, but the proportion of the total variation in test scores explained was modest. While the primary drivers of cognitive performance may not be mediated through growth, increased child growth may confer modest benefits for cognitive performance.

**Keywords:** growth, height-for-age, cognitive development

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MALNUTRITION AND INFANT/YOUNG CHILD FEEDING PRACTICES AMONG PENAN COMMUNITY IN SARAWAK, MALAYSIA

(¹)Noor, Mohd Ismail; (²)Bong, Mee Wan; (³)A Karim, Norimah.

(¹)Wife. Malaysia.; (²)BSc. Nutritionist. Nutrition Section. Sarawak State Health Department. Kuching. Sarawak. Malaysia; (³)PhD. Nutritionist. Nutritional Sciences Programme. Faculty of Health Sciences. Universiti Kebangsaan Malaysia. Kuala Lumpur. Malaysia.

**Background and objectives:** The tribal Penan estimated around 16,000 largely settled in rural and remote areas of Sarawak. The objective of this study was to determine the nutritional status and infant young child feeding (IYCF) practices in Penan children, using indicators of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD).

**Methods:** Data collection was carried out in 14 Penan villages in Sarawak from August to December 2016. Subjects consisted of 71 young children, aged below 24 months. Malnutrition was assessed using anthropometric measurements of children and categorized according to WHO Growth Standards (2006). Mothers were interviewed using a pre-tested questionnaire based on WHO IYCF Indicators.

**Results:** Majority (88.7%) of mothers interviewed were below 35 years, with 29.6% having attended primary school and 15.5% secondary school with a household income of less than MYR600 (USD 135) per month. The prevalence of underweight was 33.8%; stunting 49.3% and wasting 9.8%. Prevalence of exclusive breastfeeding under 6 months was 50% while continued breastfeeding up to 1 year was 72.2% and 41.2% at 2 years. Proportion of children aged between 6 to 23 months achieving MDD was 83.1%. Among children of different age groups, MDD achievement was low (71.4%) for those aged 6 to 11 months. For those achieving MDD, 71.2% of children received food from 4 to 5 food groups whilst 11.9% received food from 6 to 7 food groups. Majority of children received food from grain, roots and tubers group (96.6%). Other food groups given were flesh foods and Vitamin-A rich fruits and vegetables. Almost half (49.2%) of the children consumed dairy products and eggs; and MMF achieved was 83.1%. The study also revealed only 59.3% of children aged 6 to 23 months achieved minimum acceptable diet. Overall, the compliance to minimum acceptable diet indicator was low. Consumption of iron-rich foods was satisfactory at 79.7%, however only 57.1% was achieved amongst infants aged 6 to 11 months.

**Conclusions:** Effort to ensure that appropriate IYCF key messages reach Penan mothers should be strengthened, to further improve the overall nutritional status and feeding practices of this vulnerable group.

**Keywords:** nutritional status, infant young child feeding, Penan

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NUTRITION RECOMMENDATIONS FOR IMPROVING ADOLESCENT GIRLS' HEALTH AND WELLBEING

(¹)Koniz-Booher, Peggy; (²)Ramage, Abigail Kaplan; (³)Rayco-Solon, Pura; (⁴)Alvey, Jeniece; (⁵)Lamstein, Sascha; (⁶)Grey, Elaine S.; (⁷)Lutter, Chessa; (⁸)Cunningham, Sarah.

(¹)MPS. SPRING/USAID Project. JSI Research & Training Institute Inc. USA.; (²)MS. MA. Independent Nutrition Consultant. United Kingdom.; (³)MD. MSc. PhD. Evidence and Programme Guidance Unit. Department of Nutrition for Health and Development. World Health Organization. Switzerland.; (⁴)MPH. IBCLC. Global Health Fellows Program II/USAID. Public Health Institute. USA.; (⁵)PhD. SPRING/USAID Project. JSI Research & Training Institute, Inc. USA.; (⁶)MS. MPH. Global Health Fellows Program II/USAID. Public Health Institute. USA.; (⁷)PhD. Visiting Research Professor. School of Public Health. University of Maryland. United States.; (⁸)BS. SPRING/USAID Project. JSI Research and Training Institute, Inc. USA.

**Background and objectives:** Over half a billion adolescent girls between the ages of 10 and 19 live in low- and middle-income countries (LMIC), making up nearly ten percent of their populations (UNDESA 2008). The challenge of developing appropriate policies, social and behavior change strategies, effective nutrition education programs, and targeted communication tools to reach adolescent girls is complicated by the lack of specific nutrition guidance for this critical population. While guidelines exist for some adolescent interventions, adolescent girls might also benefit from nutrition interventions that target wider age groups, such as iron supplementation for women of reproductive age. In many cases, however, these interventions have not been prioritized or adapted for adolescent programming. To help provide better guidance, the USAID Strengthening Partnerships, Results: **Methods:** Building on recommendations from the 2015 technical expert meeting on adolescent and women's nutrition, co-hosted by PAHO/WHO and SPRING/USAID, a framework reflecting the determinants of and interventions for adolescent girls' nutrition, health and wellbeing was developed through a consultative, interagency process. This framework guided the selection of relevant evidence-informed recommendations from existing WHO guidelines for inclusion in the document.

**Results:** This product – Nutrition Recommendations for Improving Adolescent Girls' Health and Wellbeing – will provide global guidance for achieving optimal adolescent girls' nutrition in a user-friendly format. It organizes key interventions and related recommendations under categories, including healthy diets;
micronutrient deficiencies; undernutrition management; antenatal nutrition; water, hygiene and sanitation; physical activity; and sexual and reproductive health.

**Conclusions:** Global guidance focused on improved adolescent girls' nutrition is needed to protect gains made in child survival and early childhood development, with a focus on the adolescent period as a "second window of opportunity". This WHO product will provide Member States, donors and implementing partners with recommended evidence-informed guidance for adolescent girls' nutrition interventions and programming. It aims to catalyze and focus future investments for prioritization and development of policies, strategies, programs, and tools.

**Keywords:** Adolescent girls, Adolescent nutrition, Nutrition guidelines, WHO guidelines

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## CORRELATION BETWEEN CHRONOTYPE AND THE QUALITY OF DIET IN PREGNANT WOMEN

(1)Cabral, Bruna; (2)Gontijo, Cristiana Araújo; (3) Castro, Isabella;

(2)Balieiro, Laura; (4)Fahmy, Walid; (5)Maia, Yara; (5)Crispim, Cibele.

(1)Nutritionist. Brazil.; (2)Nutritionist. MSc. Medical Faculty. Federal University of Uberlandia. Brazil.; (3)Undergraduate student. Nutrition Course. Medical Faculty. Federal University of Uberlandia. Brazil.; (4)Physician. MSc. Prefeitura Municipal de Uberlandia. Brazil.; (5)UBERLANDIA. Brazil.

**Background and objectives:** The literature shows that chronotype can influence food consumption and individuals with an evening chronotype may consume a lower quality of diet. However, this issue is an unexplored among pregnant women. In this sense, the focus of this study was to correlate chronotype with the quality of diet in pregnant women in the first trimester.

**Methods:** We evaluated 100 pregnant women, with up to 12 gestational weeks, aged 18 to 40 years, attended at the public health service in Uberlandia city, Minas Gerais, Brazil. Properly trained nutritionists collected information about food consumption by means of three 24HR on non-consecutive days, including one day of the weekend, in order to better reflect the eating habits of the participants. The qualitative dietary assessment was performed using the Brazilian Healthy Eating Index Revised (BHEI-R), from the following components and, or food groups: Total Fruits; Whole Fruits; Total Vegetables; Vegetables Dark Green and Orange Vegetables and Legume; Total Grains; Whole Grains; Milk and Dairy Products; Meat, Eggs and Beans; Oils; Saturated Fat; Sodium; and SoFAAS. Chronotype was derived from the time of mid sleep time on free days at the weekend (MSF), with a further correction for calculated sleep debt – calculated as the difference between average sleep duration at the weekends and weekdays correlation was used and p <0.05 with significant statistic. The data were analyzed using the SPSS.21.0. To evaluate correlations between variables, Spearman's correlation coefficients, adjusted for confounders were used. Correlations were considered weak if r <0.30, moderate if r was 0.30-0.70 and strong if r >0.70. Statistical tests with p < 0.05 were accepted as significant.

