Antenatal clinic attendance (p = 0.003), skilled attendance at delivery (p = 0.003), place of delivery (p < 0.001) and time of breastfeeding initiation (p < 0.0001) were positively associated with EBF for the first 6 months postpartum. None of the independent variables were significantly associated with timely introduction of complementary foods at 6 months postpartum.

**Conclusions:** The rate of EBF was low among respondents. Less than half of respondents initiated complementary feeding at 6 months postpartum. Place of delivery, time of breastfeeding initiation, skilled attendance at delivery and antenatal clinic attendance were significantly associated with EBF for the first 6 months postpartum.

**Keywords:** Newborn, breastfeeding initiation, exclusive breastfeeding, complementary feeding, Ghana

weight less than 43 kg. PMNS was significantly and positively associated with fetal growth and offspring HAZ at birth and 2 years. For each 1 standard deviation (SD) increase in maternal height, offspring HAZ at 2 years increased by 0.30 SD. A 1SD increase in maternal preconception weight or 1 SD increase in BMI was associated with an increase in HAZ at 2 years of 0.23 (p < 0.001) and 0.06 SD (p < 0.1), respectively. In structural equation modeling, the indirect effects of mother's height, weight and BMI on HAZ at 2 years were 14%, 31% and 86% of the total effect (through impact on fetal growth and size at birth). Women with pre-pregnancy height < 150 cm, a weight less than 43 kg or BMI < 18.5kg/m2 had 2.7 (2.1-3.6), 2.1 (1.6-2.7) and 1.2 (0.96-1.7) times, respectively, the risk for stunting at 2 years of age.

**Conclusions:** Maternal preconception nutritional status is a critical indicator of offspring linear growth and risk of child stunting across the first 1000 days.

**Keywords:** preconception, nutrition, stunting, Vietnam

## ROLE OF PRECONCEPTION NUTRITION IN OFFSPRING GROWTH AND RISK OF STUNTING ACROSS THE FIRST 1000 DAYS IN VIETNAM

(1)Young, Melissa; (2)Hong Nguyen, Phuong; (3)Gonzalez Canaova, Ines; (4)Addo, Yaw; (5)Tran Mai, Lan; (6)Nguyen, Son; (7)Martorell, Reynaldo; (8)Ramakrishnan, Usha.

(1)PhD. Hubert Department of Global Health. Emory University. USA; (2)MD. PhD. Research Fellow. International Food Policy Research Institute. USA.; (3)PhD. Post Doctoral Fellow. Hubert Department of Global Health. Emory University. USA.; (4)PhD. Assistant Professor. Hubert Department of Global Health. Emory University. USA.; (5)BS. Research Analyst. Thai Nguyen University of Pharmacy and Medicine. Vietnam.; (6)MD, PhD. Pediatrician. Thai Nguyen University of Pharmacy and Medicine. Vietnam.; (7)PhD. Professor. Hubert Department of Global Health. Emory University. USA.

**Background and objectives:** There is growing interest in the health implications of preconception maternal nutritional status (PMNS), but gaps remain. We examine associations between PMNS and offspring growth during the first 1000 days.

**Methods:** This is a secondary analysis using prospective data from women who participated in PRECONCEPT, a randomized controlled trial of preconception micronutrient supplementation in Vietnam. Women/children pairs with information on preconception height/weight, at least one ultrasound measurement before 30 weeks (head and abdomen circumferences, biparietal diameter, and femoral length), singleton birth size and child length at two years were included in this analysis. We used structural equation and multivariate linear and logistic regression models to examine associations between three PMNS indicators (weight, height, BMI) on offspring growth (height for age Z-score, HAZ), and risk of stunting (< -2 HAZ) at 2 years of age. Models were adjusted for child age, gender, gestational weight gain, maternal education, socioeconomic status and treatment group.

**Results:** Of the 1,409 women included in study, a third of the women had a prepregnancy BMI <18.5kg/m2, height < 150cm or

## DIETARY INTAKE, WEIGHT GAIN AND SLEEP PATTERNS IN YOUNG CHILDREN PREDISPOSED TO OVERWEIGHT

(1)Rangan, Anna; (2)Zheng, Miaobing; (3)Olsen, Nanna Julie; (4)Rohde, Jeanett Friis; (5)Heitmann, Berit Lilienthal.

(1)PhD. Associate Professor. Discipline of Nutrition and Dietetics. The University of Sydney. Australia.; (2)PhD. Dietitian. Discipline of Nutrition and Dietetics. The University of Sydney. Australia.; (3)PhD. Nutritionist. Research Unit for Dietary Studies. The Parker Institute Bispebjerg and Frederiksberg Hospitals. the Capital Region. Copenhagen. Denmark.; (4)MSc. Nutritionist. Research Unit for Dietary Studies. The Parker Institute. Bispebjerg and Frederiksberg Hospitals. the Capital Region. Copenhagen. Denmark.; (5)PhD. Professor. Research Unit for Dietary Studies. The Parker Institute. Bispebjerg and Frederiksberg Hospitals. the Capital Region. Copenhagen. Denmark.

**Background and objectives:** Poor sleep patterns have been shown to be a contributor to obesity in both children and adults. Less evidence is available during toddlerhood period and among those with higher obesity risk. The objective of this study was to examine the relationship between sleep patterns and body weight development in a group of young obesity-predisposed children, and to assess whether dietary factors affect this relationship.

**Methods:** Participants included 368 Danish children aged 2-6 years from the Healthy Start Study, a 1.2 year randomised controlled intervention trial. Sleep habits were measured using a 7-day sleep diary, and dietary intake was assessed using 4 day food records at baseline. Multivariate linear regression with adjustment for confounders was used to assess the association of sleep duration and sleep variability with 1.2 year changes (Δ) in BMI z-score from baseline to follow-up. Energy intake was tested as a mediator in this relationship. Dietary factors associated with sleep duration and sleep variability were also examined.
**Results:** A significant inverse association was observed between nighttime sleep duration and ΔBMI z-score (β=-0.090, P=0.046) with a 1-hour difference in sleep being associated with a 239 kJ energy intake. Energy intake was found to mediate this association with all macronutrients contributing to this effect. Sleep variability, although not associated with ΔBMI z-score, was associated with several dietary factors including higher consumption of added sugars and sugary beverages and lower consumption of fruit and vegetables.

**Conclusions:** Shorter sleep duration, mediated by energy intake in early in life, seems a risk factor for weight gain among young obesity-predisposed children. Additionally, dietary factors contribute to sleep variability during childhood.

**Keywords:** children, obesity, sleep duration, sleep variability, diet

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HOW NUTRITION AND ENVIRONMENTAL INFLUENCES SHAPE CHILD DEVELOPMENT DURING THE FIRST 1000 DAYS: DIRECT AND INDIRECT ASSOCIATIONS IN FOUR PROSPECTIVE COHORTS OF YOUNG CHILDREN IN AFRICA

(1)Prado, Elizabeth; (2)Adu-Afarwuah, Seth; (3)Ashorn, Per; (1)Hess, Sonja Y; (4)Lartey, Anna; (5)Maleta, Kenneth; (6)Ouédraogo, Jean Bosco; (1)Dewey, Kathryn G; (7)Study Group, The iLiNS Project.

(1)PhD. Department of Nutrition. University of California Davis. USA; (2)PhD. Department of Nutrition and Food Science. University of Ghana. Ghana; (3)MD/PhD. Center for Child Health Research. University of Tampere School of Medicine and Tampere University Hospital. Finland.; (4)President. IUNS 2013-2017.; (5)Md/PhD. School of Public Health and Family Medicine. University of Malawi College of Medicine. Malawi; (6)PhD. Institut de Recherche en Sciences de la Santé/DRO. Burkina Faso; (7)The iLiNS Project.

**Background and objectives:** As countries mobilize to reach Sustainable Development Goal 4.2, to ensure "access to quality early childhood development" (ECD), evidence is needed to inform the design of interventions. Previous reviews have identified 44 risk factors for poor ECD in low- and middle-income countries. Our objective was to examine associations of these risk factors with ECD in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n=1023), Malawi (n=675 and 1385), and Burkina Faso (n=1122).

**Methods:** In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In all cohorts, motor and language development were assessed at 18 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors hypothesized to be associated with ECD.

**Results:** Out of 42 indicators of 34 risk factors examined, six indicators of five factors were consistently associated with

18-month language and/or motor development in three or four cohorts: children's variety of play materials, activities with caregivers, dietary diversity, linear and ponderal growth, and hemoglobin/iron status. Caregiving and child factors showed stronger associations with child development, as compared to environmental and maternal factors, even when considering both indirect and direct effects. At age 18 months, children from low socio-economic status (SES) households had fallen behind those from higher-SES households in language development in all four cohorts and in motor development in two cohorts, highlighting the importance of child development interventions targeting this early period. Associations between SES and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child bio-medical conditions. This pattern for motor development was not consistent across cohorts.

**Conclusions:** Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status. Interventions to reduce socioeconomic disparities in ECD should target caregiving behavior.

**Keywords:** language development, motor development, caregiving, growth, iLiNS Project

**Conflict of Interest Disclosure:** Funded by the Bill & Melinda Gates Foundation with additional funding from USAID through FANTA-III/FHI-360. The spouse of SYH works for the Bill & Melinda Gates Foundation. All other authors declare that we have no conflict of interest to disclose.

**Further collaborators**

Souheila Abbeddou, Mary Arimond, Ulla Ashorn, Jaden Bendabenda, Kenneth H. Brown, Emma Kortekangas, Brietta M. Oaks, Eugenia Ocansey, Harriet Okronipa, Anna Pulakka, Jérôme W Somé, Christine Stewart, Robert Stewart, Stephen A. Vosti, Elizabeth Yakes Jimenez

144/1324

CAREGIVER PERSPECTIVES AND FACTORS ASOCIATED WITH UTILIZATION OF A HOME FORIFICATION OF COMPLEMENTARY FOODS PROGRAM

(1)Young, Melissa; (2)Mehta, Rukshan; (3)Gosdin, Lucas; (3)Kekre, Priya; (4)Verma, Pankaj; (3)Larson, Leila; (5)Webb Girard, Aimee; (6)Ramakrishnan, Usha; (4)Srikantiah, Sridhar; (6)Martorell, Reynaldo.

(1)PhD. Assistant Professor. Hubert Department of Global Health. Emory University. USA.; (2)MSW. Hubert Department of Global Health. Emory University. USA.; (3)MPH. Hubert Department of Global Health. Emory University. USA.; (4)MD. CARE-India. Bihar. India.; (5)PhD. Assistant Professor. Hubert Department of Global Health. Emory University. USA.; (6)PhD. Professor. Hubert Department of Global Health. Emory University. USA.

**Background and objectives:** Home fortification of multiple micronutrient powders (MMP) is a globally recommended strat-
egy to reduce anemia. However, further information is needed on program implementation and factors associated with household utilization.

**Methods:** A cluster randomized effectiveness trial in children 6-18 months was conducted in Bihar, India within the context of an ongoing program (CARE, India: Integrated Family Health Initiative). MMPs were delivered by existing community front line workers along with counseling over the course of a year for the intervention group. The primary objective was to examine program effectiveness in reducing child anemia, stunting and improving feeding practices. For this abstract, we examine factors associated with MMP utilization and caregiver perspectives using data that were obtained at endline (n= 4292).

**Results:** There was high program exposure with 82% of caregivers in the intervention group reporting having heard/seen MMP. Of these households, 70% had ever received MMP and of those, 85% had ever consumed MMP. The top reasons caregivers reported for never feeding MMP to their child were the child was not yet receiving food (30%) or the mother/family member did not like/accept MMP (12%). Among children (n= 1523) who received MMP at endline: 91% reported finding the MMP easy to use, 66% felt the child liked the powder, 85% thought it was important to give to the child, 81% would recommend the MMP to other families. 64% had consumed MMP in the previous month, 43% had consumed MMP in the previous week. The top reasons for not consuming MMP were ran out of supply (48%) or child did not like to eat the food with MMP (31%). MMP use was significantly higher among lower SES households [OR 1.3 (95%CI:1.0-1.7); compared to high SES], lower caste [OR: 1.6(95%CI:1.0-2.5) scheduled tribe, 0.7(95%CI:0.6-0.9) other-backward-class, 0.6(95%CI:0.4-0.9) other; compared to scheduled caste] and older children 12-18mo [OR 3.6 (95%CI:3.0-4.3); compared to 6-11mo]. There were no differences by maternal age, education, religion of child gender.

**Conclusions:** Home fortification of complementary foods was a well-accepted strategy by caregivers. Key barriers to program uptake include interruptions in supply and poor complementary feeding practices.

**Keywords:** anemia, home fortification, nutrition, India, micronutrients

## FATTY ACIDS PROFILE IN BREAST MILK FROM WOMEN LIVING IN BUENOS AIRES. PRELIMINARY STUDY

**Background and objectives:** Fatty acids profile in breast milk is modified by maternal diet; this profile is important for the growing infant since it is reflected in child's tissues, particularly in the central nervous system. In recent years, the role of long chain polyunsaturated fatty acids (LCPUFA) on neurological development has been recognized. In our country, information about arachidonic acid (ARA) and docosahexaenoic acid (DHA) levels in human milk is scarce. The objective of the present study was to determine the fatty acids profile in breast milk from a high-income urban population.

**Methods:** Lactating women at 6 months postpartum attending the pediatric control visits (at a private clinic in Buenos Aires) consented to participate (n= 13). Morning milk samples were obtained by complete manual extraction from one breast and kept at -20°C. They were analyzed for fatty acids profile by gas chromatography (Perkin Elmer Claurus 500, capillary column Supelco SP2560 and FID detector) previous derivatization according to Lepage et al (J. Lipid Res 27:114-20, 1986) using nitrogen as carrier gas. Fatty acids were identified against SUPELCO FAME Mix NHI-C and FAME Mix C14-C22 standards.

**Results:** Fatty acids percentages were determined (% methyl esters /100 g total fatty acids). Median values together with maximum and minimum values are shown.

The contents of saturated, monounsaturated and polyunsaturated fatty acids were: 43.92% (50.42-29.56); 38.64% (47.79-32.46); 16.74% (23.46-11.67), respectively.

The three most abundant fatty acids, oleic, palmitic and linoleic acids, represented about 60% of total fatty acids; medians were 33.33% (41.58-25.64); 19.98% (23.87-17.25); 14.77% (20.48-9.32), respectively. For LCPUFA, ARA and DHA the following values were obtained: 0.44% (0.60-0.30) and 0.18% (0.71-0.08), respectively.

**Conclusions:** Global fatty acids profile was in agreement with published values. Regarding LCPUFA, ARA levels were similar to literature reports. This fatty acid tends to be stable and less dependent on dietary intake. On the other hand, DHA showed levels similar to those reported by other local investigators but lower than values published in other countries, particularly those corresponding to populations consuming marine foods. It would

<footnote>(1)Ronayne de Ferrer, Patricia Ana; (2)Giacomino, María Silvia;</footnote>

<footnote>(3)Pellegrino, Néstor; (4)Carola Beatriz, Greco; (5)Gibson, Verónica.</footnote>

<footnote>(1)PhD. Biochemist. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Cátedra de Bromatología. Argentina.;</footnote>

<footnote>(2)BsC. Biochemist. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Cátedra de Bromatología. Argentina.;</footnote>

<footnote>(3)PhD. Biochemist. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Cátedra de Bromatología. Argentina.;</footnote>

<footnote>(4)PhD. Biochemist. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Cátedra de Bromatología. Argentina.;</footnote>

<footnote>(5)MD. Sanatorio Mater Dei. Buenos Aires. Argentina.</footnote>
be advisable in our country to increase intake of DHA providing
foods both in pregnant and lactating women. Project UBACyT
20020130100520BA

**Keywords:** Fatty acids profile, breast milk, ARA, DHA

144/1340

MATERNAL, BREAST MILK AND INFANT B12
STATUS IN RURAL GAMBIA

(1)Eriksen, Kamilla; (2)Allen, Lindsay H.; (2)Shahab-ferdows, Setareh;

(2)Hampel, Daniela; (3)Moore, Sophie E.

(1)PhD candidate. Medical Research Council (MRC) Elsie
Widdowson Laboratory. University of Cambridge. Cambridge.

United Kingdom.; (2)Dr. USDA. ARS Western Human Nutrition
Research Center. University of California. Davis. California. USA;

(3)Dr. Division of Women's Health. King's College London. London. United Kingdom.

**Background and objectives:** Vitamin B12 is vital for infant growth and development. In rural Gambia animal source food consumption is low, placing both mothers and infants at risk of B12 deficiency. Here we investigate the relationship between maternal, breast milk and infant B12 status in a population at risk of B12 deficiency.

**Methods:** The current analysis used data collected as part of the Early Nutrition and Immune Development (ENID) study a randomised trial, conducted in rural Gambia, West Africa (ISRCTN49285450). For this analysis, only women supplemented with either multiple micronutrients (MMN) or iron and folic acid (FeFol) during pregnancy were included. Plasma and breast milk samples from 350 mother-infant dyads were analysed for vitamin B12 during pregnancy and lactation.

**Results:** In early pregnancy 7% of mothers were below the threshold for low serum B12 concentrations (<150 pmol/l), and 16% had concentrations between 150-221 pmol/l. Maternal plasma B12 was significantly higher in the MMN group at 30 weeks gestation compared to the FeFol group (p<0.01). Median breast milk B12 for the FeFol group was 161, 146 and 185 pmol/l vs. 174, 162, 207 pmol/l in the MMN group at 8, 12 and 24 weeks postpartum, respectively (not significantly different, p>0.1). Infant plasma B12 was significantly higher at birth and at 12 weeks postpartum in the MMN group vs. the FeFol group (p<0.02). Median infant plasma B12 for the FeFol group was 354, 259 and 240 pmol/l vs 368, 297, 234 pmol/l in the MMN group at birth, 12 and 24 weeks, respectively.

**Conclusions:** Mothers were mildly B12 deficient in early pregnancy, but breast milk B12 concentrations and infant B12 status indicated a greater level of deficiency. Supplementation with MMNs during pregnancy had an effect on maternal and infant B12 status, but not on breast milk B12 concentration.

**Keywords:** pregnancy, B12, breast milk, infant, multiple mi-
cronutrient supplementation

144/1343

MATERNAL VITAMIN D STATUS IN RELATION TO
FETAL GROWTH AND SURVIVAL: A PROSPEC-
TIVE COHORT STUDY

(1)Augustin, Hanna; (2)Bärebring, Linnea; (3)Bullarbo, Maria; (4)Glantz, Anna; (5)Hulthén, Lena; (6)Ellis, Joy; (7)Jagner, Åse; (8)Schoenmakers, Inez; (9)Winkvist, Anna.

(1)PhD. Nutritionist. Department of internal medicine and
clinical nutrition. University of Gothenburg. Sweden.; (2)PhD.
Department of Internal Medicine and Clinical Nutrition.

University of Gothenburg. Sweden.; (3)PhD. MD. Department of
Obstetrics and Gynecology. University of Gothenburg. Sweden.;

(4)PhD. MD. Department of Antenatal Care. Gothenburg.
Sweden.; (5)Professor. Nutritionist. Department of Internal
Medicine and Clinical Nutrition. University of Gothenburg.

Sweden.; (6)MD. Department of Antenatal Care. Södra Bohuslän.
Sweden.; (7)Midwife. Department of Antenatal Care. Gothenburg.

Sweden.; (8)PhD. Medical School. University of East Anglia. United Kingdom.; (9)Professor. Department of Internal Medicine and Clinical Nutrition. University of Gothenburg. Sweden.