**Results:** We found a significant correlation between the BHEI-R score for the total Fruit components (r=-0.239; p=0.017), Whole Fruits (r=-0.214; p=0.032) and Saturated Fat (r=-0.211; p=0.035) with chronotype.

**Conclusions:** Our data suggest that pregnant women with an evening chronotype may be more likely to a diet with less fruit and higher saturated fat. Longitudinal studies should be developed to better understand this issue.

**Keywords:** chronotype, food consumption, pregnancy, Quality Of Diet

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## CONSUMPTION OF NON-ALCOHOLIC SWEETENED BEVERAGES IN YOUNG ADULTS IN URUGUAY

(1)Elichalt, Marta; (2)Puig, Silvia; (1)Girona, Alejandra; (3)Della Santa, Ana Paula; (1)Britz, Monica; (4)Perdomo, Guillermo.

(1)MSc. Nutritionist. Nutrition School. Republic University. Uruguay.; (2)Nutritionist. Nutrition School. Republic University. Uruguay.; (3)Nutritionist. Nutrition School. Republic University. Uruguay.; (4)MSc. Biological Sciences. Nutrition School. Republic University. Uruguay.

**Background and objectives:** Sweetened drinks are one of the ultraprocessed foods that have had the greatest increase in consumption in recent years in Uruguay. A descriptive quantitative study was carried out to determine the consumption of sugar drinks in young adults aged 18 to 35 years and to compare the average amount of sugar from this consumption with the maximum amount of intake recommended by WHO free sugar in the framework of healthy eating (10% of energy needs per day).

**Methods:** The sample was non-probabilistic, a Google form was applied where it was collected: socio-demographic information, types of beverages consumed, frequency and total quantity for different types. To know the association between variables the chi square test p <0.05 was applied.

**Results:** Respond 440 young people, 75% between 18 to 29 years and 75% were women, just over half reside in the capital and have university education; 44% study and work. In relation to the frequency of consumption, tea, coffee and soft drinks predominate with a minimum frequency of 5 times per week. More than 70% exceeds the average consumption / day of 200 mL. 34% exceeds 10% of energy from free sugars only with the intake of beverages. There are no significant differences in the sugar energy intake of the drinks between sexes, ages, places of residence, or types of activity (p <0.05).

**Conclusions:** It is concluded that the habit of young adults to consume tea and coffee with sugar added and the intake of soft drinks, fruit juices and flavored waters contribute to the excessive contribution of free sugars in the study population as a risk factor for the development of diseases prevalent in Uruguay.

**Keywords:** sugar; drinks, intake
# IMPROVING COMPLEMENTARY FEEDING IN RU-RAL BANGLADESH WITH LOCAL FOOD-BASED RECOMMENDATIONS

(1)Wendt, Amanda; (2)Waid, Jillian; (3)Ali, Masum; (4)Gabrysch, Sabine.

(1)Postdoctoral Fellow. Institute of Public Health. University of Heidelberg. Germany.; (2)Director of Research, Learning, and Evaluation. Helen Keller International. Dhaka. Bangladesh.;

(3)Researcher. Helen Keller International. Dhaka. Bangladesh.;

(4)Unit Head, Deputy Institute Head. Unit of Epidemiology and Biostatistics. Institute of Public Health. University of Heidelberg. Germany.

**Background and objectives:** Poor infant and child feeding practices can lead to adverse growth and development outcomes. This is of particular concern in low- and middle-income countries. Nutrition-sensitive agricultural interventions are uniquely positioned to improve child feeding practices through improved household access to nutrient-dense foods as well as providing a platform for nutrition counseling activities.

Our objectives were to describe current food patterns of 6-23 month old children in the Food and Agriculture Approaches to Reduce Malnutrition (FAARM) trial population, identify problem nutrients which are not being fulfilled with normal dietary patterns, and create local food-based recommendations to address these deficiencies.

**Methods:** Food consumption patterns were measured as part of the FAARM cluster-randomized trial in Sylhet, Bangladesh. A 24-hour recall was conducted in 864 households (Children 6-8m: n=43; 9-11m: n=59; 12-23m: n=255) from September 2015 to August 2016, with replication in one-third of the sample. Complementary feeding patterns and food-based recommendations were evaluated using WHO Optifood linear programming software, which evaluated 10 micronutrients: calcium, vitamin C, thiamine, riboflavin, niacin, vitamin B6, folate, vitamin A, iron, and zinc.

**Results:** In all age groups, calcium, riboflavin, folate, iron, and zinc were identified as 'problem nutrients,' defined as not meeting 100% of recommended intake levels with an optimized diet. Thiamine was also identified as a 'problem nutrient' for children 12-23 months of age. Key local foods rich in these micronutrients were identified and included dark green, leafy vegetables (e.g. red amaranth, buffalo spinach), small dried or fermented fish, pulses, and eggs. For 9-11m and 12-23m age groups, increasing dark green, leafy vegetable consumption to two meals per day and consuming fish with eggs or pulses once per day ensured dietary adequacy of 5 and 7 of the 10 nutrients evaluated, respectively. For children 6-8m of age, diets remained inadequate.

**Conclusions:** Promotion of key foods which are locally available and acceptable is an important to step for effective nutrition counseling of complementary feeding. **Methods:** **Keywords:** Infant and young child feeding

Complementary feeding

Nutrition

Micronutrients

Optifood

## Further collaborators

This abstract was produced through support provided by PATH, under a grant from UK aid from the UK Government; however, the views expressed do not necessarily reflect the UK government's official policies.

# METABOLIC SYNDROME AND DIETARY PATTERNS OF OLDER ADULTS FROM THE HEALTH, WELL-BEING AND AGING SURVEY (SABE)- BRAZIL

(1)Quintiliano Scarpelli Dourado, Daiana; (2)Roediger, Manuela;

(3)Marucci, Maria de Fátima.

(1)PhD. Nutritionist. Public Health School. University of Sao Paulo;

(2)Post Doctoral Student. Nutritionist. Public Health School. University of Sao Paulo. Sao Paulo. Brazil; (3)PhD. Profesor. Public Health School. University of Sao Paulo. Sao Paulo. Brazil.

**Background and objectives:** Metabolic syndrome (MS) is common in elderly people. The feeding influences its prevalence constituting one of the modifiable risk factor with positive impact on disease control.

To investigate the association between MS and dietary patterns of older adults from São Paulo city.

**Methods:** Cross-sectional study that used data from the SABE survey: epidemiological, cohort based and home-dwelling. The study population included elderlies (≥ 60 years old), both sexes, selected by probability sampling, belonging to three cohorts A/2000 (n = 630), B/2006 (n = 214) and C/2010 (n = 311). The study variables were: gender, age, education, alcohol consumption, smoking, physical activity, number of chronic noncommunicable diseases; MS, identified according to the criteria of the National Cholesterol Education Program-Adult Treatment Panel III. The feeding data were obtained by one food frequency questionnaire with 18 food groups. Dietary patterns were determined by exploratory factor analysis of principal components. Rao & Scott and multiple logistic regression for complex sample were used, with 5% significance level. The statistical software STATA 13.1 was used.

**Results:** 1155 subjects were studied. The prevalence of MS was 57.9%. Four dietary patterns were identified: pattern 1, composed by fried foods, sausages, canned foods, sweets, tubers, spices/ sauces and processed eggs, called inappropriated; pattern 2, composed by low-fat dairy products, whole grain cereals and breads, and light, diet or zero food, called modified; pattern 3, composed by vegetable oils, rice, refined cereals and white bread, meat and legumes, called Brazilian traditional pattern; and pattern 4, fruits, vegetables and tubers, called beneficial. The modified pattern was positively associated to MS. 4th quartile modified pattern older adults had increased in 60% the risk of MS. The beneficial pattern was negatively associated to MS, in the older individuals (≥ 70 y, cohort A). The inappropriated and Brazilian traditional patterns were not significantly associated to MS.

**Conclusions:** The modified and beneficial dietary patterns were associated to MS. Modified individuals pattern showed in-
creased risk of MS. Beneficial pattern reduced the risk to the oldest older individuals. The modified pattern could be due to dietary changes implemented in the older adults daily life after diagnosis of metabolic abnormalities.

**Keywords:** metabolic syndrome; aging; food intake; factorial analysis.

(1)França, Ana Paula; (2)Marucci, Maria de Fátima; (2)Roediger, Manuela; (3)de Souza, Claudia Sebba Tosta.

(1)PhD. Nutritionist. University of São Paulo. Faculdade das Américas. São Paulo. Brazil.; (2)PhD. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (3)MSc. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** To investigate the association between abdominal obesity and demographic, clinical and behavioral variables, a cross-sectional study with 469 women (45-65 years) was conducted in two outpatient public clinics in São Paulo, Brazil.

**Methods:** The dependent variables were: abdominal obesity according to waist hip ratio (WHR) and obesity according to waist circumference (WC); the main explanatory variable was: climacteric stage (pre- or post-menopause) and the control variables were age; level of education; parity; use of hormone therapy; physical activity and smoking habit. Was performed multiple regression analysis “glm” (general linear model) using Stata 9.2 software for analysis.

**Results:** According to WHR, abdominal obesity was positively associated with age (PR=1,02; 95% CI = 1,00-1,05), and negatively associated with level of education (PR = 0,76; 95%CI = 0,64-0,92) and physical activity (PR = 0,70; 95% CI = 0,61-0,82). As indicated by WC, abdominal obesity was positively associated with age (PR = 1,02; 95% CI = 1,01-1,03) and parity (PR = 1,21; 95% CI = 1,02-1,45) and negatively with physical activity (PR = 0,70; 95% CI = 0,61-0,82).

**Conclusions:** While physical activity was a protective factor, age, level of education and parity were established as risk factors for the prevalence of abdominal obesity in women of this study group.

**Keywords:** abdominal obesity; parity; physical activity, climacteric; menopause.

(1)Guerendiain, Marcela; (2)Monzón Rodríguez, Allyson Natalie;

(3)Cando Pilatuña, Rosario Isabel; (4)Mayorga Mazón, Clara de las Mercedes; (2)Ligerini Vázquez, Lorena Johana; (2)Menendez Blanco, Cintya Yanella.

(1)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (2)Nutritionist. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)MSc. Psychologist. School of Clinical Psychology. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (4)MSc. Nutritionist. School of Nursing. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.

**Background and objectives:** There is evidence that the polyunsaturated fatty acids may play a key role in brain development, but the studies on monounsaturated and saturated fatty acids are limited. Therefore, the objective of this research was to explore the relationship between fatty acid intake and cognitive development in schoolchildren.

**Methods:** It was studied seventy-three children, from 5 to 11 years old, of the EVANES project, in this case, from San Juan school, Ecuador, located at 3240 meters above sea level. To identify levels of verbal comprehension (VC), perceptual reasoning (PR), working memory (WM), processing speed (PS) and full-scale intelligence quotient (FSIQ) the schoolchildren were evaluated using the Wechsler Intelligence Scale for Children four edition (WISC IV). In the target population, a survey was conducted in order to know the total daily consumption of food, and the fatty acids were calculated. The data were analyzed using general linear model, corrected by Bonferroni, and linear regression tests, both adjusted for age, sex and standard deviation (SD) of height. Inside the cognitive development, the sample was divided in normal (≥80 points) and low (<80 points).

**Results:** The mean and the SD for VC, PR, WM, PS and FSIQ were 79,62 ± 14.33, 81.30 ± 13.90, 86.53 ± 13.73, 89.49 ± 14.90 and 78.66 ± 12.11 points, respectively; for intake of saturated, monounsaturated and polyunsaturated fatty acids were 29.82 ± 18.56, 19.93 ± 9.88 and 7.19 ± 3.03 grams per day, respectively. It was found that children with a low VC had a higher intake of saturated and monounsaturated fatty acids. Besides, it was identified a relationship between lower PS and higher saturated fatty acid consumption, and, when we adjusted the model, the association became stronger.

**Conclusions:** An inverse relationship between the consumption of saturated and monounsaturated fatty acids, and verbal comprehension and processing speed was observed in schoolchildren of Ecuador.

**Keywords:** Cognitive development; fatty acids; monounsaturated fatty acids; saturated fatty acids.
# THE INFLUENCE THAT A LOCAL GOVERNMENT-LED MODEL WALKING PROGRAM GIVES FOR THE CHANGE OF PHYSICAL STRENGTH AND THE FIGURE

(1)Nagaoka, Tatsuki; (2)Omori, Akane; (1)Cho, Chuhwa; (3)Okubo, Mion;

(4)Koizumi, Kayo.

(1)Japan Woman's College of Physical Education Graduate School. Japan.; (2)M.S. Abiko Nikaido High School. Japan.; (3)Japan Woman's College of Physical Education. Japan.; (4)Ph.D. Japan Woman's College of Physical Education. Japan.

**Background and objectives:** The purpose of this study to compare the numerical value of the figure with the physical fitness test before and after the business of this time by the generation and examine an effect to physical training according to the generation.

**Methods:** Participants included 74 individuals ≥60years old-(n=58), ≥70(n=16) that participated in "10,000 steps of walking" in residents. The intervention combined a program to improve a physical function program to prevent declines in cognitive function. This intervention was conducted 9 times for 5 months from September 2014 to January 2017. All participants were measured their body composition, body size, physical fitness tests and steps were made at baseline and after 5 months later, and results were than compered. Body composition were measured by a whole-body bioelectric impedance analysis system (MC-780, Tanita Co.Ltd,Tokyo,Japan).And the International Society for the Advancement of Kinanthropometory(ISAK) protocol was used for measuring 5 body parts as follows ; three skinfolds(abdominals and medial calf) and 3 girths (waist, gluteal and mid-calf) on the right side of the objects'body. The statistical difference was determined by two-sided Student's t test, Difference with P<0.05 was considered significant.

**Results:** As for the steps of 5 months, a man in 70s was 11889±4700 steps of most, 5406±4022 steps of the 70s woman, that there was the least. No significant difference was found for all measurements between 60s and 70s. The long seat body ante flexion, the walking speed significantly increased the man and woman in its 60s, the woman in her 70s in approximately a program, but, as for the man in 70s, a meaningful change was not recognized. A meaningful change was not accepted for the grips between sex generations.

**Conclusions:** This study indicated that necessity of program not just walking, but to improve physical strength and increase of the quantity of muscle for 60s also.

**Keywords:** 10,000 steps of walking, elderly person,physical fitness

# ARE THERE CHANGES IN THE FATTY ACID PROFILE IN BREAST MILK WITH SUPPLEMENTATION OF OMEGA 3 SOURCES? A SYSTEMATIC REVIEW

(1)Amaral, Yasmin; (2)Marano, Daniele; (3)Silva, Leila; (3)Guimarães, Aline; (4)Moreira, Maria Elisabeth.

(1)Msc. Nutritionist. Instituto Fernandes Figueira/ Fiocruz. Brazil.;

(2)Dr. Nutritionist. Instituto Fernandes Figueira/ Fiocruz. Brazil.;

(3)Nutritionist. Instituto Fernandes Figueira/ Fiocruz. Brazil.; (4)Dr. Neonatologist. Instituto Fernandes Figueira/ Fiocruz. Brazil.

**Background and objectives:** Due to the controversies between the studies, as well as to the importance of the theme for the health of the newborn, this systematic review aims to evaluate the studies that verified the effects of Omega 3 supplementation during pregnancy and/or puerperium on the composition of LH. The bibliographical survey with this theme aims to assist the maternal and child population as well as health professionals, in order to establish the importance of supplementation as well as offering subsidies for its practice. Objective: To evaluate the effect of supplementation of Omega 3 sources on the fatty acid composition of human milk.

**Methods:** The review consisted of the search for articles published in PubMed, Virtual Health Library and Web of Science databases using the following keywords: "Fatty acids, Omega-3, Human milk and Supplementation", for which we have used the PRISMA checklist. The following selection criteria were used: articles published in English, Portuguese, Spanish or Italian, published between 2000 and 2015 and carried out in humans, according to the established strategy, resulting in 710 articles.

**Results:** All studies found a positive relationship between the consumption of Omega-3 sources and their concentration in human milk. The differences in the findings are due to the different methods used such as, for example, the specific moment of Omega-3 supplementation, the type of Omega-3 source offered, as well as sample size.