**Background and objectives:** Fetal growth depends on placentia function. Maternal vitamin D status has been inversely associated with uteroplacental dysfunction. We aimed to investigate the associations between vitamin D status in early and late pregnancy with prevalence of neonatal small for gestational age (SGA), low birth weight (LBW), preterm delivery and pregnancy loss.

**Methods:** Pregnant women were recruited at antenatal clinics in Sweden (latitude 57-58°N). Serum 25-hydroxyvitamin D (25OHD) was analyzed in gestational week ≤16 (trimester 1 (T1), N=2046) and >31 (trimester 3 (T3), N=1816) by liquid chromatography tandem mass spectrometry. Gestational and neonatal data were retrieved from medical records.

**Results:** Logistic regression showed that 25OHD at T1 was only associated with pregnancy loss (OR 0.99, p=0.041). 25OHD at T3 ≥100 nmol/L was associated with lower odds of SGA (OR 0.3, p= 0.031) and LBW (OR 0.2, p= 0.046), compared to vitamin D deficiency (25OHD <30 nmol/L). Women with a ≥30 nmol/L increment in 25OHD from T1 to T3 had the lowest odds of SGA, LBW and preterm delivery.

**Conclusions:** In early pregnancy, higher vitamin D status was associated with lower odds of pregnancy loss. In late pregnancy, high vitamin D status was associated with lower odds of fetal growth restriction. A higher increment in 25OHD during pregnancy was associated with lower odds of adverse neonatal birth outcomes. This emphasises the importance of adequate maternal vitamin D status for healthy pregnancy.

**Keywords:** pregnancy, 25-hydroxyvitamin D, fetal growth restriction
# RISK VALUES OF METABOLIC AND NUTRITIONAL PARAMETERS IN CUBAN URBAN PEOPLE REPRESENTING DIFFERENT STAGES OF LIFE COURSE

(1)Hernández Hernández, Héctor; (2)Díaz Domínguez, Maybe; (3)Ruiz Álvarez, Vladimir; (4)Lanyau Domínguez, Yeneisy; (5)Hernández-Triana, Manuel; (6)Rodríguez Domínguez, Lourdes; (7)Llibre Rodríguez, Juan Jesús; (8)Quintero Alejo, María; (9)Arocha Oriol, Caridad.

(1)Dr. MS. Center for Nutrition and Food Hygiene. National Institute for Hygiene, Epidemiology and Microbiology. Cuba; (2)Tec. Center for Nutrition and Food Hygiene. National Institute for Hygiene, Epidemiology and Microbiology. Cuba; (3)Dr. Center for Nutrition and Food Hygiene. National Institute for Hygiene, Epidemiology and Microbiology. Cuba.; (4)MS. Center for Nutrition and Food Hygiene. National Institute for Hygiene, Epidemiology and Microbiology. Cuba.; (5)Dr. PhD. Autonomous University of Nuevo León. Mexico.; (6)Dr. Polyclinic Jesús Vantroi. Cuba.; (7)Dr. Center for Alzhéimer Research. Cuba.; (8)Tec. Center for Nutrition and Food Hygiene. National Institute for Hygiene, Epidemiology and Microbiology. Cuba.; (9)Tec. Center for Nutrition and Food Hygiene. National Institute for Hygiene, Epidemiology and Microbiology. Cuba.

**Background and objectives:** Early stages of life course are crucial for detection of risk for adultness-common chronic diseases, in terms of applying early preventive interventions. In the elderly, evaluation of similar risk markers are useful to stop disease progression. Urban areas have shown a higher prevalence of chronic diseases risk factors. Our aim was to determine the prevalence of vascular risk values from main glucidic and lipidic metabolic parameters in Cuban scholars, adolescents and elders from urban areas.

**Methods:** A transversal study was carried out on 113 scholars (mean age 8, 9 years), 469 adolescents (mean age 13, 8 years), and 395 elders (mean age 78, 9 years), all from both sexes. All individuals were living in urban areas and were attending to urban schools or urban institutions for elders. Children and adolescents were apparently healthy without toxic habits. Elders had no previous diagnosis of common chronic diseases except for variable cognitive impairment. Groups were evaluated for serum glucose, triglycerides, total cholesterol (TC), HDL cholesterol, LDL cholesterol and VLDL cholesterol using standard enzymatic colorimetric assays.

**Results:** In scholars, triglycerides (49, 6%) and TC (31%) showed the highest frequencies of risk levels, as they did in adolescents: triglycerides (35,6%), TC (23.9%). In contrast, LDL (58,2%) and TC (48,6%) were the most altered in elders. Frequencies of risk levels for glucose were similar between elders and adolescents and were markedly higher between them and scholars. Both, percentages of individuals with risky values, and mean serum levels, were overtly higher in elders than in the other groups for TC and LDL. Scholars showed the highest frequency of risk levels for triglycerides, followed in order by adolescents and elders. In general, study groups did not differ in risk frequencies for HDL. Younger groups presented considerable percentages of individuals with more than one parameter altered.

**Conclusions:** This work shows an elevated prevalence of vascular risk values of metabolic parameters related to Nutrition in

scholars, adolescents and elders of urban areas. This prevalence appears to increase with age but only for some of those parameters pinpointing the need for application of risk-modifying interventions since the early stages.

**Keywords:** scholars, adolescents, elders, urban areas, lipids risk values.

# EFFECT OF PRE- AND POSTNATAL NUTRITION-AL SUPPLEMENTS ON CHILDHOOD ILLNESSES IN BANGLADESH: A CLUSTER-RANDOMIZED EFFECTIVENESS TRIAL

(1)Ullah, Md Barkat; (2)Mridha, Malay; (3)Arnold, Charles D; (4)Matias, Susana; (5)Khan, Md Showkat; (6)Siddiki, Zakia; (7)Hossain, Mokbul; (8)Dewey, Kathryn G.

(1)PhD Candidate. University of California. Davis. USA.; (2)MBBS. MSc (Nutrition). MSc (Health Ecomomics). MPH. PhD. Assistant Project Scientist. Department of Nutrition. University of California. Davis. USA.; (3)MS. Statistician. Department of Nutrition. University of California. Davis. CA 95166. USA.; (4)PhD. Assistant Project Scientist. Department of Nutrition. University of California. Davis. USA; (5)MBBS. MPH. Senior Research Investigator Initiative for Non Communicable Diseases. Health Systems and Population Studies Division. icddrb. Dhaka. Bangladesh.; (6)MBBS. MPH. Research Investigator. Initiative for Climate Change and Health. Health Systems and Population Studies Division. icddrb. Dhaka. Bangladesh.; (7)MSc. Statistician. James P Grant School of public Health. BRAC University. Dhaka. Bangladesh.; (8)PhD. Director. Program in International & Community Nutrition. Distinguished Professor. Department of Nutrition. Nutritionist in Agricultural Experiment Station. University of California. Davis. USA.

**Background and objectives:** Background: Several strategies for reducing child undernutrition in low and middle income countries are being implemented, which may affect child morbidity either positively or negatively. Objective: To examine the effects of providing lipid-based nutrient supplements (LNS) to pregnant and lactating women or providing LNS or micronutrient powder (MNP) to their children from 6 to 24 months on common childhood illnesses.

**Methods:** In a four-arm cluster-randomized effectiveness trial, women were enrolled at ≤20 wk gestation (n=4011) and received either: a) LNS during pregnancy and the first 6 months postpartum, and LNS for the offspring from 6-24 months (LNS-LNS); b) Iron and folic acid (IFA) during pregnancy and the first 3 months postpartum, and LNS for the offspring as described above (IFA-LNS); c) IFA as described above and MNP for the offspring from 6-24 months (IFA-MNP); or d) IFA as described above and no supplement for the offspring (IFA-Control). Information on acute lower and upper respiratory infection (ALRI/AURI), diarrhea and fever in the previous 14 days was collected at 6, 12, 18 and 24 months of age.

**Results:** At 6 months, prevalence of ALRI, fever or diarrhea did not differ between infants of women who received LNS vs IFA, but infants in the LNS-LNS group had lower prevalence of AURI
compared to the other three groups combined (27.7% vs 31.7%; OR 0.83(0.70, 0.99)). At 12, 18 and 24 months, there were no significant differences among the 4 arms in prevalence of fever or ALRI, but compared to IFA-Control infants, IFA-LNS infants had lower prevalence of AURI at 12 months (27.6% vs 33.9%, OR 0.74(0.56, 0.99)), and higher prevalence of diarrhea at 18 months (9.3% vs 6.0%; OR 1.74(1.00, 3.04)) after covariate adjustment. No other pairwise group differences were significant.

**Conclusions:** LNS provided pre- or post-natally may reduce AURI among infants but results were inconsistent. The difference in diarrhea prevalence in the IFA-LNS arm at 18 months was not evident in the LNS-LNS arm nor at any other time point. We conclude that providing LNS to women or LNS or MNP to children generally did not increase or decrease common childhood illnesses.

**Keywords:** child morbidity, childhood illness.

**Further collaborators:** Acknowledgement: Funding was provided by the United States Agency for International Development (USAID) through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360.

**Results:** Assessments were completed in 88 advanced age adults (31 men), mean age 90.0±3.7 years. As determined from the MNA-SF over two thirds (71.6%) of the participants were either malnourished (28.4%) or at high nutrition risk (43.2%). A third (29.5%) of the participants was at risk of dysphagia. Malnourished participants were more likely to be at risk of dysphagia (p=0.015). The MNA-SF score positively correlated with BMI (r=0.484, p<0.001); grip strength in the dominant hand (r=0.250, p=0.026), and negatively correlated with dysphagia risk (r=-0.383, p<0.001).

**Conclusions:** Malnutrition and high nutrition risk was prevalent among newly hospitalised adults of advanced age. Routine screening on admission is an important first step to identify those at nutrition risk. Findings highlight the importance of screening for dysphagia in the malnourished to help shape appropriate interventions aimed at improving nutrition status.

**Keywords:** older adults, nutrition risk, dysphagia risk, hospitalisation, New Zealand

**Further collaborators:**

Jacqueline Allen MBChB. FRACS. Otolaryngologist. University of Auckland. Auckland. New Zealand.

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## NUTRITION AND DYSPHAGIA RISK AMONG RECENTLY HOSPITALISED ADULTS OF ADVANCED AGE

(1)Wham, Carol; (1)Wham, Carol; (2)Popman, Amy; (3)Richter, Marilize.

(1)PhD. Associate Professor of Nutrition and Dietetics. Massey University. Auckland. New Zealand.; (2)MSc. Dietitian. Massey University. Auckland. New Zealand.; (3)PhD. Dietitian. Massey University. Auckland. New Zealand.

**Background and objectives:** Older adults aged over 85 years are the fastest growing population segment in New Zealand. Maintaining a high level of nutritional well being is fundamental to successful ageing. Previously the prevalence of nutrition risk among community living octogenarians has been reported to range between 31-49%, but is unknown in people of advanced age recently admitted to hospital. Admission, Treatment and Rehabilitation (AT&R) wards. The aim of this study was to establish the prevalence of nutrition risk and related factors among adults 85 years and older newly admitted to the AT&R wards at North Shore and Waitakere Hospitals in Auckland.

**Methods:** Participants were recruited within five days of admission to the AT&R wards. An interviewer administered questionnaire was used to assess sociodemographic and health characteristics, nutrition risk was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) and dysphagia risk assessed using the 10-item Eating Assessment Tool. Anthropometric measures were taken to assess body mass index (BMI), muscle mass (using bioimpedance scales) and grip strength (using a handgrip dynamometer). Pearson Chi-Square tests were used to examine differences in dysphagia risk between MNA-SF nutrition status groups. Pearson correlations were used to identify correlations between participant characteristics and nutrition status

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## ASSOCIATION BETWEEN SLEEP DURATION AND FOOD INTAKE IN ADOLESCENTS

(1)da Silva Couto, Camilla; (2)da Silva Nalin de Souza, Bárbara;

(1)Lavourinha Pinto, Rafael; (1)Guerra Cardoso, Luciana; (3)Sichieri, Rosely; (2)Massae Yokoo, Edna.

(1)BSc. Nutritionist. Collective Health Post-Graduation Program. Collective Health Institute. Federal Fluminense University. Brazil;

(2)PhD. Nutritionist. Collective Health Post-Graduation Program. Collective Health Institute. Federal Fluminense University. Brazil;

(3)PhD. Physician. Department of Epidemiology. Social Medicine Institute. Rio de Janeiro State University. Brazil.

**Background and objectives:** Short sleep duration is prevalent among adolescents and it is indicated as a factor that can interfere with food intake. The objective of the present study is to estimate the association between sleep duration and food intake data in adolescents.

**Methods:** The data is from PAPPAS study, which stands for "Parents, students and teachers for healthy eating" in Portuguese, conducted in a public school from Niterói-Rio de Janeiro, Brazil, in 2015, with students from 5th to 9th grade, aged 10 to 17 years. Sleep duration was collected by questionnaire and categorized as insufficient, adequate and excessive, according to age, as recommended by the National Sleep Foundation. To estimate nutrient intake, the mean of two 24-hour food-recall applied on two non-consecutive days was used. Multiple linear regression was performed, considering $p \le 0.05$. The analysis was performed with SPSS v.21.

**Results:** A total of 307 adolescents were included, 49.2% (n=151) males, with a mean age of 12.8 (± 1.6) years. Of these, 52.1% (n= 160) presented insufficient sleep. Crude regression models estimated that sleep duration was positively associated with energy
consumption (β= 48.35, p= 0.049), protein (β= 2.72, p= 0.010), lipids (β=1,98, p= 0,037), total fiber (β= 0.57, p= 0.034) and cho- lesterol (β= 9.07, p= 0.019), and was not associated with carbohy- drate consumption (β= 5.35, p= 0.161) and added sugar (β= 0.13, p= 0.949). After adjusting for energy consumption, sleep duration lost significance in the models, but became significant in added sugar analysis. It was observed that, at each hour of sleep, the con- sumption of added sugar was reduced by 2.8g (β= -2,79, p= 0.049). After adjusting for sex and age, an increase in the magnitude of this association was estimated (β=-3.36, p= 0.023).

**Conclusions:** This study showed that sleep duration was negatively associated with the consumption of added sugar in adolescents. Currently sleep becomes an important field of study for understanding its influence on the composition and quality of added sugars' diet and health.

**Keywords:** sleep, adolescent, food intake.

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CROSS-SECTIONAL AND LONGITUDINAL ASSOCIATIONS BETWEEN CLUSTERING OF MULTIPLE LIFESTYLE BEHAVIORS AND ADIPOSITY INDICATORS: THE ELANA MIDDLE SCHOOL COHORT

(1)Moraes, Milena; (2)Fernández-Alvira, Juan Miguel; (3)da Veiga, Gloria Valeria; (4)Moreno, Luis A.

(1)PhD. Nutritionist. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.; (2)PhD. Nutritionist. Department of Epidemiology, Atherothrombosis and Imaging. Spanish National Centre for Cardiovascular Research. Spain; (3)PhD. Nutritionist. Social and Applied Nutrition Department. Federal University of Rio de Janeiro. Brazil.; (4)PhD. Growth, Exercise, Nutrition and Development Research Group. Faculty of Health Science. University of Zaragoza. Spain.

**Background and objectives:** Cluster analysis has been used to identify the coexistence and clustering of multiple lifestyle behaviors in childhood, as well as its relation with adiposity indicators. However, few studies have applied a longitudinal perspective. Our objectives were: a) to explore how clustering of physical activity, sedentary behavior, sugar-sweetened beverages (SSB) intake and fruits and vegetables (FV) consumption is drawn among Brazilian middle school students; b) to investigate the associations between identified clusters and adiposity indicators, both in baseline and at the end of follow-up; c) to investigate the association between identified clusters with excessive weight gain over four years.

**Methods:** Lifestyle behaviors were assessed through self-report questionnaires. A combination of hierarchical and non-hierarchical gender-specific clustering analysis was applied, in order to identify clusters with similar behaviors. Analysis of variance and logistic regression were applied to examine the association between behavioral clusters and adiposity indicators (BMI and body fat percentage). Linear mixed effects models were used to assess trajectories of adiposity indicators according to clusters member-

ship. Conditional relative gain in adiposity indicators over four years were assessed by regressing z-score measures at the last evaluation on all previous z-score measures and sexual maturation.

**Results:** For 732 adolescents (mean age 11.8 years, SD 1.15 years) evaluated, four reliable clusters were identified. The "active cluster", with high physical activity level, had more boys than girls. Among boys, "neutral cluster" (with low z-scores to all behaviors) was mainly represented by students from private schools, while the "mixed cluster" (with higher z-scores to SSB and FV consumption) comprised significantly more public school students than the others. The "sedentary cluster" presented the highest proportion of overweight boys. Boys in the sedentary cluster had higher odds of having body fat percentage >1 z-score at the end of follow-up (OR = 3.18; 95% CI = 1.43-7.10), as well as excessive weight gain after four years (OR = 2.92; 95% CI = 1.04-8.20).

**Conclusions:** Especially for boys, our findings provide evidence to support the concern around sedentary behaviors worldwide, and can be useful to guide effective interventions that account for diversity of lifestyles.

**Keywords:** Energy balance-related behaviors; Cluster analysis; Adolescence; Body composition; Longitudinal studies.

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VIDEOS ABOUT DIETS BROADCAST ON YOU-TUBE: A COMMUNICATION CHANNEL VERY AC-CESSED BY ADOLESCENT

(1)Gurgel, Carolina Albuquerque; (2)Polo, Gabriela Parise; (3)dos Santos, Monica Srour Rodrigues Ferreira; (4)Ganen, Aline; (5)dos Santos, Juliana Grazini.

(1)MSc. Nutritionist. Mestrado Profissional em Nutrição do nascimento à adolescência. Centro Universitário São Camilo. Brazil.; (2)Nutrition Student. Centro Universitário São Camilo. Brazil.; (3)BSc. Nutritionist. Universidade Santa Úrsula. Brazil.; (4)PhD. Nutritionist. Mestrado Profissional em Nutrição do nascimento à adolescência. Centro Universitário São Camilo. Brazil.; (5)PhD. Nutritionist. Universidade de Paris VII. France.

**Background and objectives:** The number of adolescent who access websites such as YouTube for information on weight loss grows every day. This age group shows frequent dissatisfaction with body image, being more sensitive and vulnerable to the information contained in these videos, mainly on how to reach the ideal body through diets. Therefore, attention should be paid to the quality of the content posted, to avoid possible inappropriate eating behaviors and health damage in this specific population. Thus, the purpose of this work is to identify the contents of videos on YouTube about diets and weight loss.

**Methods:** This is an exploratory research, with a quantitative approach, carried out on the website YouTube, to characterize YouTube videos addressing diets for weight loss. A search of the videos was made from March 23 to March 27 2017 using the descriptor "diet". 2,160,000 videos were identified, but only the first fifty-five were analyzed. The exclusion criteria were humor vide-
os and / or parodies about diets and videos with an emphasis on
physical activity (hypertrophy).

**Results:** 67,3% of the analyzed videos had as approach, restrictive diets, with main content short-term weight loss practices. These videos were also the ones that had the higher viewers, approximately 2 million and were transmitted by lay people (94,6%). Only 5,5% of the videos were transmitted by health professionals, such as nutritionist (33,3%) and nutrologist (66,7%) addressing guidelines for healthy eating.