**Conclusions:** Although the studies were different in several methodological aspects, it was possible to observe the importance of Omega-3 supplementation in gestation and/or puerperium.

**Keywords:** Pregnant women; Breastfeeding; Human milk; Omega-3 Fatty Acids; Systematic review.
COMPARISON OF TOTAL LIPID AND FATTY ACID INTAKE ACCORDING TO THEIR DAILY DISTRIBUTION: RELATIONSHIP WITH STUNTING IN CHILDREN FROM ECUADOR

**Background and objectives:** It must be considered that, in childhood, the contribution of fats is essential for correct growth, vigorous physical activity and optimum intellectual development, and therefore it is necessary to maintain an adequate contribution. Our objective was to compare the daily lipid intake in the different meal times and to link the fatty acids consumption with stunting in schoolchildren of Andean region.

**Methods:** The study included 100 middle-aged children, 7.8 ± 2.17 years old, from a rural community school in Chimborazo, Ecuador. A nutritional survey was used for the registration of the food intake. The dietary consumption was evaluated, in each food time, and was calculated from the corresponding standard portion size. The total lipid and fatty acid (FA) consumption was determined transforming these data into food volume/weight (gr or ml), as appropriate, and through the latest available information in food-composition tables from Ecuador. The standard deviation score of height, applying the Child Growth Standards of Word Heath Organization (2006 and 2007) and Anthropplus, was used for nutritional status evaluation. Children were classified in stunting (height for age <-2 SD) and normal (height for age ≥-2 SD). The daily intake was analysed using the general linear model, corrected by Bonferroni, which was adjusted for sex, age and body mass index. The children were divided into two groups, stunting and normal stature.

**Results:** The contribution of fats at breakfast was higher than the other mealtimes, except lunch. The intake of total lipids in the collation at mid-morning (provide by government of Ecuador at school) was greater than middle afternoon, while in the evening collation was lower compared with all meal times. Children also presented a higher contribution of saturated FA in breakfast compared to collation. Regarding nutritional status, the saturated FA intake was higher in schoolchildren who had normal height than these who had stunting.

**Conclusions:** In schoolchildren from rural communities of Chimborazo, the main lipid intake comes from breakfast. Stunting children have a lower contribution of saturated fatty acids in relation to those with normal stature.

**Keywords:** fatty acids; mealtimes; saturated fatty acids; children.

PERCEPTION OF HEALTHY EATING AND DAILY DIETARY INTAKE IN CHILDREN AND ADOLESCENTS OF FACATATIVÁ, COLOMBIA

**Background and objectives:** The perception of healthy eating is a useful tool to identify beliefs, ideas and concepts about this term. In childhood, these factors contribute to eating behaviours and patterns. For this reason, it was analysed the differences in dietary intake according to the perception of healthy eating in children and adolescents.

**Methods:** It was included 33 children and adolescents (8-14 years old) of Facatativá, Colombia. The perception of healthy eating was obtained through a semi-structured questionnaire, based on the model used in previous studies. The narrative responses were codified and grouped into 6 categories "eating fruits and vegetables", "eating all food groups", "foods that help us grow healthy", "foods that give vitamins", "eating vegetables and proteins", "do not eat sweets or junk food". To determine the daily dietary intake, a food frequency questionnaire with 33 item was used.

**Results:** The mean of age of population was 9.8 ± 1.7 years, and for fish, milk and gran intake was 8.24 ± 11.77, 244.67 ± 192.65 and 16.01 ± 16.15 grams, respectively. The participants who reported, as healthy eating, "eating fruits and vegetables" had a lower grain consumption than "do not eat sweets or junk food" group (p=0.032). The daily fish and milk intake was higher in children who responded, "do not eat sweets or junk food" than those who said, "foods that help us grow healthy" (p=0.037) and "eating fruits and vegetables" (p=0.003), respectively.

**Conclusions:** Children and adolescents who consider a healthy eating as "do not eat sweets or junk food" present a higher intake of fish, milk and grain. This suggest that the perception of healthy eating may affect the dietary patterns in these stages of life.

**Keywords:** Perception of healthy eating; daily dietary intake; fish intake; milk intake; grain intake.

<footnote>(1)Guerendiain, Marcela; (2)Ligerini Vázquez, Lorena Johana;</footnote>

<footnote>(3)Mayorga Mazón, Clara de las Mercedes; (2)Monzón Rodríguez, Allyson Natalie; (2)Menendez Blanco, Cintya Yanella.</footnote>

<footnote>(1)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador;</footnote>

<footnote>(2)Nutritionist. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)MSc. Nutritionist. School of Nursing. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>

<footnote>(1)Rojas Infante, Diana Milena; (2)Guerendiain Margni, Marcela Esther.</footnote>

<footnote>(1)Nutritionist. Pontificia Universidad Javeriana. Bogotá. Colombia.; (2)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>
# NUTRITIONAL STATUS AND CHILD DEVELOPMENT OF PRE-SCHOOL CHILDREN IN BHUTAN

(1) Kang, Yunhee; (2) Aguayo, Victor; (3) Campbell, Rebecca; (4) Dzed, Laigden; (5) Joshi, Vandana; (6) Waid, Jillian; (7) Haselow, Nancy; (8) West, Jr., Keith.

(1) PhD. Postdoctoral fellow. Department of International Health. Johns Hopkins School of Public Health. USA.; (2) PhD. Associate Director. Chief Nutrition. UNICEF. New York. USA.; (3) PhD. Department of International Health. Johns Hopkins School of Public Health. USA.; (4) PhD. Sr. Program officer. Ministry of Health. Royal Government of Bhutan. Thimphu. Bhutan.; (5) PhD. Nutrition Specialist. UNICEF Bhutan. Thimphu. Bhutan.; (6) PhD. Helen Keller International New York. USA.; (7) PhD. Vice President for Asia-Pacific. Helen Keller International. USA.; (8) Dr. Ph. Professor. Department of International Health. Johns Hopkins School of Public Health. USA.

**Background and objectives:** Few nationally representative studies exist reporting on the nutrition and development of Bhutanese pre-school children. Using the National Nutrition Survey (NNS) 2015 and Multiple Indicator Cluster Survey 2010 (MICS-4), we evaluated household-, maternal-, and child-level risk factors for undernutrition among children aged 6 to 59 mo (n=1,506) and examined associations between early development indicators and nutritional status among children aged 36 to 59 mo (n=2,038).

**Methods:** Prevalences of stunting, wasting, underweight (height-for-age, weight-for-height, weight-for-age Z-scores, respectively, <-2) and overweight (weight-for-height Z-score>2) were estimated adjusting for survey design. Ten-item early child development index (ECDI) scores were created using UNICEF guidelines to assess four domains: literacy and numeracy, learning, physical, and socio-emotional. ECDI was defined as "on track" for children with satisfactory scores in 3 or 4 domains. Logistic regression, adjusting for sampling design, was conducted to identify predictors of undernutrition and its association with development indicators.

**Results:** The prevalence of stunting, wasting, underweight and overweight were 21.2%, 2.5%, 7.3% and 2.6%, respectively. In multivariable regressions, risk of stunting increased with age: 5.2% at <6 mo (referent), 17.1% at 6-23 mo (OR=3.59; 95%CI: 0.74, 17.4) and 24.9% at 24-59 mo (OR=6.12; 95%CI: 1.40, 26.9) and was lower among children of university-educated (OR=0.05; 95%CI: 0.00, 0.89) compared to uneducated mothers. No examined variables were significantly associated with wasting or overweight. Percentages of children who met literacy and numeracy, learning, physical, and socio-emotional were 25.5%, 99.6%, 61.4%, and 93.2%, respectively; 66.1% children were found "on track". Literacy and numeracy was negatively associated with stunting (OR=0.64; 95%CI: 0.48, 0.86), severe stunting (OR=0.55; 95%CI: 0.36, 0.83), and severe wasting (OR=0.17; 95%CI: 0.03, 1.08) providing a clear linkage between these aspects of development and chronic undernutrition. ECDI was negatively associated with severe stunting (OR=0.66; 95%CI: 0.47, 0.93). No other associations were found between nutritional status and developmental outcomes.