**Conclusions:** Most of the videos showed inadequate weight loss practices being reported mainly by lay people. In this scenario, we identify the importance of nutritionists and government health agencies, through Public Policies, to join this growing communication channel (YouTube) in promoting healthy eating habits.

**Keywords:** Diet. Youtube. Adolescent Behavior.

ADHERENCE TO HEALTHY EATING INDEX FOR PREGNANT WOMEN IS ASSOCIATED WITH LOWER NEONATAL ADIPOSITY IN A MULTIETHNIC ASIAN COHORT: THE GROWING UP IN SINGAPORE TOWARDS HEALTHY OUTCOMES (GUSTO) STUDY

**Background and objectives:** Evidence linking maternal diet quality during pregnancy with infant birth outcomes is limited in Asian populations. We investigated the association of maternal diet quality with risk of preterm birth, offspring birth size and ad- iposity in a multi-ethnic Asian birth cohort study.

**Methods:** Dietary intakes of 1051 pregnant women were as- certained at 26-28 weeks of gestation with the use of 24 h recalls and 3 d food diaries, from which diet quality (score range: 0 – 100) was measured by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP). Gestational age was established by first trimester ultrasound. Neonatal weight and length were measured

<footnote>(1)Chia, Airu; (2)Tint, Mya-Thway; (3)Tan, Kok Hian; (4)Yap, Fabian;</footnote>

<footnote>(5)Shek, Lynette; (6)Chong, Yap Seng; (7)Godfrey, Keith M; (8)Fortier, Marielle; (9)Lee, Yung Seng; (10)Chong, Mary.</footnote>

<footnote>(1)BSc. Department of Obstetrics and Gynecology. National University of Singapore Yong Loo Lin School of Medicine. Singapore.; (2)PhD. Department of Obstetrics and Gynecology. National University of Singapore Yong Loo Lin School of Medicine. Singapore.; (3)MD. Department of Maternal Fetal Medicine. KK Women's and Children's Hospital. Singapore. Duke-National University of Singapore Graduate Medical School. Singapore.; (4)MD. Department of Pediatrics. KK Women's and Children's Hospital. Singapore. Duke-National University of Singapore Graduate Medical School. Singapore. Lee Kong Chian School of Medicine. Nanyang Technological University. Singapore.; (5)MD. Department of Pediatrics. National University of Singapore Yong Loo Lin School of Medicine. Singapore. Division of Pediatric Allergy, Immunology and Rheumatology. Khoo Teck Puat-National University Children's Medical Institute. Singapore.; (6)MD. Department of Obstetrics and Gynecology. National University of Singapore Yong Loo Lin School of Medicine. Singapore. Singapore Institute for Clinical Sciences. Agency for Science, Technology, and Research. Singapore.; (7)PhD. Medical Research Council Lifecourse Epidemiology Unit. University of Southampton. Southampton. United Kingdom. National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton. Southampton. UK.; (8)MD. Department of Diagnostic and Interventional Imaging. KK Women's and Children's Hospital. Singapore.; (9)MD. PhD. Department of Pediatrics. National University of Singapore Yong Loo Lin School of Medicine. Singapore. Division of Paediatric Endocrinology and Diabetes. Khoo Teck Puat-National University Children's Medical Institute. Singapore.; (10)PhD. Saw Swee Hock School of Public Health. National University of Singapore. Singapore. Singapore Institute for Clinical Sciences. Agency for Science, Technology, and Research. Singapore.</footnote>
at birth. Body composition was assessed by air displacement plethysmography in a subset of infants (n=313) within 72 h after birth and abdominal adiposity was assessed by magnetic resonance imaging (MRI) (n=316) within the first 2 weeks of life. Associations were assessed by multivariable linear regression for continuous outcomes and logistic regression for preterm birth with adjustment for confounding factors.

**Results:** The mean (SD) maternal HEI-SGP score was 52.1 (13.6). Maternal diet quality during pregnancy was not associated with preterm birth or birth weight. Greater adherence to HEI-SGP (per 10-point increment in HEI-SGP score) was associated with longer birth length (β (95% CI) 0.13 (0.02, 0.23) cm), lower sum of neonatal triceps and subscapular skinfold thickness (β -0.16 (-0.27, -0.06) mm), lower percentage body fat (β -0.53 (-0.84, -0.21) %), lower fat-mass (β -17.52 (-29.54, -5.51) g), lower percentage abdominal superficial subcutaneous adipose tissue (β -0.16 (-0.30, -0.02) %) and lower percentage deep subcutaneous adipose tissue (β -0.05 (-0.10, -0.01) %).

**Conclusions:** Higher maternal diet quality during pregnancy was associated with longer birth length and lower neonatal adiposity, but not with birth weight and preterm birth. These findings warrant further investigation in independent studies.

**Keywords:** Maternal diet, diet quality, preterm birth, birth size, adiposity

**Conflict of Interest Disclosure:** Yap-Seng Chong and Keith Godfrey have received reimbursements for speaking at conferences sponsored by companies selling nutritional products and are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, and Danone. None of the other authors reported a conflict of interest related to the study.

**Further collaborators:** Chad Yixian Han. BSc. Department of Dietetics and Nutrition. Ng Teng Feng General Hospital. Singapore.

Ling-Wei Chen. PhD. Department of Pediatrics. National University of Singapore Yong Loo Lin School of Medicine. Singapore.

Marjorelee Colega. BSc. Singapore Institute for Clinical Sciences. Agency for Science, Technology, and Research. Singapore.

Izzuddin M. Aris. PhD. Singapore Institute for Clinical Sciences. Agency for Science, Technology, and Research. Singapore.

Mei-Chien Chua. MD. Department of Neonatology. KK Women's and Children's Hospital. Singapore.

**Background and objectives:** Moroccan food retail transition (Supermarket) introducing a changes in food retailing.

The aim the transition of food retail and its impact onhealth, overweight and high blood pressure;

**Methods:** An exploratory transverse survey with a 264 people (131 men and 133 women, sex-ratio=0.98, old of 35.5 ± 9.3 years) in Casablanca; the participants completed a questionnaire bringing socioeconomic and demographic data; some concerning preferences in food supply, as well as their dietary habits of anthropometric measures (the weight, the size and the calculation of body mass index BMI) and blood pressure

**Results:** Biological data shows that 76 participants are overweight and 87 have a high blood pressure.

The used of food stores and the purchase rate are significantly different between participants in overweight and normal participants (p0.001 and p0.05, respectively). We observed that our participants use often a combination of two or three point of purchase. The most frequent combinations are supermarkets / traditional markets with or without convenience store. Furthermore, the participants in overweight prefer shopping food before the meals, while the participants with normal weight prefer after the meals (p0.01).

An increase of overweight according to:

- The use of supermarkets (OR): 3.77; 95 % IC: 1.63-8.74, p=0.002), within the population of the men (OR): 18.58; 95 % IC: 2.44-141.80, p=0.005);

- Shopping before meals (OR): 2.44; 95 % IC: 1.28-4.67, p0.01), for the women (OR): 3.92; 95 % IC: 1.61-9.52, p0.0001); Higher study Level (OR): 2.41; 95 % IC: 1.21-4.81, p=0.012), within women (OR): 6.18; 95 % IC: 2.15-17.81, p0.001).

A reduction of this risk according to:

- Marital status (single men) reduced (OR): 0.45; 95 % IC: 0.21-0.98, p0.045);

- Habits of supermarkets purchase: by comparison with those who never go to supermarkets (OR): 0.23; 95 % IC: 0.09-0.56), for men

**Conclusions:** Grocery shopping in large department stores is now part of most Moroccan families no matter their income and education levels.

The survey shows that while the use of food department stores regularly is significant for most participants, it remains higher among overweight and high blood pressure participants.

**Keywords:** Food retail, overweight, blood pressure.

<footnote>(1)Loukili, Bouchra; (2)Bour, Abdellatif.</footnote>

<footnote>(1)Phd. Nutrition and food transition Équipe de la Transition Alimentaire et Nutritionnelle [ETAN]. Laboratoire des Essais[LEB]. Département de Biologie. Université Ibn Tofail Kenitra. Morocco; (2)Directeur PhD. Équipe de la Transition Alimentaire et Nutritionnelle [ETAN]. Laboratoire des Essais[LEB]. Département de Biologie. Université Ibn Tofail Kenitra. Morocco.</footnote>
# A PARTICIPATORY COMMUNITY-BASED APPROACH TO EFFECTIVE IMPLEMENTATION OF THE BABY FRIENDLY COMMUNITY INITIATIVE IN RURAL KENYA

(1)Kimiywe, Judith; (2)Kimani-Murage, Elizabeth; (3)Wekesah, Frederick; (4)Muriuki, Peter; (4)Wanjohi, Milka; (5)Samburu, Betty; (6)Griffiths, Paula; (7)Madise, Nyovani; (8)McGarvey, Stephen.

(1)PhD. Ass Prof Nutrition. Department of Food, Nutrition and Dietetics. Kenyatta University. Kenya.; (2)Phd. Research Scientist. Health Challenges and Systems. African Population Health Research Center. Kenya.; (3)Msc. Epidemiologist. Health Challenges and Systems. African Population Health Research Center. Kenya.; (4)Msc. Research Assistant. Health Challenges and Systems. African Population Health Research Center. Kenya.; (5)Msc. Programme manager. Maternal, Infant and Young Child Nutrition. Ministry of Health, Nutrition and Dietetics Unit. Kenya.; (6)PhD. Prof. Population Health. Department of Human Sciences. Loughborough University. United Kingdom.; (7)PhD. Prof. Demography and social statistics. Co-Director center for global Health Population, Poverty and Policy. University of Southampton. United. Kingdom.; (8)PhD. Epidemiology and anthropology. Director Health Institute. Brown University. United States of America.

**Background and objectives:** The child survival and development strategy in Kenya aims at improving child health and reduction in child mortality through the acceleration and scale-up of evidence-based high-impact interventions. Promotion of optimal maternal infant and young child delivery of such high impact interventions is marred by lack of clear evidence on what works, how it works and why. The Baby Friendly Community Initiative (BFCI) project conducted a formative qualitative study whose specific objectives were to determine the local contexts and cultural factors that influence breastfeeding and other maternal, infant and young child feeding practices in order to tailor the intervention package to the communities and to determine the enablers and barriers associated with the implementation of Baby Friendly Community Initiative and how to address them

**Methods:** The formative study employed a cluster randomized trial which used a participatory action research design for qualitative data collection. A total of 205 participants were interviewed in the study which covered 13 community units which were used as sampling units for the main project. A total of 52 interviews were done, 16 Focus Group Discussions, 14 In-depth Interviews and 22 Key Informant Interviews. The key informants included chiefs, village elders, religious leaders, women leaders, CBO leaders, Traditional Birth Attendants and health professionals at sub county and health facilities. In-depth interviews included pregnant women, breastfeeding women, HIV positive women and Health professionals. Focus group discussions were done with fathers, old and young mothers, grandmothers and Community Health Volunteers.

**Results:** Results revealed that cultural factors and traditions had great influence on maternal and child feeding practices. Mothers' decisions were also highly influenced by the health workers, community and family members, religious leaders and Traditional birth

attendants. This information was used to develop appropriate and targeted intervention strategies for effective BFCI implementation.

**Conclusions:** End line qualitative data showed a great improvement in addressing some of the key barriers and enhancement of the existing enablers. There were significant positive outcomes for key indicators; the number of antenatal visits, health facility deliveries, exclusive breastfeeding, growth monitoring, motivation and capacity building of community health volunteers and functional mothers support groups.

**Keywords:** Baby Friendly Community Initiative, Enablers/Barriers

**Further collaborators**

Koibatek Sub County Health management Team

# IMPACT OF HEALTH AND NUTRITION EDUCATION ON HEALTHY LIFESTYLE TO IMPROVE NUTRITIONAL STATUS AND REDUCE FREQUENCY OF ILLNESS OF ELDERLY PEOPLE IN URBAN DHAKA

(1)Laboni, Fatema; (2)Sultana, Syeda Saliha Saliheen; (3)Roy, Swapan Kumar.

(1)MSc. Food Science and Nutrition. University of Mysore. Research Officer. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (2)MSc. Food and Nutrition. University of Dhaka. Associate Professor. Dept. of Food & Nutrition. College of Home Economics. University of Dhaka. Bangladesh.; (3)PhD. Nutrition. University of London. Senior Scientist. BOT and Chairperson. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.

**Background and objectives:** According to BBS (2007) the number of the elderly people aged 60 and over in Bangladesh was 9.41 million and by 2025, along with four other Asian countries, will account for 44% of world's total elderly population. This rapidly increasing population is an important group urging for the need of health and nutrition intervention. The objective of the study was to see the impact of nutrition and health education towards improving food consumption practice, nutritional status and morbidity rate among elderly population.

**Methods:** A 6 months longitudinal comparative study was conducted in Dhaka, Bangladesh. Data were collected from 164 elderly people (Intervention group=82, Control group=82) aged > 60 years both male and female in selected old homes. Health and nutrition education with minimum one hour duration within 2 contacts were given only in the intervention group following both face to face and in group intervention method. Baseline and end line anthropometric (weight, height, BMI) data, disease morbidity history and dietary intake (using 24 hours recall method) were recorded for both the intervention and control group using same standard questionnaire. Participant response, encouragements, dietary diversity, food frequency and health & disease status were observed.

**Results:** There was significant weight gain in the intervention group. The mean of weight of intervention group before intervention was 48.86 ± 6.18 and after intervention was 49.92 ± 5.97.
Prevalence of hygiene practice was higher in intervention group comparing to control group. Habit of hand washing was 48.7% higher in the intervention group.

The intervention resulted in reduced morbidity among the elderly population. At the end line 76.8% of control group and 43.9% of intervention group were attacked by any contagious disease (cough, Diarrhea, pain, anorexia, nausea). Food diversity and balanced food choice were also improved in the intervention group comparing to the control group.

**Conclusions:** Nutrition and health education to elderly people has great potential to increase their nutritional status, hygiene practice and decreasing disease morbidity. The result of this study will be effective constructing strategy for addressing the urgent issues of reducing the short life expectancy among elderly people.

**Keywords:** Nutrition, Health, Elderly, Hygiene, Life expectancy

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## ACCEPTANCE OF AND COMPLIANCE WITH MULTI-MICRONUTRIENT AND IRON-FOLIC ACID CAPSULES IN BANGGAI DISTRICT, INDONESIA

**Background and objectives:** One obstacle to increasing compliance with multi-micronutrient (MMN) or iron-folic acid (IFA) supplementation in pregnant women is the side effects, such as a bad smell, nausea, vomiting, stomachache, or headache. To address this problem, in this study, IFA and MMN were each encapsulated in soft capsules, and we evaluated the compliance and acceptance reported by respondents.

**Methods:** This study was conducted in three sub-districts of Banggai district from October 2016 to February 2017. The subjects were preconception women who were newlywed and 18-35 years

of age and who did not have serious diseases, such as tuberculosis, heart disease, or kidney failure. Both IFA and MMN tablets were crushed and then placed in capsule shells with the same color and size. The capsules were randomly delivered to the respondents, who consumed a capsule once per week unless they were menstruating, at which time consumption was daily. Of the 102 preconception women who were recruited, 40 were interviewed about consumption and any side effects that they felt. The level of pleasure was scored on a 3-point hedonic scale, and the response for each sensory quality, namely, color, odor, taste and size, was rated 2 or 3 (likable or very likable). The data were analyzed based on distribution and frequency.

**Results:** The results showed that 36 respondents (90%) consumed the capsules consistently, as recommended. As many as 38 respondents (95%) liked the color, 37 (92.5%) described no odor, 37 (92.5%) liked the flavor, and 37 (92.5%) liked the size. Ten respondents (25%) reported an increase in appetite, and 5 respondents (12.5%) reported deeper sleep. Approximately 4 respondents (10%) reported headache, and 2 (5%) complained of constipation.

**Conclusions:** Encapsulation of MMN or IFA may be an alternative approach for increasing compliance with consumption and reducing side effects.

**Keywords:** Compliance, Acceptance, MMN, IFA

**Further collaborators:** Inayah Hi. Zaini Dg. Taha, Researcher. Banggai District Health Office.

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## MFSD2A IN BLOOD AS POTENTIAL BIOMARKER OF THIS CARRIER IN PLACENTA AND RELATIONSHIP TO CHILD DEVELOPMENT

**Background and objectives:** Gestational diabetes mellitus (GDM) is a global health challenge, and its prevalence is expect-

<footnote>(1) Monoarfa, Yustiyanty; (2) Otoluwa, Anang Samudera; (3) Widasari, Lucy; (4) Said, Rugaya; (5) Habib, Halimah; (6) Handajani, Retno;</footnote>

<footnote>(7) Kuntoro, Kuntoro; (8) Gumilar, Erry; (9) Wirjatmadi, Bambang;</footnote>

<footnote>(10) Thaha, Abdul Razak.</footnote>

<footnote>(1) Doctoral Candidate at Department of Nutrition. School of Public Health. Airlangga University. Indonesia; (2) MD. MPPM. Dr. Lecturer. Academy of Nursing. Luwuk. Banggai. Indonesia;</footnote>

<footnote>(3) MSi. PhD. Doctoral Candidate at Department of Nutrition. School of Public Health. Hasanuddin University. Indonesia;</footnote>

<footnote>(4) SSt. MKes. Staf at Department of Public Health. Banggai District Health Office. Indonesia; (5) BSc. Staff at Banggai Religious Affairs. Banggai District. Indonesia; (6) MD. Msi. PhD. Lecturer. Department of Biomedical. Airlangga University.</footnote>

<footnote>Indonesia.; (7) MD. MSc. Dr. Lecturer. Department of Biostatistic and Population. Faculty of Public Health. Airlangga University. Indonesia.; (8) MD. MSc. Dr. Lecturer. Department of Fetomaternal Health. School of Medicine. Airlangga University. Indonesia.; (9) MD. MSc. PhD. Lecturer. Department of Nutrition. School of Public Health. Airlangga University. Indonesia; (10) MD. MSc. Dr. Lecturer. Department of Nutrition. School of Public Health. Hasanuddin University. Indonesia.</footnote>

<footnote>(1) Sanchez-Campillo, María; (2) Ruiz-Palacios, María; (3) Ruiz-Alcaraz, Antonio J.; (4) Prieto-Sánchez, María Teresa; (4) Blanco-Carnero, José Eliseo; (5) Zornoza, Matilde; (6) Ruiz-Pastor, María José; (7) Demmelmair, Hans; (8) Koletzko, Berthold; (9) Larqué, Elvira.</footnote>

<footnote>(1) PhD. Biologist. Department of Physiology. Faculty of Biology. Campus Espinardo. University of Murcia. Spain;</footnote>

<footnote>(2) PhD. Biologist. Department of Physiology. Faculty of Biology. Campus Mare Nostrum. University of Murcia. Spain; (3) PhD. Biologist. Department of Biochemistry. Molecular Biology B and Immunology. University of Murcia. Spain; (4) PhD. Gynecologist. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia.</footnote>

<footnote>Spain; (5) PhD. Pediatrician. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia. Spain; (6) Student. Biotechnology. Department of Biochemistry. Molecular Biology B and Immunology. University of Murcia. Spain; (7) PhD. Engineer. Ludwig-Maximilians-Universität Munich. Dr. von Hauner Children's H; (8) PhD. Pediatrician. Ludwig-Maximilians-Universität Munich. Dr. von Hauner Children's H; (9) PhD. pharmacist.</footnote>

<footnote>Department of Physiology. Faculty of Biology. Campus Mare Nostrum. University of Murcia. Spain.</footnote>
ed to increase further along with increasing obesity rates. Infants born to GDM mothers have reduced docosahexaenoic acid (DHA) levels in cord blood which could affect their neurological development. Recently, the membrane transporter Major Family Super Domain 2a (MFSD2a) was associated with the selective DHA transport as lysophospholipids. MFSD2a is an orphan transporter, whose ligands range from carbohydrates to amino acids, drugs, or organic anions, with great importance in regulating metabolism. Mean MFSD2a levels are lower in GDM placentas which could affect materno-fetal DHA transport and child development. We aimed to evaluate whether MFSD2a in blood of pregnant women can serve as a biomarker of placental MFSD2a at delivery

**Methods:** Three groups of pregnant women were recruited: 25 health controls, 23 GDM with dietary treatment, and 20 GDM with insulin treatment. Maternal and neonatal anthropometric and biochemical parameters were evaluated. The MFSD2a expression was analysed by Western-blotting in maternal whole blood and serum obtained in the third trimester and in placenta at parturition

**Results:** MFSD2a level in maternal whole blood, but not in serum, was significantly lower in both GDM groups than in controls (GDM-diet 0.56±0.07b, GDM-insulin 0.49±0.46b, controls 0.9±0.08a, p<0.001). MFSD2a in maternal blood was positively correlated with placental MFSD2a (r = 0.287, p = 0.035) and inversely with the concentration of DHA in maternal serum lysophospholipids (r = 0.34, p = 0.018). MFSD2a in maternal blood correlated with cord insulin resistance (r=0.340, p=0.013), cord serum total protein (r=0.276, p=0.05) and cord serum triglycerides (r=0.280, p=0.05). MFSD2a in maternal blood also correlated to neonatal head circumference at 15 days and 1 month of age with similar trend during the first year of life of the baby.

**Conclusions:** MFSD2a concentrations in maternal whole blood are associated with MFSD2a levels in placenta and appear to affect placental DHA transport as well as offspring head size. MFSD2a in whole blood of pregnant women during the third trimester may serve as a biomarker of placental DHA transport capacity

**Keywords:** Membrane fatty acid carrier/ docosahexaenoic acid/Gestational Diabetes Mellitus/Human pregnancy/Neonatal head circumference

**Further collaborators**

Manuel Sanchez-Solis. msolis@um.es. PhD. Pediatrician. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

**Background and objectives:** There is evidence to suggest that obesity in later life could be determined by nutrition during the early life period. The type of nutrition during the postnatal period may play a critical role in appetite control during early and later life. The aim of this study was to examine whether breastfeeding during infancy is associated with breakfast consumption in adolescence. Previous evidence already demonstrated positive associations between breakfast skipping and body fat content in the same HELENA adolescent population.

**Methods:** Cross-sectional school-based study with 2929 adolescents of nine European cities participating in the HELENA study. Parents completed a questionnaire about breastfeeding duration. Breakfast habits were assessed by different agreement categories to the statement 'I often skip breakfast'. Agreement categories were grouped into breakfast 'consumers', 'occasional consumers' and 'skippers'.

**Results:** Twenty nine percent of the adolescents were breakfast skippers. Significant differences were found for skipping breakfast according to breastfeeding duration for female adolescents only. The chance of skipping breakfast was higher for girls who had been breastfed less than 4 months (OR = 2.77, 95% CI 1.35-2.32) than those who had been breastfed for 4 months or more. Girls who had never been breastfed, had also larger chance of skipping breakfast (OR = 2.20, 95% CI 1.56-3.12), compared to those who had been breastfed for 4 months or more.

**Conclusions:** Breastfeeding for more than 4 months was inversely associated with breakfast skipping among adolescent girls suggesting that breastfeeding may encourage the development of appetite control in later life.

**Keywords:** breastfeeding, breakfast, adolescent

**Further collaborators:** Stefaan De Henauw, Denes Molnar, Anthony Kafatos, Cinzia Le Donne, Silvia Pisanu

<footnote>(1)Choma Bettega Almeida, Claudia; (2)Taconeli, Cesar Augusto;</footnote>

<footnote>(3)Crispim, Sandra; (4)Gottrand, Frédéric; (5)Kersting, Mathilde;</footnote>

<footnote>(6)Moreno, Luis A.; (3)Höfelmann, Doroteia; (7)Julian Almarcegui, Cristina; (8)Gunter, Marc; (9)Huybrechts, Inge.</footnote>

<footnote>(1)PhD. Nutritionist.Federal University of Parana. Brazil.; (2)PhD. Statistician. Federal University of Parana. Brazil.; (3)PhD. Nutritionist. Federal University of Parana. Brazil.; (4)PhD. Pediatrician. National Institute of Health and Medical Research. Jeanne de Flandre University Hospital. France.; (5)PhD. Research Department on Child Nutrition. Pediatric University Clinic. Ruhr-University Bochum. Germany.; (6)PhD. Faculty of Health Sciences. University of Zaragoza. Spain.; (7)Department of Public Health and Primary Care. University of Cambridge. United Kingdom.; (8)PhD. Molecular Epidemiologist. Nutrition and Metabolism Section. International Agency for Research on Cancer. France; (9)PhD. Nutricionist. Nutrition and Metabolism Section. International Agency for Research on Cancer. France.</footnote>
# EXPLORING THE INFLUENCE AND TRANSFER OF INFANT AND YOUNG CHILD FEEDING PRACTICES TO MOTHERS: FORMATIVE RESEARCH FOR THE SPOON PROJECT IN COLOMBIA, GUATEMALA AND MEXICO

(1)Bernal, Ines Jennifer; (2)Garcia-Meza, Rosario; (3)Duque, Tiffany;

(4)Bonvecchio, Anabelle; (5)Cosio, Izchel; (6)Gonzalez, Wendy;

(6)Tumilowicz, Alison.

(1)PhD. Consultant for Global Alliance for Improved Nutrition (GAIN). Switzerland.; (2)MA. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.;

(3)MPH.RDN. Consultant for Global Alliance for Improved Nutrition (GAIN). Switzerland.; (4)PhD. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México.; (5)Msc. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México.; (6)PhD. Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland.

**Background and objectives:** Exclusive breastfeeding (EBF) for 6 mo and adequate complementary feeding (CF) practices remain a challenge in Colombia, Guatemala and Mexico. Mothers typically receive advice on adequate infant and young child feeding (IYCF) practices from health professionals, as well as from informal sources such as family members. Little is known about the content and strategies used by different actors to influence these IYCF practices. Our aim was to explore sources of information, messages, and actors that influence IYCF practices.

**Methods:** As part of the formative research of the SPOON project, which aims to implement a strategy to prevent chronic malnutrition and reduce the risk of future obesity in children aged 0-23 months, in-depth interviews were conducted with health professionals (n=26), key informants (n=37) and mothers/car egivers (n=70) in Colombia, Guatemala and Mexico. Interviews were translated-transcribed verbatim, coded and analyzed using N-Vivo.11.

**Results:** In all settings, formal IYCF advice is commonly pro vided by doctors, nurses and health educators during the provi sion of health services and informal advice is provided mostly by grandmothers, and sometimes husbands in a home setting. Moth ers value receiving counseling from health professionals because they are trusted, as well as from grandmothers because they are experienced and knowledgeable, and often provide foods. Advice provided from both sources sometimes contradicts IYCF practices as recommended by the WHO. Common advice given by grand- mothers includes the importance of offering colostrum (Guatema- la), the timing of introduction of specific foods (often resulting in premature of delayed complementary feeding), and the limited duration of continued breastfeeding among girls (Colombia), the importance to give different foods beside only the baby bottle. In- fluential strategies used by grandmothers include sharing success ful-unsuccessful experiences and timely advice.

**Conclusions:** Mothers' IYCF practices are influenced by a dynamic integration of advice received from health providers,

preceding generations, past experiences on infant nutrition and personal beliefs. Behavior Change Communication strategies must consider influential figures and cultural determinants that influence the adoption of appropriate IYCF practices.

**Keywords:** infant and young child feeding practices, formative research, Colombia, Guatemala, Mexico

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

# EFFECTS OF GESTATIONAL WEIGHT GAIN, NUTRIENT INTAKE, AND PASSIVE SMOKING ON LOW-BIRTH-WEIGHT DELIVERY

(1)Hsu, Wen-Yin; (2)Lo, Hui-Chen; (3)Wu, Cheng-Hsuan; (4)Kao, Mei-Ding.

(1)PhD. LD. Department of Nutrition. Puli Christian Hospital. Puli. Taiwan.; (2)PhD. LD. Department of Nutritional Science. Fu Jen Catholic University. New Taipei City. Taiwan.; (3)MD. Department of Obstetrics & Gynecology. Changhua Christian Hospital. Changhua. Taiwan.; (4)MS. Department of Food and Nutrition. Providence University. Taichung. Taiwan.

**Background and objectives:** Evidence showed that maternal anthropometrics and nutritional status before and during pregnancy may affect the birth weight of neonates and increase the risk of low-birth-weight (birth weight<2500g, LBW) delivery. The aim of this study was to investigate the effects of pre-pregnancy body mass index (BMI) and maternal body weight gain, dietary intake, and blood biochemical parameters during pregnancy on the inci dence of LBW delivery in Taiwan.

**Methods:** Healthy women (n=520, age 29.1 ± 4.2 y) at 8 to 12 weeks of pregnancy were recruited from prenatal clinics. Back ground information, anthropometrics, biochemical parameters, and dietary intake from 24 h-recall were obtained from the first, second, and third trimesters to delivery. Clinical outcomes of neo nates were also collected.

**Results:** The results showed that 53.7% of women were prim- iparous with 4.31% of LBW delivery. Gestational weight gains (GWG) in the first trimester and throughout pregnancy were significantly lower in mothers with LBW delivery (LBW group) than those with non-low-birth-weight delivery (non-LBW group, p<0.05). Mothers who had lower GWG than the Institute of Medicine (IOM) guidelines had increased risk of LBW delivery (OR=7.64, 95% CI=1.56, 37.3, p<0.05). Mothers in the LBW group exposed to passive smoking for longer periods of time than those in the non-LBW group. In addition, maternal intakes of protein, cholesterol, calcium, phosphorus, potassium, iron, and vitamin B2, circulating white blood cell counts (WBC), and serum albu min levels were significantly lower, whereas serum magnesium and ferritin levels were significantly higher in the LBW group than in the non-LBW group.

**Conclusions:** Maternal gestational weight gain, WBC, micro nutrient intakes, protein, magnesium and iron status, and passive
smoking may simultaneously affect the delivery and neonatal outcomes.

**Keywords:** nutrient intake, gestational weight gain, low birth weight, passive smoking

**Conflict of Interest Disclosure:** This study received grant from the Ministry of Health and Welfare (DOH95-TD-F-113-043-(2)2/1, DOH95-TD-F-113-043-(2)2/2)

The authors had no conflict of interests

(1)Gao, Ying; (2)Jia, Keyu.

(1)Shanghai Institutes for Biological Sciences. Chinese Academy of Science. China.; (2)BS. Shanghai Institutes for Biological Sciences. Chinese Academy of Sciences. China.

**Background and objectives:** Studies have shown that nutritional status during early life (including prenatal and postnatal nutrition) could affect individual's epigenetic profile, which subsequently influence the infant growth, including neural development. We aimed to study the relationship between fatty acids profile in breast milk and infant executive function.

**Methods:** Eight hundred new born infants were recruited and followed up for 30 months. Breast milk was sampled at 42nd day and 8th month old, and the fatty acids profiling of breast milk were evaluated with GC-FID. The executive function of infants was tested with Bayley Scale, AB task, and planning task at 8th month and 30th month. The relationship between fatty acid level and executive function was evaluated with linear regression. iCluster analysis was also used to classify the study subjects into subgroups according to fatty acids pattern.

**Results:** We found that the levels of saturated fatty acids (SFA) were increased in breast milk of 8th month compared to 42nd day (P=0.10). In contrast, poly-unsaturated fatty acids (PUFA) levels (P=0.04) and the n3/n6 PUFA ratio (P<0.001) were decreased. In 42nd day breast milk, the levels of C10:0, C14:0, and C14:1n5 were negatively correlated with distraction score of full term infants. In 8th month breast milk, the levels of C12:0 and C14:0 were positively correlated with finer motor score; and C20:0 level was positively correlated with distraction score of full term infants. For pre-term infants, levels of C14:1n5, C16:1n7, C18:3n3, C18:3n6, and C20:4n6 in both 42nd day and 8th month breast milk were positively correlated with gross motor and planning score.

**Conclusions:** Fatty acids levels in breast milk were changing at different time and individual fatty acids had different effects on executive function at different time. More fatty acids were found to be correlated with executive function of pre-term infants compared to full term infants.

**Keywords:** fatty acids, executive function, breast milk

**Further collaborators:** Hong Zhou

(1)Ghosh, Shibani; (2)Liang, Lichen; (3)Kabunga, Nassul; (4)Agaba, Edgar; (5)Griffiths, Jeffrey; (6)Duggan, Christopher; (7)Webb, Patrick; (8)Bashaasha, Bernard.

(1)PhD. Nutritionist. Feed the Future Innovation Lab for Nutrition. Friedman School of Nutrition Science and Policy. Tufts University. USA.; (2)PhD. Statistician. Feed the Future Innovation Lab for Nutrition. Friedman School of Nutrition Science and Policy. Tufts University. Boston. USA.; (3)PhD. Agricultural Economist. International Food Policy Research Institute. Kampala. Uganda.; (4)MS. MPh. Nutritionist. Feed the Future Innovation Lab for Nutrition. Friedman School of Nutrition Science and Policy. Tufts University. Kampala. Uganda.; (5)MD. PhD. Infectious Disease Specialist. Feed the Future Innovation Lab for Nutrition. Friedman School of Nutrition Science and Policy and School of Medicine. Tufts University. Boston. USA.; (6)PhD. Nutritionist. Pediatrician. Harvard T.H. Chan School of Public Health and Boston Children's Hospital. Boston. USA.; (7)PhD. Nutritionist. Agricultural Economist. Feed the Future Innovation Lab for Nutrition. Friedman School of Nutrition Science and Policy. Tufts University. Boston. USA; (8)PhD. Agricultural Economist. College of Agricultural and Environmental Sciences. Makerere University. Kampala. Uganda.

**Background and objectives:** Rates of overweight have been increasing in Uganda women of reproductive age while stunting rates in children under five remain high. The objective of this analysis is to assess the association of being a stunted child in a household with an underweight versus overweight female caregiver within the context of the changing profile of the nutrition burden in Uganda.

**Methods:** This analysis utilizes data from two rounds of data collected on the households in 2012 and 2014 on a female caregiver and all children under five years of age in 3 North and 3 South West Ugandan districts (random self weighting sample, n= 8589 women and children). Anthropometric data were collected on both female caregivers and all children under five. Data were collected on socio-demographics, household food security, agricultural production, individual health and dietary pattern (caregiver and children under five). Mixed effects logistic regressions, accounting for repeated measures, were conducted using STATA 14.

**Results:** Stunting prevalence in children under five in the pooled sample was 28.2% and in households with underweight, normal and overweight caregivers 27.2%, 28.3% and 29%, respectively. Controlling for confounders and survey year, children with an overweight caregiver were less likely to be stunted than children with underweight caregivers (OR=0.68, CI=0.50-0.93, p=0.016). Being stunted was also significantly strongly associated with being boy (OR=1.47 CI=1.29-1.68, p=0.000), older age group (13- 24 months, OR 5.10, CI 4.06- 6.40, p=0.000, 25-59 months, OR=5.18 CI 4.26- 6.30, p=0.000) and geographical location with children from the South West more likely to be stunted than children from
the North. (OR 4.45 CI 3.75-5.27, p=0.000). Other important factors include caregiver age (OR =0.98, CI=0.97-0.99, p=-0.003), caregiver education (OR=0.95, CI=0.93-0.98, p=0.000) and household wealth (OR=0.83, CI=0.76-0.89, p=0.000).

**Conclusions:** Stunting in children under five and overweight in women co-exist in the same rural Ugandan households. But nature of this relationship is confounded by factors such as gender of the child, age, geographical location, caregiver's age and education and household wealth. Particular emphasis needs to be given to future analysis to determine the extent of the difference in the association by geographical location.

**Keywords:** Stunting, Overweight, Rural Households, Uganda

144/1586

DEVELOPMENT OF AN M-HEALTH INTERVENTION FOR THE INFANT AND YOUNG CHILD FEEDING COUNSELLING IN THE PLANTATION SECTOR OF SRI LANKA

(1)Senarath, Upul; (2)Godakandage, Sanjeeva; (2)Jayawickrama, Hiranya; (3)Wickramasinghe, Aravinda; (4)Siriwardena, Indika; (5)Partheepan, Kunarathinam; (6)Gamagedera, Nimal; (7)Weerasinghe, Manuj; (8)Alam, Ashraful; (9)Dibley, Michael.

(1)MD. Professor in Community Medicine. Faculty of Medicine. University of Colombo. Colombo. Sri Lanka.; (2)MD. Consultant Community Physician. Family Health Bureau. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (3)MSc. Medical Officer. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (4)MEcon. Ministry of Technology and Research. Colombo. Sri Lanka.; (5)MPH. Research Assistant. South Asia Infant Feeding Research Network. Sri Lanka.; (6)MD. Consultant Community Physician. Office of Provincial Director of Health Services. Uva Province. Badulla. Sri Lanka.; (7)MD. Senior Lecturer in Community Medicine. Faculty of Medicine. University of Colombo. Colombo. Sri Lanka.; (8)PhD. Postdoctoral Research Associate. Sydney School of Public Health. University of Sydney. Australia.; (9)MPH. Professor in Global public health nutrition. Sydney School of Public Health. University of Sydney.

**Background and objectives:** Sri Lankan health indicators are relatively better when compared to similar socio-economic countries. But the progress on child under-nutrition is poor, which is prominent in plantation sector. M-health is a possible technology to deliver feeding counselling, with relatively lower costs in these settings by improving access, quality, and timeliness.

The aim of this study was to develop an M-health intervention suitable for the plantation sector of Sri Lanka for infant and young child feeding counselling.

**Methods:** The research team conducted a formative study in the plantation sector to assess the acceptability of an intervention using mobile phones, registration of the clients, mode (text or voice) and timing of messages and signal strength. This lead to the development of an intervention with four stages.

**Results:** Stage I

Age appropriate sequence of text and voice messages were developed, aiming pregnant mothers with gestational age over 28 weeks and mothers of infants up to 2 years of age. Messages focused on encouraging mothers on exclusive breastfeeding, appropriate complementary feeding, relevant hygienic practices, immunization and micronutrient supplementation. Text messages were in Tamil text and voice messages were in female Tamil voice. Both were interactive messages and at the end of each massage the receiver was asked whether there are any feeding issues and the urgency of the issue. All the issues were notified to Public Health Midwife (PHM) through another text message.

Stage II

A mobile platform was developed to send the above messages to registered clients in partnership with a professional mobile service provider in Sri Lanka - Dialog Axiata PLC Messages sent on fixed dates and times during the week.

Stage III

Mobile application was developed for the use of the PHM, with the same mobile service provider for the registration of the clients. The application worked online and offline and was able to operate through smart phones or computers.

Stage IV

Clients and PHM were trained on use of mobile phones.

**Conclusions:** An M-health intervention was developed for infant and young child feeding counselling for the plantation sector of Sri Lanka which needs to be pilot tested.