**Conclusions:** Whereas weight-for-height is superimposed on the WHO referent distribution, one-fifth of Bhutanese preschoolers are stunted, a condition that is negatively associated with children's literacy and numeracy achievement and maternal education. Severely stunted children require remedial care, both nutritionally and to promote catch-up in aspects of their development.

**Keywords:** stunting; risk factors; early child development index; literacy and numeracy; Bhutan

# ANALYSIS OF THE ASSOCIATION BETWEEN NUTRITIONAL STATUS AND DIETARY INTAKE IN CHILDREN AND ADOLESCENTS OF FACATATIVÁ, COLOMBIA

(1) Rojas Infante, Diana Milena; (2) Guerendiain Margni, Marcela Esther.

(1) Nutritionist. Pontificia Universidad Javeriana. Bogotá. Colombia.; (2) PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.

**Background and objectives:** The food intake is one of the most important factors that determines the nutrition and health in childhood. For this reason, it was analysed the relationship between the nutritional status and daily dietary intake in children and adolescents of Facatativá, Colombia.

**Methods:** A descriptive cross-sectional study was conducted, involving 33 children and adolescents (9.8 ± 1.7 years old). The nutritional status was defined according to the standard deviation score of height and body mass index (BMI), using the Child Growth Standards of Word Heath Organization, 2006 and 2007, adapted for the Colombian population in 2016. Taking into account the BMI-for-age, children and adolescents were classified in: thinness (< -2 SD), risk of thinness (≥-2 to <-1 SD), normal (≥-1 to ≤+1 SD), overweight (>+1 to ≤+2 SD) and obesity (>+2 SD). Considering the height, they were divided in: stunting (height-for-age <-2 SD), risk (height-for-age >-2 to <-1 SD) and normal (height-for-age ≥-1 SD). The daily dietary intake was assessed using a food frequency questionnaire with 33 item.

**Results:** The mean of weight was 32.9 ± 9.5 kg and for height 1.3 ± 0.1 m. The 39.4% of children had risk of stunting and 48.5% normal height; the 63.6% presented a normal BMI and 21.2% excess weight. It was found relationship between the standard deviation score of height-for-age and the butter intake (-0.482, p=0.005). The daily intake of tomato had an inverse association with the weight (p=0.043) and positive with the standard deviation score of height-for-age (p=0.032). The BMI presented a negative relationship with daily carrot consumption (p=0.038), and the intake of sugar was positively associated with the height.

**Conclusions:** As expected, it has been found relationship between food intake and nutritional status. Tomato and carrot consumption, could have beneficial effects on the nutritional status
gression, household size showed consistently negative association with z-scores in both physiologic categories. Other strong predictors of z-scores were belonging to the richest quintile and being a widow/widower. Apart from educational attainment of household head and wealth index, there were no other clear trends observed in the associations of the different parameters to the z-scores.

**Conclusions:** The results of this study underscores the need to improve nutritional status prior to the onset of puberty to maximize vertical growth. On the other hand, interventions focused on sustaining nutritional gains during the post-pubertal stage should be similarly implemented without compromising BMI. Providing interventions that lead to improvement in wealth is a good place to begin with.

**Keywords:** Adolescent Nutrition, Filipinos, HAZ, BAZ

A second model to determine low-weight risk according to BMI showed a significant association (R2 = 69) with TSFmm, ACcm, pre-albumin and number of drugs in use (OR = 0.78, p = 0.010, OR = 0.51, P = 0.000, OR = 0.92, p = 0.043, OR = 0.65, p = 0.045, respectively).

**Conclusion:** Barthel's Index, schooling level, triceps skin fold and arm circumference were associated with an increased risk of malnutrition. Barthel's index, prealbumin, skin fold of the triceps, arm circumference and number of drugs are associated with low weight according to BMI.

**Keywords:** Older adults, malnutrition, MNA, anthropometry.

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ASSESSMENT OF MALNUTRITION RISK AND NUTRITIONAL STATUS OF OLDER PEOPLE AT HOSPITAL ADMISSION

(¹)Núñez, Iliana; (¹)Gómez, Milagros; (²)Rios, Israel.

(¹)Nutritionist. Nutrition and Dietetic Department. Medicine School. University of Panama. Panama city. Panama.; (²)MSc. Nutritionists. Nutrition and Dietetic Department. Medicine School. University of Panama. Panama city. Panama.

**Background and objectives:** Introduction: Malnutrition in the elderly is of multicausal origin even in hospitals. Objective is to evaluate the nutritional status and risk factors of older adults admitted to the geriatric acute ward of Irma De Lourdes Tzanetatos Hospital (ILTH).

**Methods:** Methodology: Observational, analytical and transverse study in 94 patients admitted to the geriatric ward of Irma De Lourdes Tzanetatos Hospital. Data were collected from January to March 2016. Included anthropometric measurements, nutritional risk screening according to Mini Nutritional Assessment (MNA), clinical and hospital data, Barthel Index and Charlson Comorbidity (CC); Biochemical data and sociodemographic information. Multivariate logistic regression was used to determine risk factors associated with malnutrition.

**Results:** Of the 94 patients, 51 (54%) were female, mean age 77.9 ± 8.2 years; 39.4% had cardiovascular disease admission diagnosis, 35.1% presented severe functional disability, 95.8% severe lean mass, according to the arm muscle area (AMA). According to MNA, 50.0% were malnourished; according to BMI, 54.2% were in the low weight category; And according to the CC, 45.7% with high comorbidity. Barthel's index, schooling, triceps skin fold (TSFmm) and arm circumference (ACcm) were significantly associated (R2 = 0.61) with an increased risk of malnutrition according to MNA (OR = 46.5, p = 0.001, OR = 13.8, p = 0.009, OR = 0.78, p = 0.005, OR = 0.73, p = 0.046, respectively). For nutritional status according to BMI, Barthel's index and pre-albumin were significantly associated (R2 = 0.43) with low weight (BMI <23kg / m2), (OR = 14.3, p = 0.003 and OR = 0, 91, p = 0.024, respectively).

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PRO-INFLAMMATORY TRIGGERS IN SCHOLARS: LEPTIN, IL-6, FIBRINOGEN, AND HIGH-SENSITIVITY C-REACTIVE PROTEIN

(¹)Alvarez Cordova, Ludwig Roberto; (²)Santana Porben, Sergio;

(³)Sierra Nieto, Victor Hugo; (⁴)Fonseca Perez, Diana Maria; (⁵)Rojas Criollo, Melina Isabella; (⁶)Escobar Valdivieso, Gustavo Saul;

(⁶)Espinoza Caicedo, Jason Amadeus; (⁷)Moran Zuloaga, Juan Luis.

(¹)Medical doctor. Magister in Clinical Nutrition. Institute of Biomedicine. University Chatolic of Santiago of Guayaquil. Ecuador.; (²)Medical doctor. Magister of Public Health. University of La Habana. Cuba.; (³)Economist. Magister in Sciences. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.; (⁴)Nutritionist. Magister in Clinical Nutrition. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.; (⁵)Nutritionist. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.; (⁶)Biologist. Institute of Biomedicine. University Catholic of Santiago of Guayaquil. Ecuador.; (⁷)Nutritionist. Faculty of Medical Sciences. University Catholic of Santiago of Guayaquil. Ecuador.

**Background and objectives:** Obesity is a major health problem shown to be associated with a pro-inflammatory state. Adipocyte dysfunction results in the expression of pro-inflammatory mediators which, in turn, contribute to the development of chronic inflammation states. We documented the serum levels of leptin and their association with markers of systemic inflammation in obese children.

**Methods:** Cross-sectional study of 46 scholar children (Boys: 45,7%). BMI, waist circumference and body fat percentages were obtained by means of anthropometric and bioimpedance techniques. Leptin, fibrinogen and C-reactive protein measurements were made by recommended analytical protocols in fasting blood samples.

**Results:** Average BMI was 23,28 ± 4,39 kg/m2. Only 6.5% of the children had elevated CPR values. In sharp contrast with this finding, leptin values were increased in 93,5% of them.

**Conclusions:** Obesity is associated with increased leptin values. This finding confirms the presence of a state of insulin resistance resulting from adipocyte dysfunction. The increase in leptin values precedes the rise of inflammation markers that will eventuate
ally lead to endothelitis and atherosclerosis. Obese children are at
high risk of cardiovascular disease.