**Keywords:** M-health. IYCF counselling. plantation sector. Sri Lanka

**Further collaborators** Renuka Jayatissa, UNICEF. Sri Lanka

Gamini Jayakody. UNICEF. Sri Lanka

Basuru Kumarasena, Dialog Axiata PLC. Colombo. Sri Lanka

Madushanka Wanigasuriya, Dialog Axiata PLC. Colombo. Sri Lanka

Archchuna Ramanathan. SAIFRN. Sri Lanka.

Claudio Umesh, SAIFRN. SAIFRN. Sri Lanka

Prasantha Arumapperuma. Ministry of Health Nutrition and Indigenous Medicine. Sri Lanka
# PROLONGING MICRONUTRIENTS SUPPLEMENTATION 2-6 MONTHS PRIOR TO PREGNANCY SIGNIFICANTLY IMPROVES BIRTH WEIGHT BY INCREASING HPL PRODUCTION AND CONTROLLING IL-12 CONCENTRATION: A RANDOMIZED DOUBLE BLIND CONTROLLED STUDY

(1)Sri Sumarmi, Sri Sumarmi; (2)Melaniani, Soenarnatalina; (3)Kuntoro, Kuntoro; (4)Wirjatmadi, Bambang; (5)Dachlan, Erry Gumilar; (6)Thaha, Abdul Razak; (7)Soekirman, Soekirman.

(1)PhD. Department of Nutrition. Faculty of Public Health. Universitas Airlangga. Surabaya. Indonesia.; (2)PhD. Statistitian. Department of Biostatistic and Population Study. Faculty of Public Health. Universitas Airlangga. Surabaya. Indonesia.; (3)Professor. Statistitian. Department of Biostatistic and Population Study. Faculty of Public Health. Universitas Airlangga. Surabaya. Indonesia.; (4)Professor. Nutritionist. Department of Nutrition. faculty of Public Health. Universitas Airlangga. Surabaya. Indonesia.; (5)Professor. Gynecologist. Department of Fetomaternal. Dr Soetomo General Hospital. Surabaya. Indonesia.; (6)Professor. Nutritionist. Department of Nutrition. Faculty of Public Health. Hasannudin University. Makassar. Indonesia.; (7)Professor. Nutritionist. Indonesian Nutritional Fortification Foundation. Jakarta. Indonesia.

**Background and objectives:** The role of multi-micronutrients (MMN) supplementation to improve birth weight is still debatable. Its role on pregnancy outcomes may involve the Interleukin 12 (IL-12) and human Placental Lactogen (hPL). This research was conducted to evaluate the effect of prolonging multi-micronutrients supplementation 2-6 months prior to pregnancy on birth weight in relation to IL-12 and hPL concentration during the 3rd trimester of pregnancy.

**Methods:** A randomized double blind community-based trial was conducted at District of Probolinggo East Java, Indonesia. A two-arms study consists of group I received placebo before pregnancy and continued with daily iron and folic acid (IFA) during pregnancy, and group II received multi-micronutrient containing 15 micronutrients, 2 other days before pregnancy and continued with daily dose during pregnancy. A sample size of 115 pregnancy outcomes was obtained from 420 eligible brides-to-be. The primary outcome variable is birth weight. Concentration of IL-12 and hPL in the last trimester, gestational age, maternal weight gain and placental weight were assessed as the intervening variables. Preconceptional BMI, concentration of serum retinol, serum zinc, and serum ferritin prior to pregnancy were assed as baseline data. Data were analyzed using analysis of covariance to evaluate effect of supplementation. Causal relationship among variables was tested by using analysis of structural equation modelling.

**Results:** The characteristic between treatment group and control group were not different (Box's M value p = 0,398; Hotelling's Trace value p = 0,478I). Results show that compare to iron folic acid supplementation, subjects who received multi-micronutrients supplementation 2-6 months prior to pregnancy have lower IL-12 concentration by 0.10 pg/mL (p=0,665), higher hPL concentration by 1.14 mg/L (p=0,014), longer gestational age by 1.66 weeks (p=0,539),

but no difference of total weight gain (p=0,995). There is significantly higher of placental weight and birth weight by 83.59 grams (p=0,000) and 309.89 grams (p=0,000) respectively (p=0,000).

**Conclusions:** It implies that prolonging multi-micronutrient supplementation 2-6 months prior to pregnancy and being continued during pregnancy improves birth weight by increasing hPL production and placental weight, as well as controlling maternal immune response, particularly reducing IL-12 concentration in last trimester.

**Keywords:** preconception nutrition, multi-micro nutrients, human placental lactogen, interleukin-12, birth weight

**Further collaborators:** This research was funded by Indonesian Danone Institute Foundation

# THE LONG-TERM EFFECT OF MATERNAL AND EARLY CHILDHOOD SUPPLEMENTATION ON GROWTH AND BODY COMPOSITION AT 4-6 YEARS OF AGE IN GHANAIAN CHILDREN

(1)Kumordzie, Sika; (2)Arimond, Mary; (3)Adu-Afarwuah, Seth; (4)Young, Rebecca R.; (5)Ocansey, Maku Eugenia; (6)Okronipa, Harriet; (7)Prado, Elizabeth; (8)Oaks, Brietta; (9)Dewey, Kathryn G.

(1)MPhil. Graduate Student Researcher. Program in International and Community Nutrition. Department of Nutrition. University of California, Davis. USA; (2)MSc. Analyst. Program in International and Community Nutrition. Department of Nutrition. University of California, Davis. USA.; (3)PhD. Lecturer. Department of Nutrition and Food Science. University of Ghana. Ghana.; (4)MSc. Statistician. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. USA.; (5)MPhil. Graduate Student Researcher. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. USA.; (6)MSc. Graduate Student Researcher. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. USA.; (7)PhD. Assistant Project Scientist. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. USA.; (8)PhD. Postdoctoral Scholar. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. USA.; (9)PhD. Professor. Program in International and Community Nutrition. Department of Nutrition. University of California. Davis. USA.

**Background and objectives:** Nutrition during the first 1000 days influences short and long term health outcomes including growth. Although several studies have examined the effect of nutritional supplementation on growth from birth to 24 months, few have evaluated the long-term effects of early supplementation beyond this period. We previously reported that maternal and child lipid-based nutrient supplements (LNS) provided during pregnancy and 6 months postpartum for the mother and from 6 to 18 months for the child increased mean attained length at 18 months. Our current objective is to report effects on growth and body composition at 4-6 years of age.
**Methods:** We conducted a follow-up study of children born to women who participated in the International Lipid-based Nutrient Supplements (iLiNS)-DYAD trial in Ghana. Women (n=1320) were randomized to receive 1 of 3 treatments at ≤20 weeks gestation: 1) iron and folic acid during pregnancy and placebo calcium tablet for 6 months postpartum, 2) daily multiple micronutrient tablets during both periods, or 3) LNS during both periods. Children whose mothers received LNS also received LNS from 6 to 18 months of age. At 4-6 years of age, we determined the effect of the intervention (LNS vs. non-LNS) on the primary outcomes height, height-for-age z-score (HAZ) and percent body fat determined by the deuterium dilution method. Other growth indicators were secondary outcomes.

**Results:** Follow-up anthropometric results represent 76.8% of live births from the main trial (n=966). There were no significant differences between LNS vs non-LNS groups in height [106.7 vs. 106.3 cm (β = 0.37; 95% CI -0.19, 0.93; p=0.347)], HAZ [-0.50 vs.-0.56 (β = 0.06; 95% CI -0.06, 0.18; p=0.347)], stunting (<-2 SD) [6.2 vs. 5.8% (β = 1.12; 95% CI 0.62, 2.03; p=0.706)], or percent body fat [15.7 vs. 15.6% (β = 0.09; 95% CI -0.60, 0.78; p=0.802)].

**Conclusions:** Although we had previously observed a difference in length at 18 months, there was no effect of LNS on height at 4-6 years of age in this cohort, which had a low stunting rate. There was no adverse impact of LNS on body composition or overweight.

**Keywords:** Growth, body composition, supplementation, lipid-based nutrient supplements

144/1601

KNOWLEDGE, ATTITUDES AND PRACTICES OF FIRST LEVEL HEALTH WORKERS TOWARDS BREASTFEEDING, COMPLEMENTARY FEEDING AND MICRONUTRIENTS SUPPLEMENTS IN MEXICO: FORMATIVE RESEARCH FOR THE SPOON PROJECT

**Background and objectives:** Adequate breastfeeding (BF), complementary feeding (CF) and micronutrients intake (MI) are important determinants of children growth and development. The first-level health workers in most cases are the gatekeepers of child nutrition information to mothers or caregivers during their visits to primary health care. The objective of this work was to identify first-level health workers' knowledge, attitudes and practices related to the promotion of BF, CF and micronutrient supplements (MS).

**Methods:** As part of the formative research of the SPOON project, which aims to implement a strategy to prevent chronic malnutrition and reduce the risk of future obesity in children aged 0-23 months, in-depth interviews with health workers (HW, n=8) were conducted to document their knowledge, attitudes and practices towards BF, CF and MS. Interviews were transcribed in verbatim, coded and analyzed using N-Vivo.11.

**Results:** HW recognize that BF is the best food for children, and they recommend exclusive breastfeeding (EBF) without any other type of food or liquid during the first six months. They mentioned that illness is a motive to interrupt BF (HIV, or with intake of strong medicine such as penicillin). According to them weaning starts at six months, some think that during this period breastmilk is useless or less nutritious for infants. They also think that the total duration of BF should be one year, and prolonging BF beyond than a year might causes emotional dependence and problems with social integration. They recommend that CF starts with semisolid foods, and they prescribe MS, however their information about appropriate CF and MS is scarce. Most of their information about BF, CF and MS, comes from personal/familiar experiences and some from vocational training

**Conclusions:** Even though HW recommend EBF, certainly their knowledge, attitudes and practices contradicts WHO recommendations towards total duration of BF. Since HW are important sources of information to mothers, they affect mother's knowledge and practices related to child nutrition. Therefore, it is important to design a multidimensional strategy that address HW' lack of knowledge to the adequate promotion of CF and the use of MS.

**Keywords:** Health workers, infant and young child feeding practices, micronutrients supplements, knowledge, formative research, Mexico

144/1609

ACCEPTABILITY OF UNSWEETENED SMALL QUANTITY LIPID-BASED NUTRIENT SUPPLEMENT (SQ-LNS) IN CHILDREN AGED 6 TO 23 MONTHS: FORMATIVE RESEARCH FOR THE SPOON PROJECT IN COLOMBIA, GUATEMALA AND MEXICO

**Background and objectives:** The SPOON project aims to design a social and behavior change communication (SBCC) strat-

<footnote>(1)Armendariz, Gabriela; (2)Alvarado, Rocio; (3)Bonvecchio, Anabelle;</footnote>

<footnote>(4)Gonzalez, Wendy.</footnote>

<footnote>(1)MHP. MD. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México; (2)MPH. Nutritionist. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México;</footnote>

<footnote>(3)PhD. Nutritionist. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México;</footnote>

<footnote>(4)PhD. Nutritionist. Consultant for Global Alliance for Improved Nutrition (GAIN). Switzerland.</footnote>

<footnote>(1)Gonzalez, Wendy; (2)Bonvecchio, Anabelle; (2)Duque, Tiffany;</footnote>

<footnote>(2)Bernal, Ines Jennifer; (3)Montenegro-Bethancourt, Gabriela;</footnote>

<footnote>(2)Alvarado, Rocio; (2)Armendariz, Gabriela; (2)Cosio, Izchel;</footnote>

<footnote>(4)Vossenaar, Marieke; (5)Tumilowicz, Alison.</footnote>

<footnote>(1)Global Alliance for Improved Nutrition (GAIN). Switzerland;</footnote>

<footnote>(2)Consultant for the Global Alliance for Improved Nutrition (GAIN). Switzerland.; (3)Research Institute and Higher Education on Health Sciences (IECIS). Rafael Landívar University. Guatemala.; (4)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (5)Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland.</footnote>
egy to prevent malnutrition among children aged 0-24 months through adequate infant and young child (IYC) feeding practices, including home-fortification with SQ-LNS. In the context of the nutrition transition and the evidence linking IYC feeding to overweight and obesity, we aimed to assess acceptability of unsweetened SQ-LNS, and to identify context-specific barriers and facilitators of use.

**Methods:** As part of extensive formative research, a 14-day home feeding trial was conducted with a convenience sample of caregivers of children aged 6-24 months in poor urban communities of Pasto, Colombia (n=16), Baja Verapaz, Guatemala (n=28) and Nayarit, Mexico (n=30). Caregivers were instructed to administer a daily 20-g portion of SQ-LNS directly from the sachet or mixed with foods. Participants received three home-visits during which interviews were conducted to investigate use; in addition "used" sachets were collected. Focus groups discussions were also conducted.

**Results:** The proportion of caregivers who reported offering SQ-LNS on all 14 days was 71% in Guatemala, and approximately half in Colombia (47%) and Mexico (53%). Most caregivers chose to mix SQ-LNS with food (80% Colombia, 75% Guatemala, 71% Mexico) and approximately half reported children finishing the portion (52% Colombia, 60% Guatemala, 45% Mexico). At the level of the child, barriers included dislike of the flavor (peanut), rejection, and large portion size. At the level of the caregiver, barriers included difficulty in finding the right food to mix with, lack of patience to feed, activities outside the house and lack of collaboration of the father. Side effects such as diarrhea, change in stool color and constipation were mentioned. Perceived benefits included prevention of illness, increased appetite, activity, wellbeing and weight gain. Caregivers' recommendations for use of SQ-LNS include mixing it with a variety of favorite foods such as sweet foods and feeding with patience and playfulness.

**Conclusions:** To maximize acceptability and adherence, the SBCC strategies across the 3 settings must emphasize the variation in feeding practices and barriers uncovered through the study.

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

Sri Lanka with the support of UNICEF in 2007. The intervention was implemented in 12 of the most nutritionally vulnerable districts. The children aged 6 to 23 months were eligible to receive MMN supplement. The purpose of the present evaluation is to assess the effectiveness of MMN supplementation programme in the 12 intervention districts including a comparison between recipients and non-recipients.

**Methods:** We conducted secondary data analyses of 2 national surveys conducted early and late phases of the MMN intervention. The secondary data analysis employed data from the Nutrition and Food Security Survey 2009 (NFSS 2009) and the National Nutrition and Micronutrient Survey 2012 (NNMS 2012).

**Results:** The analysis revealed that only 45.2% of the children in the age group 6-23 months in the 12 intervention districts have received MMN powder in 2012. The comparison between the two surveys showed a significant and substantial reduction in the prevalence of anaemia in children aged 6-23 months by 11.7%, and an increase in mean Hb level by 0.3 g per dl between 2009 and 2012. Using the NNMS 2012 data, the micronutrient status was compared between children who received MMN and never received MMN in the 12 intervention districts. The results revealed that the prevalence of anaemia was lower (25.2%) among those who have received MMN powder compared to those who haven't received it (29.7%), but this difference was statistically non-significant. However, there was a statistically significant reduction in the prevalence of Iron Deficiency Anaemia among recipients of MMN (10.1%) in comparison to non-recipients (15.7%). There is also a significant improvement in the mean Haemoglobin level by 0.15 g per dl in the recipients.

**Conclusions:** The present evaluation has demonstrated that MMN supplementation for home fortification has clear benefits in reducing Iron deficiency anaemia in infants and young children in the pilot districts. In conforming to global guidelines, it is recommended that prevalence of anaemia more than 20% in the age group 6-23 months be used as the cut-off in determining scale up.

**Keywords:** multiple micronutrient supplementation. Anaemia. programme evaluation.

<footnote>(1)Senarath, Upul; (2)Jayatissa, Renuka; (3)Siriwardena, Indika.</footnote>

<footnote>(1)MD. Professor in Community Medicine. Faculty of Medicine. University of Colombo. Colombo. Sri Lanka.; (2)MD. Consultant Medical Nutritionist. Medical Research Institute. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (3)MEcon. Senior Scientist. Ministry of Technology and Research. Colombo. Sri Lanka.</footnote>
# INFANT AND YOUNG CHILD FEEDING POLICY PROCESS AND PROGRAMMES IN SRI LANKA: AN ANALYSIS OF STAKEHOLDERS

**Background and objectives:** Child nutrition indicators have not improved on par with other health indicators in Sri Lanka. Evidence-based interventions to improve infant and young child feeding (IYCF) practices are well documented. Adoption of such interventions, guided by robust polices, and backed by unstinted support from all stakeholders are pre-requisites for successful IYCF programmes, to tackle childhood malnutrition. This study was designed to describe the role of stakeholders in IYCF policies and programmes in Sri Lanka, in order to identify opportunities for improvement.

**Methods:** Technical and funding links of stakeholders involved in IYCF policies and programmes in Sri Lanka were analysed using Net-Map technique. Thirty five experts knowledgeable about IYCF programmes were selected for this purpose, and individually interviewed.

Data were analysed using ORA (Organizational Risk Analyzer) software. Relative importance of stakeholders was assessed through 'centrality' measures ('in-degree', 'out-degree', 'closeness' and 'betweenness'). In addition, 'level of influence' and 'support' of each stakeholder were also measured. The ORA software identified 'communities', i.e. groups of stakeholders closely connected.

**Results:** For technical and funding support for IYCF policies and programmes, 56 and 37 stakeholders respectively were identified.

Regarding technical support, stakeholders in the government health sector had the highest 'centrality' measures, 'level of influence' and 'support', followed by development partners. The research and academic, non-governmental organization (NGO) and government non-health stakeholders had relatively low 'centrality' and 'level of influence', though most of them were 'supportive'.

In the funding support map also government health sector stakeholders were prominent. High 'in-degree' suggested adequacy of funds for this main sector. Generally high 'supportiveness', 'level of influence' and 'centrality' of these stakeholders facilitate favourable distribution and utilization of funds for IYCF activities. Development partners had high 'out-degree' and 'level of influence' measures. Government non-health and NGO sectors had low 'in-degree', 'closeness' and 'level of influence' measures, though 'supportive'.

'Communities' in both technical and funding support maps were diverse, indicating healthy support and collaboration between stakeholders of various sectors.

**Conclusions:** The stakeholder analysis demonstrated that the government health sector was most active in IYCF programmes in Sri Lanka. For further improvement, strategic involvement of stakeholders in other sectors seems an attractive option.

**Keywords:** Infant and young child feeding, Stakeholder analysis, NetMap, Sri Lanka

**Further collaborators**

HALAGAMA Sathya

NIMALANSrisothinathan

ARCHCHUNA Ramanathan

UMESH Claudio

# NUTRITIONAL SITUATION, FEEDING PRACTICES OF CHILDREN AND REPRODUCTIVE AGE MOTHERS FROM BANGANG RURAL COMMUNITY, CAMEROUN

**Background and objectives:** Health and nutrition problems are the result of unsatisfactory food intake or severe and repeated infection, or a combination of both. In Cameroon, malnutrition rate among pregnant and lactating women, infant and young children is increasing. This work aimed at evaluating feedings practices, anthropometric measurements (aged, weights and heights), the nutritional status of the mothers and children aged 0 to 59 months, in order to prepare nutrition education and intervention.

**Methods:** A cross-sectional study was conducted in six pilot health centers at Bangang Rural Community in western Cameroon. Two hundred and ninety six (296) mothers with 440 children (214 male, 226 female) aged 0 to 59 months were randomly selected. Anthropometric measurements were taken on mothers and their children using NCHS/WHO international growth reference. A questionnaire was developed to collect information on

<footnote>(1)Godakandage, Sanjeeva; (2)Senarath, Upul; (3)Jayawickrama, Hiranya;</footnote>

<footnote>(4)Siriwardena, Indika; (5)Wickramasinghe, Aravinda; (6)Arumapperuma, Prasantha; (7)Uddin, Shahadat; (8)Thow, Anne Marie.</footnote>

<footnote>(1)MBBS. MSc. MD. PGCert. Consultant Community Physician.</footnote>

<footnote>Family Health Bureau. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (2)MBBS. MSc.</footnote>

<footnote>MD. Professor in Community Medicine. Faculty of Medicine.</footnote>

<footnote>University of Colombo. Colombo. Sri Lanka.; (3)MBBS. MSc. MD.</footnote>

<footnote>Consultant Community Physician. Family Health Bureau. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (4)BSc. MEcon. Senior Scientist. Ministry of Technology and Research. Colombo. Sri Lanka.; (5)MBBS. MSc. Medical Officer.</footnote>

<footnote>Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (6)MBBS. MSc. Medical Officer. Epidemiology Unit. Ministry of Health, Nutrition and Indigenous Medicine.</footnote>

<footnote>Colombo. Sri Lanka.; (7)PhD. Lecturer. Complex Systems Research Group & Project Management Programme. School of Civil Engineering. University of Sydney. Sydney. Australia.; (8)BSc. MPP. PhD. Senior Lecturer. Menzies Centre for Health Policy. School of Public Health. University of Sydney. Sydney. Australia.</footnote>

<footnote>(1)Kana Sop, Marie Modestine; (2)Mananga, Marlyne-Josephine;</footnote>

<footnote>(3)Nolla, Nicolas Polycarpes.</footnote>

<footnote>(1)University of Douala. Faculty of Science. Department of Biochemistry. Douala.; (2)PhD. Biochemist/Nutritionist.</footnote>

<footnote>Department of Biochemistry Faculty of Science. University of Yaoundé I. Youndé. Cameroon.; (3)PhD. Biocmemist/Nutritionist.</footnote>

<footnote>Department of Biochemistry. Faculty of Science. University of Douala. Cameroon.</footnote>
the socio-economic and demographic status of mothers. Statistical analyses were done using ENA Smart and SPSS software

**Results:** With BMI classification of mothers according to WHO criteria, 3.38 %, 55.40 %, and 42.22 % of the mothers were underweight, normal and overweight respectively. For the children, from Z-scores, 2.6 %, 10 %, and 42.22 % were wasted, underweight and stunted respectively. Very low rate of exclusive breastfeeding (3.54%) before 6 months, early complementary feeding were observed. The most frequents consumed food were cereals and tubers whose nutrients are poorly bioavailable. The daily proteins, minerals, vitamins, were generally poor

**Conclusions:** In Bangang rural community, many the high rate of malnutrition was linked to lack of knowledge, inappropriate breastfeeding and complementary feeding practices, poor access to health infrastructure, illiteracy and poverty. Hence, effective mother's nutrition education should be implemented to improve good feeding practices and then, reduce malnutrition

**Keywords:** Nutritional status, children, feeding practices, mothers, Cameroon

**Background and objectives:** MMR in Banggai district (2014) is relatively high (279/100.000) compare to thenational target 2015 (102/100.000). Stunting is also high, 36,8% based on Basic Health Research (2013), as well as low birth weight baby (LBW) that reach 164 cases (2015). Root cause for all these problem is malnutrition in the first 1000 days of life especially in pregnancy. One of the program to improve the nutrition status of pregnant is the improvement of the nutritional and health status of women pre-conception through Integrated Health Post (Posyandu) for pre-conception women (PcW).

**Methods:** The program started at the beginning of January 2015, by organizing national seminar and workshop inviting prominent scholars and stakeholders in the field to share their knowledge and experiences. The output of the seminar and workshop is the commitment of local government and stakeholders to support the SUN Program. We visited mutlisector office and public

health center (Puskesmas) to do socialization. A pilot project was initiated in the village namely Padangon, and we launched Posyandu for PcW in every village. Program started with health and nutrition classes for bridegroom. After that, all the bride included as a member of the Posyandu for PcW. In Posyandu, we did counseling on health reproduction, nutrition education, check up of BMI, HB concentration, upper arm circumference (UAC), and blood pressure, and delivering multi micronutrient (MMN) supplement. To analyze the result, we compare data before and after program implementation from facility report.

**Results:** From the beginning of the program until the end of 2016: MMR decreased from 13 become 7 cases; LBW from 164 to 138 cases; prevalence of chronic energy deficiency of PcW (UAC < 23 cm) from 23.5% to 12% and anemia prevalence of PcW decreased from 56% to 38%.

**Conclusions:** Preconception care offers great opportunities to improve nutrition status, prevent anemia, reduced maternal mortality, and low birth weight baby. It's important to implement the preconception care as part of maternal and child health and nutrition program in SUN Movement. It takes a strong commitment from local leaders.

**Keywords:** Preconception, SUN, MMR, LBW, anemia, local leader

**Conflict of Interest Disclosure:** Research Asisstant

**Further collaborators:** Stakeholder and Research Collaboration

<footnote>(1)Razak Thaha, Abdul; (2)Yatim, Herwin; (3)Labolo, Mustar; (4)Tongko, Ramli; (5)Rahmat, Rusdi; (6)Rahmat, Rusdi; (6)Wayan Suartika, I;</footnote>

<footnote>(7)Monoarfa, Yustiyanty; (8)S. Otoluwa, Anang.</footnote>

<footnote>(1)Prof. Department Nutrition of Science. Faculty of Public Health. Hasanuddin University.; (2)Regent of Banggai District. Indonesia.;</footnote>

<footnote>(3)Vice Regent of Banggai District. Indonesia; (4)Head of Banggai District Planning. Development, and Training Board. Indonesia.;</footnote>

<footnote>(5)Head of Banggai District Food Security Board. Indonesia.; (6)Head of Banggai District Women Empowering and Child Protection Office. Indonesia.; (7)PhD Student in Airlangga University. Indonesia; (8)Head of Banggai District Health Office. Indonesia.</footnote>
POLYUNSATURATED FATTY ACIDS TRANSFER ACROSS THE PLACENTA WAS LOWER IN OBESE COMPARED TO NORMAL WEIGHT PREGNANT WOMEN

(1)Gázquez, Antonio; (2)Ruiz-Palacios, María; (3)Prieto-Sánchez, María Teresa; (4)García-Hernández, Carmen María; (3)Blanco-Carnero, José Eliseo; (5)Schierbeek, Henk; (6)van Goudoever, Johannes B; (7)Demmelmair, Hans; (8)Koletzko, Berthold; (9)Larqué, Elvira.

(1)MSc. Biologist. Ludwig-Maximilians-Universität Munich. Division of Metabolic and Nutritional Medicine. Dr. von Hauner Children's Hospital. Munich. Germany; (2)PhD. Biologist. Department of Physiology. School of Biology. Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU). University Clinical Hospital "Virgen de la Arrixaca". University of Murcia. Murcia. Spain.; (3)MD. PhD. Gynecologist. Obstetrics and Gynecology Service. Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU). University Clinical Hospital "Virgen de la Arrixaca". University of Murcia, Murcia. Spain.; (4)BSc. Gynecologist. Obstetrics and Gynecology Service. Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU). University Clinical Hospital "Virgen de la Arrixaca". University of Murcia. Murcia. Spain.; (5)PhD. Clinical Chemist. Department of Paediatrics. Emma Children's Hospital. Free University of Amsterdam. Amsterdam. Netherlands.; (6)MD, PhD. Professor of Paediatrics. Emma Children's Hospital. Free University of Amsterdam. Amsterdam. Netherlands. Department of Paediatrics. Free University of Amsterdam. Amsterdam. Netherlands.; (7)PhD. Engineer. Ludwig-Maximilians-Universität Munich. Division of Metabolic and Nutritional Medicine. Dr. von Hauner Children's Hospital. Munich. Germany.; (8)MD, PhD. Professor of Paediatrics. Ludwig-Maximilians-Universität Munich. Division of Metabolic and Nutritional Medicine. Dr. von Hauner Children's Hospital. Munich. Germany.; (9)PhD. Professor of Physiology. Department of Physiology. School of Biology. Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU). University Clinical Hospital "Virgen de la Arrixaca". University of Murcia, Murcia. Spain.

**Background and objectives:** The incidence of obesity during pregnancy is increasing. Early programming of obesity could take place since very early stages of life, even during gestation. However, little is known about the mechanisms involved in this process. Our aim was to investigate the in vivo metabolism and placental transfer of fatty acids (FA) labelled with stable isotopes across the placenta in obese and normal weight pregnant women.

**Methods:** 10 controls (BMI 20-25kg/m2) and 10 obese pregnant women (BMI >30kg/m2) received orally, 12h before elective caesarean section, 0.05mg/kg 13C-oleic acid (13C-OA), 0.05mg/kg 13C-linoleic acid (13C-LA) and 0.01mg/kg 13C-docosahexaenoic acid (13C-DHA). Maternal blood was collected at -8h, -4h, -2h and at time of caesarean section; placental tissue and cord blood were also collected at delivery. VLDL, LDL and HDL were isolated by ultracentrifugation. Lipid fractions from serum and placenta were isolated by thing layer chromatography. All samples

were analysed for 13C enrichment by gas chromatography com-
bustion isotope ratio mass spectrometry (GC-C-IRMS).

**Results:** Both maternal serum triglycerides and cholesterol levels were similar in obese and normal weight pregnant women. Maternal insulin, placental weight and cord glucose tended to higher values in the obese group (n.s.). Both DHA and LA were significantly higher in plasma non-esterified fatty acids in obese vs. normal weight women (LA: 1.19±0.16% vs. 0.83±0.08%, P=0.058, DHA: 0.18±0.04% vs. 0.09±0.01%, P=0.046). HDL and LDL lipoproteins showed higher enrichment of LA and especially of DHA in the obese group, which may affect placental uptake of these FA. Tracer concentrations in total lipids of placenta were similar in both groups. However, the FA transfer to the fetus, evaluated by the ratio between cord and maternal 13C-FA plasma concentrations, was lower in obese women compared to controls, with a significant difference for LA (0.25±0.03% vs. 0.39±0.06%, P=0.04).

**Conclusions:** The materno-fetal placental fatty acid transfer of LA and DHA is lower in obese pregnant women without hyperlipidemia than in women with normal body weight.

**Keywords:** lipids, tracer study, mass spectrometry, docosahexaenoic acid, pregnancy

**Further collaborators:** The authors thank Dewi van Harskamp and Efraim Oosterink for their help with the analysis of samples and Dr. Anibal Nieto for subject's recruitment.

Financial support: This study was supported by the European Union's 7th Framework Programme Early Nutrition project (grant agreement No. 289346), the European Research Council Advanced Grant META-GROWTH (ERC-2012-AdG 322605), and the Excellence Network for Maternal and Child Health and Development (RED SAMID III, RD 16/0022/0009).

SCALING UP REVITALIZED BABY FRIENDLY HOS-
PITAL INITIATIVE: DAY OF BIRTH TO 24 MONTHS
- MALAWI CASE STUDY

(1)Nyaku, Albertha; (2)Guta, Janet; (3)Straubinger, Sarah; (4)Bwanali, Florence.

(1)MPH. Nutrition Team Lead. Maternal and Child Survival Project. PATH. Washington DC. USA; (2)MSC. Deputy Director. Ministry of Health. Lilongwe. Malawi; (3)BA. Program Coordinator. Maternal and Child Survival Project. PATH. Washington DC. USA; (4)BA. Nutrition Advisor. Maternal and Child Survival Project. Lilongwe. Malawi.

**Background and objectives:** Malawi 2016 DHS indicates a 10% decline in exclusive breastfeeding (EBF) and 37% of children under 5 are stunted. Only 31% of children under 2 years who had diarrhoea were breastfed. The Baby Friendly Hospital Initiative (BFHI) initiated in 1993 had collapsed since 2005. With limited tools and training, health providers aren't able to effectively support mothers, track and refer children under 2 years who are not thriving nutritionally.

Building on the ongoing scale-up of BFHI, the Maternal and Child Survival Program (MCSP), worked with the Ministry of
Health in collaboration with the World Health Organization in more than 20 districts, reaching over 1000 health workers to revitalize and scale up BFHI. Main objective: through effective integration along the continuum of care (COC), improve rates of early initiation of breastfeeding, EBF and timely complementary feeding at six months.

**Methods:** Designed and implemented an innovative package of interventions that optimized opportunities to strengthen and integrate along CoC at three main levels: 1) district health management teams plan, budget and implement, 2) sustainable on-site mentoring of health facilities to integrate BFHI into CoC of maternal, newborn and child health services including continuous assessment, and 3) operationalization of the community infant and child tracking system linked to health facilities. Data along the value chain of the CoC linked to the District Health Information System.

**Results:** Over 60% increase in early initiation of BF (2015-2016). More than 1000 health workers and over 1000 village volunteers have been trained whilst nearly 200 high volume health facilities and hospitals have been revitalized and operational in BFHI. Functioning linkages established between new mothers and trained community counsellors including new tools for messaging on the benefits of breastfeeding and sustaining behaviour for EBF and timely complementary feeding. Referral kits in use for tracking infants and children who are failing to breastfeed and not thriving nutritionally.

**Conclusions:** Globally BFHI continues to experience many challenges, which has resulted in slow scale-up. However, the Malawi case study demonstrates that scale-up and sustainability can be achieved using the systems strengthening along the continuum of care and community linkages approach.

**Keywords:** BFHI, Breastfeeding, Sustainable, Innovation, Thriving

**Further collaborators:** Ministry of Health Malawi. World Health Organization. USAID. Maternal and Child Survival Project. JHPIEGO. PATH.

has nutrition specific and sensitive components as well as a robust monitoring system that includes representative surveys every four months, measuring a range of indicators, including Minimum Acceptable Diet (MAD) and Minimum Dietary Diversity (MDD) for children 6-23 months of age. Currently, early warning systems to detect vulnerability to food insecurity and malnutrition rely primarily on household food security indicators. Nutrition indicators, such as MAD or MDD, if sufficiently sensitive to dietary changes, have potential to enhance such systems through capture of vulnerable household members' nutrition information.

The objective is to explore the sensitivity of MAD and MDD to predictable changes based on Malawi's seasonal calendar to inform design of early warning surveillance systems.

**Methods:** WFP analysed data from the representative surveys conducted in the programme district from 2015 to present. MAD and MDD measured at different times of the year were compared to the agricultural seasons (January (lean season), May (harvest), September (post-harvest)). IBM SPSS (v 20.0) was used to generate contingency table chi-square test ($\alpha=0.05$).

**Results:** Monitoring activities revealed that MAD and MDD changed in a predictable manner with the agricultural seasons across a 24-month period. In 2015, values for MAD were lowest during the lean season, highest during harvest, and intermediate post-harvest (10% vs 28% vs 14%; $p<0.05$). Values for MDD were also lowest during the lean season, highest during harvest, and intermediate post-harvest (12% vs 34% vs 20%; $p<0.05$). The same patterns were found in 2016 and 2017.

**Conclusions:** The regularly conducted surveys revealed that the two key nutrition indicators were sensitive to predictable changes in seasons. These findings suggest that MAD and MDD could be useful as early warning indicators in food security and nutrition surveillance systems.

**Keywords:** Minimum Acceptable Diet (MAD), Malawi, seasonality, stunting prevention, early warning

**Conflict of Interest Disclosure:** As a part of this SUN Stunting prevention programme in Malawi, Ntchisi district, World Food Programme collects trimesterly monitoring surveys where Minimum Acceptable Diet and Minimum Dietary Diversity indicators are assessed.

<footnote>(1)Farhikhtah, Arghanoon; (2)Aburto, Nancy; (3)Mlambo, Trust;</footnote>

<footnote>(4)Dinucci, Alessandro; (5)Nyirenda, Jason.</footnote>

<footnote>(1)MSc. RD. UN World Food Programme. Nutrition Division. Rome. Italy.; (2)MSc. Phd. Nutritionist. Nutrition Division. UN World Food Programme. Rome. Italy.; (3)MPH. Nutritionist. Nutrition Unit. UN World Food Programme. Lilongwe. Malawi; (4)MA. MSc. Nutrition Division. UN World Food Programme. Rome. Italy.; (5)MSc. Nutrition Unit. UN World Food Programme. Lilongwe. Malawi.</footnote>
## FOOD CONSUMPTION PROFILE AND PHYSICAL ACTIVITY IN CHILDREN AT PRESCHOOL CARED AT HEALTH SCHOOL CENTER BUTANTÃ/ COLLEGE OF MEDICINE UNIVERSITY OF SÃO PAULO

**Background and objectives:** Healthy dietary behavior formation along the period of preschool consists with the prevention of childhood obesity.

1. Check the risk of prevalence for overweight at preschool children cared at Pediatric nutrition clinic in the Health School Center Butantã

2. Check the food consumption profile of the preschool children

3. Compare the dietary frequency consume of the preschool children with the risk for overweight and weight excess in eutrophic children.

**Methods:** Studied Population: Preschool children attended at pediatric service care at Health School Center Butantã in which mothers accepted the participation of the attendance at the Pediatric nutrition clinic (N=69).

Measures and evaluations: weight, height. Evaluation of the nutritional profile based on standards of the World Health Organization; evaluation of the dietary intake by the dietary frequency questionnaire.

**Statistical Analysis:** frequency, measures and X²; analysis performed by SPSS® Software.

**Results:** The average age of the group is 2.53 years (+1.38), with 49.3% of girls and 50.7% of boys. The percentage of preschool children with overweight risk was 23.2% and the unhealthy food with the highest frequency intake by the children was: fruit yogurt, which in 50.1% consumes two to four times per week, and biscuits without filling are consumed by 50.5% two to four times per week. The amount of hours spent in front of the TV was 2.07 hours (+2.13).

At the analysis of the groups the intake of meat and chicken cheeseburger (one time per week, p=0,05); fermented milk (two to four times per week, p=0,001); sausages (two to four times per week, p=0,002) were more frequent in risk and excess groups than in eutrophic groups.

**Conclusions:** The prevalence of overweight risk in preschool children was 23.2%.

The unhealthy foods most consumed by preschool children with overweight risk were fruit yogurt and biscuit without filling.

The intake of cheeseburger, fermented milk and sausages were significantly higher in groups of children with excess and overweight risk than in eutrophic children.

**Keywords:** weight excess, pre-schools, unhealthy habits

## INFLAMMATION AND METABOLIC HEALTH BY BODY MASS INDEX IN EUROPEAN ADOLESCENTS: THE HELENA STUDY

**Background and objectives:** Inflammation may influence the cardio-metabolic profile which relates with the risk of chronic diseases. Thus, the objectives are: to assess the inflammatory status by metabolic health/body mass index (BMI) category and to assess how inflammation can predict the cardio-metabolic profile in European adolescents, considering BMI.

**Methods:** 659 adolescents (295 boys) from a cross-sectional European study were included. Adolescents were classified by metabolic health based on age- and sex-specific cut-off points for glucose, blood pressure, triglycerides, high density cholesterol and BMI. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors (C3, C4) and cell adhesion molecules were assessed.