**Keywords:** Pediatric Obesity; Body Composition; Inflammation; Leptin; Nutritional Assesment

THE VARIETY AND DIVERSITY OF THE DIET OF BREASTFED INFANTS AND YOUNG CHILDREN FROM THE PROVINCE OF BAJA VERAPAZ IN GUATEMALA IS LOW

**Background and objectives:** The WHO recommends exclusive breastfeeding for 6 months, followed by the progressive introduction of safe, nutritious and appropriate complementary foods (CF). Qualitative research in the province of Baja Verapaz indicates both premature and delayed introduction of CF. We aimed to assess the dietary variety and diversity of CF offered to infants and young children (IYC) aged 6 to 23 months old in this setting.

**Methods:** Convenience samples of IYC aged 6-8 months (n=6), 9-11 months (n=9) and 12-23 months (n=13) were derived from distinct sites and ethnicities across the province of Baja Verapaz. We aim to increase the sample size to 100 in the near future. IYC diets were assessed by means of previous-day dietary recalls collected from mothers. Dietary diversity among breastfed infants was computed using the WHO food groups which include: (i) grains, roots and tubers, (ii) legumes and nuts, (iii) dairy products (milk, yogurt, cheese), (iv) flesh foods (meat, fish, poultry and liver/organ meats), (v) eggs, (vi) vitamin-A rich fruits and vegetables and (vii) other fruits and vegetables. Dietary variety was calculated by adding all food items mentioned within these food groups; non-nutritive beverages and food were not included.

**Results:** Most IYC had been breastfed the day of the interview (n=23, 82%) and all breastfed infants were receiving CF. The most commonly consumed foods were corn-dough tortilla (consumed by 19), banana (n=9), rice (n=8), sweet bread (n=7) and Incaparina® gruel (n=7). IYC consumed a median of 5 food and beverage items, and dietary variety ranged between 2 and 9. Median dietary diversity was 3, and ranged between 1 and 6 food groups. Median dietary diversity was 2, 3 and 3 at for IYC aged 6-8, 9-11 and 12-23 months, respectively. Only 4(14%) of breastfed IYC consumed a minimum dietary diversity, as recommended by the WHO.

**Conclusions:** No instance of protracted EBF was documented in the 6-8 month period. However, the variety and diversity of CF offered to IYC in Baja Verapaz is alarmingly low and unlikely to be nutritionally adequate. Further investigation into the quality of the diet of IYC is merited.

**Keywords:** infant and young child feeding, minimum dietary diversity, dietary variety, human milk, Guatemala

**Further collaborators**

This research was conducted in collaboration with the Global Alliance for Improved Nutrition (GAIN) with funding from the Inter-American Development Bank

BREASTFEEDING AND PRESCHOOL CHILDREN INTELLIGENCE QUOTIENT IN RURAL HIGHLANDS IN ECUADOR

**Background and objectives:** The nutrition during the early stages of life, is essential for an adequate neurological development. Beneficial effects of breast milk were reported even in pre-term infants. Thus, our objective was to analyse the relationship between breastfeeding and intelligence quotient in children from a rural school in Chimborazo.

**Methods:** The study included 37 children, belonging to EV-ANES project, aged 5 to 6 years, from San Juan primary school, in Chimborazo, Ecuador. They were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI™). A survey to parents was applied to identify the duration of exclusive breastfeeding and age of weaning. The breastfeeding parameters were divided into quartiles (Q1: ≤5, Q2: 6-6; Q3: 7-9 and Q4: >10 months, for exclusive breastfeeding, and Q1: ≤12, Q2: 13-18; Q3: 19-24 and Q4: >25, for weaning age). The verbal, manipulative and total intelligence quotient (IQ) was classified as extremely low (<70), borderline (70-79), low average (80-89), average (90-109), high average (>110) and superior (>120). Data analysis was performed by applying Chi-square test. Differences were considered significant at p<0.05. This study was conducted in accordance to the ethical rules of the Declaration of Helsinki and was approved by the Ethic Committee of the San Francisco de Quito University.

**Results:** The means of total, verbal and manipulative IQ scores were 89.25 ± 10.43, 86.46 ± 11.55 and 96.39 ± 9.96, respectively. Likewise, the value of duration of exclusive breastfeeding

<footnote>(1)Montenegro-Bethancourt, Gabriela; (2)Garcia-Meza, Rosario;</footnote>

<footnote>(3)Gonzalez, Wendy; (4)Vossenaar, Marieke; (5)Solomons, Noel W.</footnote>

<footnote>(1)PhD. Researcher. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala; (2)MA. Researcher. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (3)PhD. Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland.; (4)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.;</footnote>

<footnote>(5)MD. Director. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.</footnote>

<footnote>(1)Díaz Silva, Alicia Virginia; (2)Cando Pilatuña, Rosario Isabel;</footnote>

<footnote>(3)Guerendiain Margni, Marcela Esther.</footnote>

<footnote>(1)Psychologist. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (2)MSc. Psychologist. School of Clinical Psychology. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.; (3)PhD. Nutritionist. School of Medicine. Metabolism and Nutrition Disorders research group. Faculty of Health Sciences. National University of Chimborazo. Riobamba. Ecuador.</footnote>
was 7.61 ± 4.34 months and the age of weaning was 17.89 ± 6.28 months. The manipulative IQ registered three levels, low average, average and high average, and there were no extremely low, borderline and superior scores. When we compared the quartiles of duration of exclusive breastfeeding according to the classification of intelligence quotient, it was observed that the average manipulative IQ was more frequent in the higher quartiles, and the low average level in Q1 (p=0.039). Although, no differences for weaning age were found.

**Conclusions:** The duration of exclusive breastfeeding may be a key factor in cognitive development of preschool children. However, further studies are required since other environmental factors could be influencing the results.

**Keywords:** Breastfeeding; cognitive development; intelligence quotient; preschool children; highlands.

practices were inappropriate; 41% of the children attained a minimum dietary diversity; only 27% attained minimum acceptable diet and 76% attained minimum meal frequency. With the exception of the minimum meal frequency, adjusted logistic regression findings showed that infants living in food secure households were significantly more likely to achieve appropriate infant feeding practices than those in food insecure households: minimum meal frequency (AOR 1.26, p= 0.530); minimum dietary diversity (AOR 1.84, p= 0.046) and minimum acceptable diet (AOR 2.35, p= 0.008).

**Conclusions:** The present study adds to the body of knowledge by showing how household food security relates to infant feeding practices in low-income settings. The findings imply that interventions aimed at improving infant feeding practices and ultimately nutritional status need to also focus on improving household food security.

**Keywords:** Infant feeding practices, household food security, urban informal settlements, complementary feeding

(¹)Njoki, Teresia; (²)Ochola, Sophie; (³)Mutua, Martin; (⁴)Kimani-Murage, Elizabeth.

(¹)BSc. Research Officer. Health Program. African Population and Health Research Center. Kenya.; (²)PhD. Senior Lecturer and Chairman. Foods Nutrition and Dietetics department. Kenyatta University. Kenya.; (³)MSc. Data Analyst. Health Program. African Population and Health Research Center. Kenya.; (⁴)PhD. Research Scientist. Health Program. African Population and Health Research Center. Kenya.

**Background and objectives:** Studies in the urban informal settlements show widespread inappropriate infant and young child feeding (IYCF) practices and high rates of food insecurity. These together with unique challenges with regards to child survival in these settings has led to widespread and persistent under-nutrition rates. Globally, few studies have explored the linkage between food security and infant feeding practices. This study assessed the association between household food security and IYCF practices in two urban informal settlements in Nairobi, Kenya.

**Methods:** The study adopted a longitudinal study design that involved a census sample of 1110 children less than 12 months of age and their mothers aged between 12-49 years. A researcher-administered questionnaire was used to collect information on infant and young child feeding practices (initiation of complementary foods, dietary diversity, frequency of feeding and minimum acceptable diet); household food security; maternal demographic and socio-economic characteristics. Logistic regression was used to determine the association between food insecurity and IYFC practices having controlled for maternal demographic and socio-economic characteristics as these may influence IYFC practices.