**Results:** Metabolically abnormal (MA) adolescents had higher values of C3 (p<0.001) and C4 (p=0.032) compared to those metabolically healthy (MH). C3 concentrations significantly increased with the deterioration of the metabolic health and BMI (p<0.001). Adolescents with higher values of CRP had higher probability of being in the overweight/obese-MH group than those allocated in

<footnote>(¹)Prado de Lima Ramos, Bianca; (¹)Tomaz Cabral Ribas Martins, Bruna;</footnote>

<footnote>(¹)Guimarães de Angelis, Karina; (¹)Kupper Lima, Victoria; (²)Harumi Miranda Omori, Luciana; (³)Bechere Fernandes, Maria Teresa.</footnote>

<footnote>(¹)Student. Nutritionist. Faculdade de Saúde Pública da Universidade de São Paulo. Brazil; (²)MD. Faculdade de Medicina da Universidade de São Paulo. Brazil; (³)PhD. MD. Faculdade de Medicina da Universidade de São Paulo. Brazil.</footnote>

<footnote>(¹)González Gil, Esther; (²)Cadenas-Sanchez, Cristina;</footnote>

<footnote>(³)Santabárbara, Javier; (⁴)Bueno-Lozano, Gloria; (⁵)Iglesia, Iris;</footnote>

<footnote>(⁶)González-Gross, Marcela; (⁷)Molnar, Denes; (⁸)Gottrand, Frédéric;</footnote>

<footnote>(⁹)Ortega, Francisco B.; (¹⁰)Moreno, Luis A.</footnote>

<footnote>(¹)PhD student. Nutritionist. Growth, Exercise, Nutrition and Development research group. University of Zaragoza. Zaragoza. Spain; (²)MSc. PROFITH "PROmoting FITness and Health through physical activity" research group. Department of Physical Education and Sport. Faculty of Sport Sciences.University of Granad. Spain; (³)PhD. Department of Preventive Medicine and Public Health. University of Zaragoza. Zaragoza. Spain.; (⁴)PhD. Service of Pediatrics. Hospital Clínico Universitario "Lozano Blesa". Zaragoza. Spain.; (⁵)MSc. GENUD "Growth, Exercise, NUtrition and Development" Research Group. Faculty of Health Sciences. Universidad de Zaragoza. 9MSc. Instituto Agroalimentario de Aragón (IA2). 10MSc. Instituto de Investigación Sanitaria Aragón (IIS Aragón). Spain; (⁶)PhD. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn). PhD. ImFine Research Group. Facultad de Ciencias de la Actividad Física y del Deporte-INEF. Universidad Politécnica de Madrid. Madrid; (⁷)PhD. Department of Pediatrics. University of Pecs. Pecs. Hungary; (⁸)Phd. Univ Lille 2, INSERM U995. CHU-Lille. France.; (⁹)PhD. PROFITH "PROmoting FITness and Health through physical activity" research group. Department of Physical Education and Sport. Faculty of Sport Sciences.University of Granada. Spain.; (¹⁰)PhD. GENUD "Growth, Exercise, NUtrition and Development" Research Group. Faculty of Health Sciences. Universidad de Zaragoza. Spain. 19PhD. Instituto Agroalimentario de Aragón (IA2). PhD. Instituto de Investigación Sanitaria Aragón (IIS Aragón). Spain.</footnote>
other categories. Finally, high C3 and C4 concentrations increased
the probability of having an unfavorable metabolic/BMI status.

**Conclusions:** Metabolic/BMI status and inflammatory bio-
markers are associated, being the CRP, C3 and C4 the most related
inflammatory markers with this condition. C3 and C4 were asso-
ciated with the cardio-metabolic health consistently.

**Keywords:** Inflammation, metabolic health, metabolic syn-
drome, inflammatory biomarkers, adolescents.

**Further collaborators:** Stefaan De Henauw (PhD. Department of Public Health. Ghent University. Ghent. Belgium), Antonios Kafatos (PhD. Preventive Medicine and Nutrition Unit. School of Medicine. University of Crete. Crete. Greece.), Kurt Widhalm (PhD. Department of Pediatrics. Division of Clinical Nutrition. Medical University of Vienna. Vienna. Austria), Yannis Manios (phd.Department of Nutrition and Dietetics. Harokopio University. Athens. Greece.), Alfonso Siani (Phd Unit of Epidemiology and Population Genetics. Institute of Food Sciences. National Research Council. Avellino, Italy.), Francisco Amaro-Gahete (phd.Department of Medical Physiology. School of Medicine. University of Granada. Granada. Spain.), David Cañada (phd. ImFine Research Group. Facultad de Ciencias de la Actividad Física y del Deporte-INEF. Universidad Politécnica de Madrid. Madrid), Laura Censi (PhD. CREA (Council for Agricultural Research and Economics) - Research Center for Food and Nutrition. Rome. Italy.), Mathilde Kersting (Phd. Research Institute of Child Nutrition. Rheinische Friedrich-Wilhelms-University Bonn. Dortmund. Germany.), Jean Dallongeville (Phd. INSERM U1167. Institut Pasteur de Lille. Lille. France.), Ascensión Marcos (Phd. Immunonutrition Group, Institute of Food Science. Technology and Nutrition. (ICTAN). Spanish National Research Council (CSIC). Madrid, Spain.)

mg iron, 0.4g folic-acid) initiated as early as possible and contin-
ued throughout pregnancy for all adolescent and adult women to
prevent anemia and poor birth outcomes. Despite the benefits of
maternal IFA supplementation, many low- and middle-income
countries continue to face high anemia rates. Unfortunately, low
coverage of these programs remains a problem due to lack of
supplies, late or no attendance to antenatal care (ANC) and de-
mand-side issues. Community-based distribution (CBD) of IFA
may aid with supply and/or access issues. A literature review of
CBD of IFA in low and middle income (LMIC) countries was con-
ducted to understand how to improve coverage and utilization for
pregnant women and young girls at the community level.

**Methods:** An extensive review of peer-reviewed and grey litera-
ture of CBD of IFA supplementation for pregnant women, girls and
women of reproductive age in low and middle income countries was
conducted. Authors reviewed and screened titles and abstracts. A
final pool of 26 articles was included in this review. Components of
program implementation including cadre of health worker, supply
and demand issues, and coverage were reviewed.

**Results:** CBD programs had moderate success with midwives, and community health workers who counseled on health benefits and compliance with IFA supplementation. CHWs were more likely to identify and reach a greater number of women earlier in pregnancy, as women presented late to ANC. CBD channels had greater consistency in terms of adequate supplies of IFA in comparison to clinics and vendors, who faced stock-outs. Targeting women of reproductive age through school and community settings showed high compliance and demonstrated reductions in anemia.

**Conclusions:** CBD of IFA can be a valuable platform for increas-
ing access and coverage of IFA supplementation.

**Keywords:** anemia, iron folic-acid supplementation, community distribution, pregnant women, girls

**Background and objectives:** Globally, anemia affects 29% of pregnant women and 38% of non-pregnant women. Anemia puts women at greater risk of mortality, morbidity, postpartum hemorrhage, and poor birth outcomes, including preterm births and low birth weight. The World Health Organization (WHO) recommends daily iron-folic acid (IFA) supplementation (30-60

<footnote>(1)Kavle, Justine; (2)Landry, Megan; (3)Gottwalt, Allison.</footnote>

<footnote>(1)PhD. Senior Nutrition Advisor. Maternal Newborn Child Health and Nutrition Division. Maternal and Child Survival Program (MCSP)/ PATH. USA.; (2)PhD. Consultant and Adjunct Faculty. Department of Prevention and Community Health, Milken Institute of Public Health. George Washington University. USA.; (3)MPH. Program Assistant. Maternal Newborn Child Health and Nutrition Division. Maternal and Child Survival Program/ PATH. USA.</footnote>
# TIMING OF INITIATION OF BREASTFEEDING AND EARLY-NEWBORN SEPSIS: EVIDENCE FROM RU-RAL BANGLADESH

(1)Raihana, Shahreen; (2)Rahman, Mohammad Masudur; (3)Tahsina, Tazeen; (4)Rahman, Qazi Sadeq-ur; (5)Islam, Sajia; (6)Huda, Tanvir Mahmudul; (7)Arifeen, Shams El; (8)Dibley, Michael.

(1)Research Investigator.MPhrm. MPH. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b). Bangladesh; (2)Senior Research Investigator. MBBS. MHE. MPS. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research. Bangladesh (icddr,b). Bangladesh; (3)Senior Research Investigator. MBBS. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b). Bangladesh; (4)Senior IT Development Specialist. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b). Bangladesh; (5)Research Investigator. MPH. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (6)Research Associate and PhD Candidate. Sydney School of Public Health. Sydney Medical School. The University Of Sydney. Australia; (7)PhD. Senior Director and Senior Scientist. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (8)Professor in Global Public Health Nutrition. Sydney School of Public Health. Sydney Medical School. The University Of Sydney. Australia.

**Background and objectives:** In Bangladesh, neonatal deaths decreased by 46% during 1990-2014. However, it remains high (28.0/1000 live-births), with early-neonatal deaths (19.3/1000) contributing over 65% of neonatal deaths. Neonatal sepsis is the cause of 24% neonatal deaths, while only 36% women start to breastfeed their newborn within 1st hour of birth. Early initiation of breastfeeding has a positive impact on neonatal health.

We aim to explore the effect of timing of breastfeeding initiation on early-newborn sepsis in rural Bangladesh.

**Methods:** We used data from a large community based trial in Bangladesh where pregnant women were enrolled from 2013-2015 covering 30,646 newborns. Sepsis was defined using neonatal danger signs reported by "The Young-Infants Clinical Science Study Group". Timing of initiation of breastfeeding was categorized as within 1hr, 1-24 hr,24-48hr, and more than 48hr of birth. Analysis includes descriptive statistics, risk attribution and binomial logistic-regression while adjusting for clustering effects of the trial design, and other maternal and infant characteristics.

**Results:** 29,172 live-births had information on initiation of breastfeeding. Of these, 4,121(14.1%) neonates had signs of sepsis till 7th day after birth. Two-thirds of the newborns [68.3%, (n=19,913)] had breastfeeding initiated within 1hr of birth. Mean time to initiation was 3.8hrs and by the end of 48hrs all but 3.5% neonates were breastfed. Breastfeeding within first hour was lower among women who delivered through caesarean section [46.5% vs 72.8%, (p<0.05)]. The incidence of sepsis increased as

initiation of breastfeeding was delayed from 1hr (12.0%), 24hrs (15.7%), 48 hrs (27.7%) to more than 48hrs (36.7%) after birth. Overall, initiation after 1hr, 24hrs and 48hrs were associated with 6.8%, 20.4% and 23.4% higher attributable risk of having sepsis compared to those who initiated within 1hr, 24hrs and 48hrs respectively. Initiating breastfeeding after 1st hour significantly increases risk of having signs of sepsis during the first 7 days [1-24hr: OR=1.37(95%,CI:1.25-1.50); 24-48hr: OR=2.84(95%,-CI:2.29-3.50); ≥48hr: OR=4.21(95%,CI:3.55-5.00)].

**Conclusions:** Findings indicate that timing of initiation of breastfeeding, especially within the first hour of birth, has significant protective effect on early-newborn sepsis. Tailored community-based intervention to promote initiation of breastfeeding within first hour of birth will help to reduce neonatal sepsis leading to neonatal deaths.

**Keywords:** Early breastfeeding, neonatal sepsis, maternal characteristics, infant, live-birth

# DIETARY CONSUMPTION AND IRON DEFICIENCY ANEMIA IN INFANTS AGED 18-24 MONTHS

(1)Bouchenak, Malika; (2)Hadj Kadi, Amira; (3)Dida, Nawal;

(2)Benadouda, Soraya; (2)Hamous, Amina; (4)Saadelhachemi, Houria;

(5)Ghomari, Hanane; (4)Hachelaf, Wahiba; (6)Boureghda, Imad;

(7)Bouziane Nedjadi, Karim.

(1)PhD. Laboratoire de Nutrition Clinique et Métabolique. Algeria;

(2)MSc. Laboratoire de Nutrition Clinique et Métabolique. Université d'Oran1 Ahmed Ben Bella. Algeria; (3)PhD. Laboratoire de Nutrition Clinique et Métabolique. Université d'Oran1

Ahmed Ben Bella. Algeria; (4)MSc. Clinique A. Cabral. CHU Oran. Algeria;

(5)MD. Laboratoire de Nutrition Clinique et Métabolique. Université d'Oran1 Ahmed Ben Bella. Algeria; (6)MD. Danone

Nutricia ELN, Alger.; (7)PhD. Clinique A. Cabral. CHU Oran. Algeria.

**Background and objectives:** Iron deficiency (ID) is one of the most widespread nutritional disorders in both developing and industrialized countries, making it a global public health concern. ID and iron deficiency anemia (IDA), during the first years of life, are associated with impaired cognitive function and decreased motor activity. The major cause of micronutrient malnutrition is a diet consisting mainly of staple foods and lacking in animal sources. The aim of this study was to evaluate dietary consumption in infants with IDA or not

**Methods:** Infants (n=130, B/G: 72/58), aged 21±5 months, were recruited in three pediatric consultation and immunization centers of Oran. Dietary consumption, by the "24H recall" followed by 3 days record, was evaluated. Fresh blood count, plasma ferritin, and soluble receptors of transferrin (RsTf) were measured.

**Results:** Body mass index was 17±3 in infants, with 14% underweight, 25% overweight, and 15% obesity. Iron deficiency was defined according to several models: 22% met model criteria of ferritin<12µg/L and 73% with low ferritin or high RsTf or low mean corpuscular volume (MCV). IDA (Hb<11g/dL) was present in 48% of Infants (B/G: 35/27) with low MCV (<70µ3) compared to infants
without IDA (p<0.001). There was no significant difference in di-
etary consumption between infants with IDA or not. Total energy
intake (TEI) represented 909±230 vs 961±273Kcal/d) but differed
to recommended values (900Kcal/d).3 Intakes of proteins (12%)
and carbohydrates (57%) were high, while that of lipids (31%) was
decreased, compared to recommendations. 4 Qualitatively, animal
proteins (74%), simple carbohydrates (49%) and saturated fatty ac-
ids (SFA) (51%) were high, compared to recommendations. Dietary
iron consumption (5.6±3mg) was reduced compared to recom-
mended value (7mg), showing that 81% of infants were deficient.

**Conclusions:** Dietary imbalance is probably at the origin of some micronutrients deficiencies, in particular iron leading anemia in half of infants. It is necessary to sensitize mothers to well monitoring and diversifying feeding of their infants, thus ensuring dietary balance for their growth and development.

1Detzel P., Wieser S. Annals Nutr 2015:66(Suppl 2):35-42.

2Jáuregui-Lobera. Dove Medical Press. 2014;10:2087-95.

3Martin et al. Tec & Doc 2001 ; 605: 255-91.

4https://www.anses.fr/fr/system/files/NUT2006sa0359.pdf

**Keywords:** Infants - Dietary consumption - Iron deficiency Anemia - Ferritin - RsTf

**Further collaborators:** SAIDANI Hidayet. MSc1, SOUALI Ahlem. MSc1, Université d'Oran Ahmed Ben Bella.

SMAHI SED. PhD. CHU-Tlemcen-Algeria

144/1672

INITIATION OF BREASTFEEDING AND MORTALITY RISK FOR NEWBORN IN RURAL BANGLADESH

(1)Rahman, Mohammad Masudur; (2)Raihana, Shahreen; (3)Tahsina, Tazeen; (4)Rahman, Qazi Sadeq-ur; (5)Islam, Sajia; (6)Huda, Tanvir Mahmudul; (7)Arifeen, Shams El; (8)Dibley, Michael.

(1)Senior Research Investigator.MBBS.MHE.MPS. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (2)Research Investigator. MPHrm. MPH. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (3)Senior Research Investigator. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (4)Senior IT Development Specialist. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (5)Research Investigator. MPH. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (6)Research Associate and PhD Candidate. Sydney School of Public Health. Sydney Medical School. The University Of Sydney. Australia; (7)PhD. Senior Director and Senior Scientist. Maternal and Child Health Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Bangladesh; (8)Professor in Global Public Health Nutrition. Sydney School of Public Health. Sydney Medical School, The University Of Sydney. Australia.

**Background and objectives:** The average annual rate of reduction of neonatal mortality is 2.6% and neonatal mortality

contributes about 61% of under-five mortality in Bangladesh. Ev-
idence has shown that early initiation of breastfeeding has a posi-
tive impact on neonatal health and survival. Although, the major-
ity of Bangladeshi mothers breastfeed their infants till 23 months
of life, initiation of breastfeeding in the 1st hour of life is only 36%.

We aim to explore the effect of timing of initiation of breast-
feeding on cause specific neonatal mortality in rural Bangladesh.

**Methods:** We collected data from a large community based trial in Bangladesh during July 2013 till March 2015, which covered 30,646 live births. Primary outcome is the number of breast-fed neonates. Neonates who died within 48 hours of birth were excluded from analysis to reduce reverse causality. Timing of initiation of breastfeeding is categorized as- within 1hr, 1-24 hr, 24-48hr, and more than 48hr of birth. Our analysis includes descriptive statistics and binomial logistic regression while adjusting for clustering effect of the trial design. Verbal autopsies were used to ascertain cause of death.

**Results:** 244 newborns died between 2-28 days of birth giving a mortality rate of 8.5/1,000 live-births. We excluded 501 neonates who died before day 2, as they may have been too sick for early initiation of breastfeeding. More than half of the infants [68.3%, (n=19,805)] started breastfeeding within 1hr of birth. Neonatal deaths were higher among children for whom breastfeeding was initiated after an hour of birth (10.1 vs 7.6/1000 live-births, p<0.05). Compared with those fed within the first hour after birth, risk of mortality was 1.0 [(95%,CI: 0.69 to 1.45)], and 2.37 [(95%,CI: 1.26 to 4.45)] times higher among newborns first breast-fed within 24hrs and 48hrs of birth respectively. Newborns who initiated breastfeeding within 24-48hrs had a higher risk of death (RR=2.37 (95%,CI:1.26 to 4.45), after adjusting for birth-weight, gestational age and parity compared to newborns who were breastfeed within 1hr.

**Conclusions:** Our findings highlight the importance of breast-
feeding for reduction of neonatal mortality. Promoting need for ear-
ly initiation of breastfeeding through community-based interven-
tions may have potential to significantly reduce neonatal mortality.

**Keywords:** Early-breastfeeding, neonatal health, mortality, birth-weight, gestational age
## INFANT AND YOUNG CHILD FEEDING PROGRAMMES IN SRI LANKA: THE POLICY LANDSCAPE

(1)Godakandage, Sanjeeva; (2)Senarath, Upul; (3)Jayawickrama, Hiranya; (4)Siriwardena, Indika; (5)Wickramasinghe, Aravinda; (6)Arumapperuma, Prasantha; (7)Thow, Anne Marie.

(1)MBBS. MSC. MD. PGCert. Consultant Community Physician. Family Health Bureau. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (2)MBBS. MSc. MD. Professor in Community Medicine. Faculty of Medicine. University of Colombo. Colombo. Sri Lanka.; (3)MBBS. MSc. MD. Consultant Community Physician. Family Health Bureau. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (4)BSc. MEcon. Senior Scientist. Ministry of Technology and Research. Colombo. Sri Lanka.; (5)MBBS. MSc. Medical Officer. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (6)MBBS. MSC. Medical Officer. Epidemiology Unit. Ministry of Health, Nutrition and Indigenous Medicine. Colombo. Sri Lanka.; (7)BSc. MPP. PhD. Senior Lecturer. Menzies Centre for Health Policy. School of Public Health. University of Sydney. Sydney. Australia.