**Results:** The findings showed high household food insecurity as only 17.4% of the households were food secure. Infant feeding

(¹)Dibley, Michael; (²)Huda, Tanvir Mahmudul; (³)Rahman, Mohammad Masudur; (⁴)Raihana, Shahreen; (⁵)Tahsina, Tazeen;

(⁶)Rahman, Qazi Sadeq-ur; (⁷)Islam, Sajia; (⁸)Arifeen, Shams El;

(⁹)Agho, Kingsley; (¹⁰)Raynes-Greenow, Camille.

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

**Background and objectives:** Iron-deficiency is the most common nutritional deficiency globally. Due to the high iron requirements, it is highly prevalent and severe in pregnant women. Our objective was to evaluate if iron-folic acid supplementation starting in the first trimester of pregnancy and sustained throughout pregnancy reduces neonatal mortality.
**Methods:** We conducted a community based, cluster randomized controlled trial in five districts in Dhaka Division, Bangladesh with a combined population of >10 million. In the intervention clusters trained BRAC village volunteers identified pregnant women and provide consenting women with capsules (Eskayef Bangladesh Ltd) containing 60 mg of elemental iron and 400µg of folic acid. We measured ground water iron levels in all study households using a validated test kit [±0.1 mg/L, HACH Iron Test kit, Model IR-18B]. We compared the neonatal mortality rates and their 95% confidence intervals adjusted for clustering in each ground water iron-level group. We used Cox proportional hazards mixed models for mortality outcomes and include ground water iron level as an interaction term in the mortality model.

**Results:** We recruited a total number of 36,532 pregnant women. Overall the enhanced distribution of iron/folic acid did not reduce neonatal mortality (HR 0.94, 0.78 to 0.1.12, P=0.521). However in sub-population with low ground water iron levels, iron/folic acid significantly reduced risk of neonatal mortality by 42% (HR 0.58, 0.37 to 0.90, P=0.015). Neonatal mortality was not reduced in sub-populations with medium (HR 1.05, 0.83 to 1.32..., P=0.671) or with high ground water iron levels (HR 1.01, 0.74 to 1.38, P=0.940).

**Conclusions:** In rural populations in Bangladesh where the ground water iron level is less than 0.5 mg iron/L, early antenatal supplementation with iron/folic acid approximately halved neonatal mortality compared with the usual program. This effect was removed with ground water iron levels of >0.5 mg iron/L. Our results indicate a causal role of iron in reducing neonatal mortality in deficient populations. Overall pregnant women in developing countries need sufficient doses of iron in nutrient supplements to maximize reductions in neonatal mortality.

**Keywords:** iron-folic acid, first trimester, pregnancy, neonatal mortality, ground-water iron

**Further collaborators:**

1. Ashraful Neeloy. neeloy.alam@sydney.edu.au.

Research fellow, Sydney School of Public Health, the University of Sydney

2. Kaosar Afsana. Afsana.k@brac.net

Director. Health Nutrition and Population. BRAC. Bangladesh

3. Morseda Chowdhury. mcho5496@uni.sydney.edu.au

BRAC. Bangladesh

4. Lucky Ghose. lucky.ghose@brac.net

Senior Medical Officer. BRAC. Bangladesh

5. Abu Bakkar Siddique. Email: abu.bakkar@icddrb.org

Statistical Officer. Maternal and Child Health Division. icddr.b, Bangladesh

6. Md Moinuddin. moinuddin@icddrb.org

Statistician. Maternal and Child Health Division. icddr.b, Bangladesh

# THE CONTRIBUTION OF BEVERAGES TO THE CONSUMPTION OF ADDED SUGARS. REPORTED DIETARY INTAKE IN THE ARGENTINE POPULATION. RESULTS OF ELANS STUDY

(1)Favieri, Andrea Lorena; (2)Guajardo, Viviana Beatriz; (3)Nogueira Previdelli, Agatha; (4)Gerardi, Alejandro; (5)Gómez Salas, Georgina;

(6)Fisberg, Mauro; (7)Kovalskys, Irina.

(1)BSc. Nutritionist. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (2)BSc. Psychologist. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (3)PhD. Professor. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu São Paulo. Brazil.; (4)BSc. Sociologist. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (5)MSc. Professor. Departamento de Bioquímica.

Escuela de Medicina. Universidad de Costa Rica. Costa Rica.; (6)MD. Instituto Pensi. Fundação Jose Luiz Egydio Setubal. Hospital Infantil Sabara. São Paulo. PhD. Professor. Departamento de Pediatria. Universidade Federal de São Paulo. São Paulo. Brazil;

(7)MD. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.

**Background and objectives:** High intake of added sugar (AS) is a public health concern due to its association to many diseases. The present study aims to identify the amount and main sources of AS in the Argentine population

**Methods:** Data were obtained from 1266 Argentines participating in Latin American Health and Nutrition Study (ELANS), a multicenter study of a nationally representative randomized sample of urban population of eight LA countries between November 2014 and July 2015. Data from two face to face 24-hour recall (separated by 5 days) were used to identify the intake of the major foods and beverages containing AS. The weighed-proportions formula developed by Block et al (1985) in which the relative contribution (RC) of a given food item/food group is defined as: RC=(Total AS grams from a food item x 100)/Total AS grams from all food items was used, and performed by age, gender, socioeconomic level (SEL). Descriptive statistical data analysis was performed with SPSS 20.

**Results:** Median consumption of AS was 80,6 g /day, 15% of total energy (TE). The Sugar Sweetened Beverages (SSB) grouped were the highest contribution of AS intake (76.3%). The foods contributed with 23.7%. Soft drinks (SD) (34.5 %) infusions (27.8%) juice dry mix (7.9%) juice RTD (4.7%), other beverage (1.4 %). In women 32% of the AS was added to the infusions and 28.7% was in SD, while in men, less AS was added to Infusions 24.2% but brings in SD 39.4%. The AS from infusions, increased by age in women (23.8% in 15 to 19y until in 36.7% in 50-65y) in adolescents SD provided 37.2% (41.1% in men and 28.1% in women). In low SEL women, the infusions provided 37.2% of the AS and mainly based on mate (30%) while in men of high SEL the SD raise up to 48.5%.

**Conclusions:** In Argentina, the consumption of Added Sugars comprised 15% of TE and the main sources are SSBs. In men, main source of AS are soft drinks and the infusions are in women. A local consideration is the proportion of AS coming in mate (19.5%).
**Keywords:** Added sugars, Argentine population, multicenter study

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

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

144/2448

DIETARY INTAKE AND MAIN SOURCES OF FATS IN THE ARGENTINE POPULATION. RESULTS OF ELANS STUDY

(1)Kovalskys, Irina; (2)Guajardo, Viviana Beatriz; (3)Nogueira Previdelli, Agatha; (4)Gerardi, Alejandro; (5)Gómez Salas, Georgina; (6)Fisberg, Mauro; (7)Favieri, Andrea Lorena.

(1)MD. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (2)BSc. Psychologist. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (3)PhD. Professor. Faculdade de Ciências Biológicas e da Saúde. Universidade São Judas Tadeu São Paulo. Brazil.; (4)BSc. Sociologist. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.; (5)MSc. Professor. Departamento de Bioquímica. Escuela de Medicina. Universidad de Costa Rica. Costa Rica.; (6)MD. Instituto Pensi. Fundação José Luiz Egydio Setubal. Hospital Infantil Sabara. São Paulo. PhD. Professor. Departamento de Pediatria. Universidade Federal de São Paulo. São Paulo. Brazil.; (7)BSc. Nutritionist. Nutrition and Health Area. International Life Science Institute (ILSI). Buenos Aires. Argentina.

**Background and objectives:** High fat diets, especially saturated fat is associated with cardiovascular disease. The present study aims to identify the consumption and main food sources of fats in the Argentine's diet.

**Methods:** Data were obtained from 1266 Argentines participating in the Latin American Health and Nutrition Study (ELANS), a multicenter study of a nationally representative randomized sample of urban population of eight LA countries between November 2014 and July 2015. Data from two face to face 24-hour recall were used to identify the intake of the major foods containing fats. The weighed-proportions formula developed by Block et al (1985) in which the relative contribution (RC) of a given food item/food group is defined as: $RC=(\text{Total fat grams from a food item} \times 100)/\text{Total fat grams from all food items was used, and performed by age, gender, socioeconomic level (SEL). Descriptive statistical data analysis was performed with SPSS 20}$

**Results:** The median of energy intake (EI) was 2154 kcal/day (2434 kcal/day in men and 1911 kcal/day in women). Median fat

intake was 78.8 g/day representing a 33% of the daily EI, while saturated fats was 27.4 g/day (11.4% of the EI). Five food groups were identified as major sources of fats: the oils and fats (O&F) (30.4%), meats (27.2%), bakery products (13.6%), dairy (13.3%) and pizza (7.1%). Meats as a source of fats increased with age from 23% (15-19y) to 30.9% (50-65y), becoming the first source in men of 50-65 y. Inversely, the percentage of total fats from dairy and O&F is slightly higher in women than in men. Differences in the source of fats are found comparing low with high SEL: more proportion of fat from meat (27.5% and 21.6% respectively) and O&F (31.5 and 21.6% respectively) in low SEL and higher fats from pizza in high SEL compared to low (16.4 and 8.7% respectively). No differences were found by BMI.

**Conclusions:** Argentine identity includes high proportion of fats coming from meats & animal fats, oils, bakery products, and/or pizza. Public health interventions reinforcing other cultural options based on drivers of food choice could be beneficial.

**Keywords:** Fats intake, sources of fats, Argentine population

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

**Further collaborators:**
on behalf of the ELANS Study Group
# EFFECTS OF BIOMARKER INFLAMMATORY AND CARDIOMETABOLIC ON QUALITY OF LIFE OF BRAZILIAN OLDER ADULTS: HEALTH, WELL-BEING AND AGING STUDY (SABE STUDY)

**Background and objectives:** Scientific evidence shows relationship of chronic inflammation, elevated cardiometabolic biomarker levels and quality of life (QoL). This study verified associate of elevated inflammatory and cardiometabolic biomarker levels, in older adults with impaired quality of life, in different domains.

**Methods:** Cross-sectional population-based study (SABE Study), including older adults (≥ 60 years-old). The inflammatory and cardiometabolic biomarkers used were uric acid, fibrinogen, C-reactive protein serum levels e glycated hemoglobin, fasting blood glucose, triglycerides and cholesterol, respectively, determined using sensitive regular immunoassays (ELISA). QoL was assessed using the SF12 questionnaire. Socio-demographic information and health conditions used as control variables were: sex, age and educational level; number of non-communicable diseases, self-reported conditions (chronic pains, hypertension, diabetes and cardiovascular disease), functional capacity, body mass index and waist circumference, respectively, determined using specific questionnaire. Multiple logistic regression was used to analyze this association.

**Results:** From the 1.344 older adults, 1255 were eligible to be part of this study. There was no association of uric acid, fibrinogen, fasting blood glucose, triglycerides and cholesterol with QoL. Older adults with one or more chronic diseases (OR =1.75, p = 0,000), hypertension (OR =2.35; p = 0,000), BMI higher than 30kg/m2 (OR =2.25, p = 0,000), high levels of CRP (OR =2.85, p = 0,000) and glycated hemoglobin (OR =1.31, p = 0,000), were associated with low values in the physical domain of SF12.

**Conclusions:** The joint associations elevated inflammatory and cardiometabolic biomarker levels have a significant and negative effect on physical domain of quality of life in older adults, demonstrating the importance of control of these biomarkers for better physical well-being.

**Keywords:** quality of life; chronic inflammation; older adults; cardiometabolic biomarker.

# MOTHERS AND CHILDREN: ARE THEIR DIET'S RELATED? RESULTS OF MINISALTEN STUDY

**Background and objectives:** Children's diet composition could be influenced by many factors and It is supposed that mothers have a crucial role during the first years of life. The aim of this study was to determine the relationship between mother's diet and their first grade children.

**Methods:** The present analysis comprises the baseline assessment (June to November 2015) of the MiniSALTEN Study (an obesity prevention program). All children attending first grade of 12 Buenos Aires Public schools and their mothers were invited to participate. For both mothers (M) and children (CH) were measured: weight and height. A 24 hour recall was collected in a face to face interview with mothers to assess their diet and her kid's. Children's intake was completed with observational information at school. Intake data were entered and analyzed with NDS-R, Nutrition Data System. BMI Z score calculated (WHO 2007). Descriptive statistical data analysis was performed with SPSS 14.0 for Windows. Pearson correlation was calculated between M and children's intake.

**Results:** Final sample was composed by 188 dyads. Children's mean age was 6.68 y. Prevalence of overweight was 26,3 % and obesity 22 %. Pearson correlations between M and children's diets were the following: Saturated fats r = 0.481, Total fat r= 0.471, Monounsaturated r= 0.448, Polyunsaturated r= 0.416 and Energy r= 0.359. Both diets were well balanced in macronutrients distribution. M: 52%, 16% and 32% of total energy and CH: 54%, 15% and 31% of total energy. Median total kcals a day were 1682.3 kcals/d (SD 656.3) and 1797 kcals/d (SD 591.7) M and CH respectively. In both cases, saturated fats were 12% of the total energy but more added sugars were part of children diets: 18.4 % and 14.4 % respectively. Additionally, fiber was much more present in mother's diets than in their children (22.4 g and 12 g/d respectively).

**Conclusions:** Although significant correlations were found between both diets in saturated, total fat and monounsaturated fats, children's diet is higher in added sugars, total energy and lower in fiber than their mothers.

**Keywords:** Children's intake, Mother's diet, Fats, Total calories, Added sugars

<footnote>(1)Almeida Roediger, Manuela de; (2)Marucci, Maria de Fátima;</footnote>

<footnote>(3)Licio Ferreira Santos, Jair; (4)Duim, Ethienne Larissa; (5)Quintiliano Scarpelli Dourado, Daiana; (6)Sebba Tosta de Souza, Claudia;</footnote>

<footnote>(5)França, Ana Paula; (7)de Oliveira Duarte, Yeda Aparecida.</footnote>

<footnote>(1)Postdoctoral student. Nutritionist. Program of Nutrition in Public Health. School of Public Health. University of São Paulo. Brazil.;</footnote>

<footnote>(2)Senior teacher. Nutritionist. Department of Nutrition. School of Public Health. University of São Paulo. Brazil; (3)Senior teacher.</footnote>

<footnote>Statistical. Medical School of Ribeirão Preto of the University of São Paulo. Brazil.; (4)PhD student. Physiotherapist. Department of Epidemiology. Public Health School. University of São Paulo. São Paulo. Brazil.; (5)PhD. Nutritionist. Program of Nutrition in Public Health. School of Public Health. University of São Paulo. Brazil.;</footnote>

<footnote>(6)Master. Nutritionist. Program of Nutrition in Public Health. School of Public Health. University of São Paulo. Brazil.; (7)PhD.</footnote>

<footnote>Nurse. School of Nursing. University of São Paulo. Brazil.</footnote>

<footnote>(1)Zonis, Luciana Noemi; (2)De Gregorio, Maria Jose; (3)Indart Rougier, Paula; (3)Favieri, Andrea Lorena; (4)Rausch Herscovici, Cecile;</footnote>

<footnote>(5)Kovalskys, Irina.</footnote>

<footnote>(1)BSc. Nutritionist. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.;</footnote>

<footnote>(2)BSc. Sociologist. Department of Anthropological Sciences. University of Buenos Aires. Argentina.; (3)BSc. Nutritionist. Nutrition & Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.; (4)PhD. Nutrition & Health Area. ILSI Argentina (International Life Sciences Institute).</footnote>

<footnote>Buenos Aires. Argentina.; (5)MD. Nutrition & Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.</footnote>
**Conflict of Interest Disclosure:** The source of funding for the research is the Coca-Cola Foundation. The authors declare that they have no competing interests. The funding source had no role in study design, data collection and analysis, decision to publish, or preparation of manuscripts.

**Further collaborators**

On behalf of the MiniSALTEN Study Group.

144/2464

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

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

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

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

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

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

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

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

144/2474

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

144/2493

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

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

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

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

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

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

Further collaborators

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

144/2496

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

**Background and objectives:** Sarcopenia is considered as an emerging public health problems and challenges worldwide, including in Malaysia, but very limited information concerning the influence of lifestyle factors and blood inflammation levels on

<footnote>(1)Ribeiro Neves, Paulo Augusto; (2)Alzineth Campos, Chiara;</footnote>

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

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

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

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