**Background and objectives:** Infant and young child feeding (IYCF) practices play a critical role in growth and development of children. A favourable environment supported by appropriate policies and positive contributions from all stakeholders are prerequisites for achieving optimal IYCF practices. As Sri Lanka has identified childhood malnutrition as a priority issue, this study aimed to assess the IYCF-related policy environment in Sri Lanka. This would help to identify opportunities to strengthen the policy environment to better support appropriate IYCF and reduce childhood malnutrition.

**Methods:** The research team mapped national level policy-related documents on IYCF across four selected domains of best-practice interventions. Mind mapping and causal analysis was used to identify relevant policy sectors and types. Documents were identified by searching government archives and websites, and through officials from Ministry of Health and other relevant Ministries. A matrix was designed to capture data from IYCF policy-related documents using a thematic approach, and a narrative synthesis of data from different documents was conducted.

**Results:** Twenty four policies and policy related documents were identified containing provisions in the areas of global recommendations for best-practice IYCF, marketing of breast milk substitutes, strengthening health and non-health systems, maternity benefits, inter-sectoral collaboration, capacity building, health education and supplementation. Twenty of them belonged to the health sector. Significant policy support for IYCF was evident across the four domains studied, i.e. general policy support, dissemination of evidence based information, capacity building of healthcare workers and enabling mothers/caregivers to engage with best-practice interventions.

On the other hand, there is no separate, written policy on IYCF in Sri Lanka, and it is not specifically mentioned in high level policy documents that demonstrates political will and strategic direction.

**Conclusions:** Globally accepted major evidence-based recommendations are covered in the policies and policy documents studied. This is in line with the findings of Gupta et al. (2013) of an assessment conducted in 40 countries, that Sri Lanka generally had good policy support for IYCF programmes.

In order to further improve, advocacy should be targeted towards strategic support for IYCF in high-level policy documents, and enhanced involvement of non-health sectors need to be explored.

**Keywords:** Infant and young child feeding, Nutrition policies, Sri Lanka

**Further collaborators**

DIBLEY Michael John
IHALAGAMA Sathya
NIMALAN Srisothinathan
ARCHCHUNA Ramanathan
UMESH Claudio

## NO DIFFERENCES BETWEEN THE INTAKES OF MACRO AND MICRONUTRIENTS IN PRESCHOOL CHILDREN, WITH AND WITHOUT EXCESS WEIGHT, CARED AT HEALTH SCHOOL CENTER BUTANTÃ/COLLEGE OF MEDICINE UNIVERSITY OF SÃO PAULO

(1)Tomaz Cabral Ribas Martins, Bruna; (1)Prado de Lima Ramos, Bianca;

(1)Guimarães de Angelis, Karina; (1)Kupper Lima, Victoria; (2)Harumi Miranda Omori, Luciana; (3)Bechere Fernandes, Maria Teresa.

(1)Student. Nutritionist. Faculdade de Saúde Pública da Universidade de São Paulo. Brazil.; (2)MD. Faculdade de Medicina da Universidade de São Paulo. Brazil.; (3)PhD. MD. Faculdade de Medicina da Universidade de São Paulo. Brazil.

**Background and objectives:** A deficit of micronutrients normally is associated with unhealthy dietary behaviors.

1. Check the food consumption profile of the preschool children cared at Pediatric nutrition clinic in the Health School Center Butantã,

2. Compare the dietary frequency consume (micro and macro-nutrients) of the preschool children with the risk for overweight, weight excess and eutrophic children.

**Methods:** Studied Population: Preschool children attended at pediatric service care at Health School Center Butantã in which mothers accepted the participation of the attendance at the Pediatric nutrition clinic (N=69).

**Measures and evaluations:** weight, height. Evaluation of the nutritional profile based on standards of the World Health Organization; evaluation of the dietary intake by the dietary frequency questionnaire.

**Statistical Analysis:** Averages and T student Test for independent samples; analysis preformed by SPSS® Software and AVANUTRI®.

**Results:** The average age of the group is 2.53 years (+1.38), with 49.3% of girls and 50.7% of boys. At the analysis of groups
it is not possible to observe significant differences between the
consumption of the studied macro and micronutrients. An av-
erage intake of proteins and sodium were revealed high, in the
two groups regarding to the references (IDRs, 2002). The intake
of protein and sodium, respectively, on the excess and overweight
risk group=79.4g/day(+38.4), 1.8g/day(+0.93) and eutrophic
group=73.4g/day(+41.5), 2.06g/day (+1.02). Still, the average in-
take of calcium was low in the two groups regarding the reference
above. The intake of calcium on the excess and overweight risk
group was 979.8mg/day(+814.2) and in the eutrophic group it was
759,6mg/day(+377.4).

**Conclusions:** The groups of risk, excess weight and eutrophic children exhibited similar macro and micronutrient consumption. The protein and sodium intake are higher than the references, and the calcium intake are discreetly lower at the preschool population, revealing the needing of orientation about healthy eating behaviors to the children.

**Keywords:** weight excess, pre- schools, micronutrients

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LIPIDOMIC ANALYSIS REVEALS THE SIGNIFICANT INCREASE OF DIACYLGLYCEROPHOSPHOCHOLINES IN UMBILICAL CORD BLOOD FROM PREGNANT WOMEN WITH GESTATIONAL HYPERCHOLESTEROLEMIA

Yu, Huanling; Zhang, Ran; Zhou, Qi; Cai, Xueping; Dong, Shan; Le, Zhiyin; Cai, Xiaxia; Xiao, Rong.

School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China.

**Background and objectives:** Gestational hypercholesterolemia has been recognized as risk factors of some pregnancy complications. We supposed that maternal hypercholesterolemia modified the lipid profile of fetus.

**Methods:** Thirty hypercholesterolemic pregnant women and matched controls were recruited and cord blood was sampled. Lipidomic analysis was used to evaluate the lipid profile change between the two groups.

**Results:** The results showed that content of diacylglycerophosphocholines (PC) were significantly affected. PC (16:0/20:4) and PC (18:0/20:4) were selected as the most important lipid spices in cord plasma which positive related to total cholesterol (TC) and high density lipoprotein cholesterol (HDL) levels in cord blood. The contents of these two PCs were significantly high in hypercholesterolemic group than that in control group.

**Conclusions:** These results suggested that gestational hypercholesterolemia might program the phospholipide metabolism in offspring.

**Keywords:** Lipidomic, cord blood, gestational hypercholesterima, glycerophosphocholines

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DESIGNING A LARGE MULTI-SECTOR PROGRAMME
TO REDUCE STUNTING IN BANGLADESH. LESSONS
FROM SUCHANA

(1)Schofield, Lilly; (2)Seal, Ayan Shankar; (3)Tanvir, Ahmed; (4)Self, Vanessa; (5)Roschnik, Natalie; (6)Hasan, Sajedul.

(1)MSc. Nutrition Advisor. Save the Children. UK.; (2)MSc.Nutrition Advisor. Save the Children. Bangladesh; (3)PhD. Monitoring and Evaluation Advisor; (4)MSc. Senior Food Security Advisor. Save the Children. UK; (5)MSc. Senior Nutrition Advisor. Save the Children. UK; (6)MSc. Team Lead Suchana. Save the Children. Bangladesh.

**Background and objectives:** Bangladesh has made significant progress in addressing chronic malnutrition with national stunting rates falling from 51% to 36% between 2004 and 2014. Progress has not been uniform across the whole country however and in Sylhet, stunting rates have remained at 50%. The Suchana programme was developed over 4 years using an iterative and collaborative process to design a programme to address the multi-faceted causes of malnutrition.

**Methods:** A series of studies were undertaken between 2012 and 2015 to understand the context of under nutrition in Sylhet Division and design a programme tailored to that context. These included a political economy analysis, governance study, food security and nutrition survey, Household Economy Analysis (HEA), Cost of Diet (CotD) assessment, formative research, multi-hazard risk analysis, social protection and child poverty assessment, food security and nutrition scoping study, value chain study and health and nutrition services mapping, and review of learning from similar programmes.

**Results:** Five core programme pillars were identified: 1) Improved nutrition governance; 2) improved access to and utilization of nutrition specific and nutrition sensitive services; 3) better nutrition through improved economic status; 4) Community mobilisation for optimal IYCF and Maternal Child Health and Nutrition (MCHN) behaviour and practices; and 5) robust evidence of impact generated for scale up. It targets 250,000 vulnerable households in Moulvibazar and Sylhet districts and is delivered through a coalition technical and implementing partners, working across 8 Ministries, in a phased approach over 6 years. The first year learning phase has just been completed generating valuable learning and recommendations to further improve the approach.

**Conclusions:** Suchana is unique yet challenging because it uses systems based, multi-sector and multi-pronged approach to addressing the underlying causes of malnutrition. It was designed with a strong evidence base and highly iterative process which is equally rare.

**Keywords:** Stunting, food security, systems, multi-sector, Bangladesh

**Further collaborators**

Collaborating organisations include Save the Children, Helen Keller International (HKI), World Fish, International Development Enterprises (iDE), Department of International Development (DFID) and the European Union (EU)
# DIETARY PATTERNS AND CHANGES IN FRAILTY STATUS - THE ROTTERDAM STUDY

(1)Schoufour, Josje; (2)de Haas, Sandra; (2)de Jonge, Ester; (2)Voortman, Trudy; (2)Steenweg-de Graaff, Jolien; (2)Kiefte-de Jong, Jessica;

(2)Franco, Oscar; (2)Ikram, Arfan; (2)Schoufour, Josje.

(1)PhD. Nutritionist. Department of Epidemiology. Erasmus MC, Rotterdam. The Netherlands; (2)Department of Epidemiology. Erasmus MC. Rotterdam. The Netherlands.

**Background and objectives:** The frailty index, developed by Mitnitski and Rockwood, appraises frailty as the accumulation of health-related and age-related deficits. The included deficits cover a broad range of health aspects including cognition, disabilities, laboratory abnormalities, and comorbidities. To provide more insight into how diet quality is associated with the frailty index and changes in frailty status over time we aim to: (1) examine the cross-sectional association between adherence to national dietary guidelines (a priori defined dietary pattern) and population-specific (a posteriori derived) dietary patterns and the frailty index in middle-aged and elderly populations and (2) examine if these a priori and a posteriori defined dietary patterns are associated with changes in frailty over a four year follow-up period.

**Methods:** Cross-sectional and longitudinal analysis embedded in the population-based Rotterdam Study (n=2,632 aged 45 years. Diet was assessed at baseline (year 2006) using food-frequency questionnaires. Dietary patterns were defined a priori using an existing index reflecting adherence to national dietary guidelines and a posteriori using principal component analysis. A frailty index was composed of 38 health deficits and measured at baseline and follow-up (4 years later). Linear regression analyses were performed using adherence to each of the dietary patterns as exposure and the frailty index as outcome (all in Z-scores).

**Results:** Adherence to the national dietary guidelines was associated with lower frailty at baseline (β -0.05, 95%CI -0.08, -0.02). Additionally, high adherence was associated with lower frailty scores over time (β -0.08, 95% CI -0.12, -0.04). The PCA revealed three dietary patterns that we named a “Traditional” pattern, high in legumes, eggs and savoury snacks; a “Carnivore” pattern, high in meat and poultry; and a “Health Conscious” pattern, high in whole grain products, vegetables and fruit. In the cross-sectional analyses adherence to these patterns was not associated with frailty. However, adherence to the “Traditional” pattern was associated with less frailty over time (β -0.09, 95%CI -0.14, -0.05).

**Conclusions:** Even in a population that is relatively young and healthy, adherence to dietary guidelines could help to prevent or delay frailty.

**Keywords:** Dietary patterns, diet quality, elderly, frailty, frailty index

# EXCESS WEIGHT AND INADEQUACY OF MACRO AND MICRONUTRIENT ADOLESCENT INTAKE IN A TOWN OF BRAZILIAN NORTH EAST

(1)Oliveira, Halsia Stefane; (2)Martins da Silva, Háquila Andrea;

(3)da Silva Neves, Sherida; (4)Vale do Carmo, Amanda; (4)Rodrigues

Queiroz, Iara Saionaria; (4)Patrício Rebouças, Nathalia.

(1)MSc. Nutritionist. Federal Institute of Education Science and Technology of Ceará campus Crato. Crato. Brazil; (2)MSc. Nutritionist. Federal University of Ceará. Fortaleza. Brazil; (3)MSc.

Nutritionist. University of Fortaleza. Fortaleza. Brazil; (4)Student of Nutrition. University of Fortaleza. Fortaleza. Brazil.

**Background and objectives:** Adolescence is a stage of intense body modification. The eating habits during this period are associated with increased risk of obesity and other chronic non-communicable diseases. The objective was to correlate excess weight with macronutrient intake and inadequate micronutrient intake of adolescents in a town of brazilian northeastern.

**Methods:** Adolescents students at public school answered three 24-hour dietary recall. The intake of energy and nutrients was estimated based on the Brazilian Food Composition Table. The inadequacy prevalences were estimated using the Estimated Average Requirement method as a cut-off point, the macronutrients were analized by Acceptable Macronutrient Distribution Range. Weight and height measurements were performed for BMI calculation and nutritional status classification as recommended by the WHO. The descriptive analysis of the data and the analytical test of the chi-square. The analyses were stratified according sexes.

**Results:** The analysis of nutritional status by sex showed that the girls had higher frequency of adequate weight (62.2%) and overweight (33.3%), compared to boys, who were respectively 47.2% and 13.9%. On the other hand, obesity was higher in boys, being 38.8% compared to 4.4% in girls. The mean energy consumption of male participants was higher (2352.5 kcal) than female (2200.7 kcal), however with no statistically significant difference. The percentage contribution of carbohydrates, proteins and lipids to total energy intake was similar among the different sexes and nutritional status. The consumption was out of the range in 6.3% for carbohydrates, 28.4% for proteins and 36.8% for lipids. Micronutrients that had the highest prevalence of inadequacy were calcium (92.6%), vitamin A (78.7%) and vitamin C (52.6%). Adequate iron consumption is present in the most subjects (87.2%). There were also no statistically significant differences in micronutrient intake by sex or nutritional status. The ERICA study in Brazil found either the highest prevalence of inadequacy with calcium and vitamin A, similar results among sexes. However, inadequate iron intake was higher among females.

**Conclusions:** There were no relation between sexes, nutritional status and inadequacy of micronutrients or high intake of macronutrients. There were a high prevalence of weight excess and inadequacy of calcium, vitamin A and vitamin C.

**Keywords:** Food Consumption; Nutritional Status; Adolescents
SNACKING BEHAVIOR IN ADOLESCENT GIRLS
LIVING IN URBAN CITIES IN JAVA, INDONESIA

(1)Blum, Lauren; (2)Mellisa, Ayu; (3)Kurnia Sari, Eny; (4)Novitasari Yusadiredja, Isma; (5)Tumilowicz, Alison; (6)van Liere, Marti; (7)Shulman, Susan; (8)Menon, Ravi.

(1)Global Alliance for Improved Nutrition. USA.; (2)BA. PT Kadence International. Jakarta. Indonesia.; (3)BSc. Global Alliance for Improved Nutrition. Jakarta. Indonesia.; (4)MD. Consultant. Global Alliance for Improved Nutrition. Jakarta. Indonesia.; (5)PhD.Global Alliance for Improved Nutrition. Geneva. Switzerland.; (6)PhD. Global Alliance for Improved Nutrition, Geneva, Switzerland.; (7)Consultant. Global Alliance for Improved Nutrition. Geneva. Switzerland.; (8)MSc. Global Alliance for Improved Nutrition. Jakarta. Indonesia.

**Background and objectives:** Adolescence is a critical period in the lifecycle characterized by physical, social and development- tal changes that impact on health and eating behavior. Indonesia is experiencing dramatic economic and infrastructural changes, causing greater access to the global food industry and media. This transition is influencing modifications in food intake, leading to new nutritional challenges in adolescent girls. Social science re- search was conducted to examine factors affecting eating and snacking behaviors in adolescent girls between 16-19 years of age. An overall aim was to inform the development of a communica- tion strategy to improve snacking behavior.

**Methods:** Qualitative research was conducted between November 2016 and January 2017 in five urban sites in Java, Indonesia. Methods: **Results:** Freelisting results identified over 200 snack foods, with the most salient being packaged foods such as chips and cookies or fried foods available from street vendors or fast food restaurants, with little mention of fruits or vegetables. Respondents typically snacked multiple times daily, either with friends or while alone, with girls commonly storing snacks in their bedroom. Triggers for snacking included boredom, cravings, the desire to replace a heavy meal, and the need for a “companion” while studying, watching movies, or browsing social media, a regular activity of adolescent girls. Snack food selection is guided by taste, price, and accessibility, while health is not considered. Factors influencing snacking included its central role while social- izing with friends, parental provision of snack foods and pocket money, the ubiquitous availability of snacks and their low price, and media advertisements, as well as a limited understanding of food content, nutritional needs and the adverse effects of poor food consumption.

**Conclusions:** Routine consumption of low quality snack foods high in sugar, salt and fat will likely have long-term implications on the nutritional status and health of Indonesian adolescent girls. This in-depth study provided context-specific information for the development of a social media campaign designed to motivate girls to modify snacking practices.

**Keywords:** snack food consumption, qualitative research, ad- olescent girls, social media campaign, Asia

ENHANCING CAPACITY OF COMMUNITY SYS-
TEMS TO IMPROVE MATERNAL INFANT AND
YOUNG FEEDING PRACTICES: APPROACHES
AND TOOLS USED IN THE BABY-FRIENDLY-COM-
MUNITY-INITIATIVE

(1)Samburu, Betty; (2)Judith, Kimiywe; (3)Kimani-Murage, Elizabeth; (4)Wekesah, Frederick; (5)Muriuki, Peter; (6)Wanjohi, Milka; (7)Kiige, Laura; (8)Ahoya, Brenda; (9)Kavle, Justine; (10)Njoroge, Brian.

(1)Msc. Programme Manager Maternal Infant and Young Child Nutrition. Ministry of Health. Nutrition and Dietetics Unit. Nairobi. Kenya.; (2)PhD. Ass. Prof. Nutrition. Department of Food Nutrition and Dietetics. Kenyatta University. Nairobi. Kenya.; (3)PhD. Research Scientist. African Population and Health Research Center. Kenya.; (4)Msc. Epidemiologist Public Health Research. African Population and Health Research Center. Kenya.; (5)Msc. Research Assistant. African Population and Health Research Center. Kenya.; (6)BSC. Research Assistant. African Population and Health Research Center. Kenya.; (7)Msc. Nutrition Specialist-Maternal Infant and Young Child Nutrition and HIV/AIDS. UNICEF. Kenya.; (8)Msc. Nutrition Advisor Maternal Neonatal Child Health program/PATH. Kenya.; (9)PhD. Senior Nutrition Advisor Maternal Neonatal Child Health Program/ PATH. Washington, DC. USA.; (10)Msc. Nutrition Specialist Kenya Nutrition and Health Programme Plus. Kenya.

**Background and objectives:** Background: In Kenya, 39% of mothers deliver at home and those discharged from hospital require continuity of care hence Baby Friendly Hospital Initiative does not reach some women. Baby-Friendly-Community-Initiative (BFCI) could fill this gap.

**Objective:** To describe community based approach and tools used in implementation of BFCI to improve maternal infant and young child feeding practices.

**Methods:** Method: Participatory research on community engagement in BFCI, desk review, country case studies and exchange study to Cambodia. A package of BFCI implementation was developed which includes BFCI implementation guidelines, training package, orientation package, communication and advocacy materials. Eighty (8) step point plan and 11 key interventions/activities were determined in the implementation package. Monitoring and assessment tools were developed which includes mentorship and supervision tool, community self-assessment tools, individual child feeding and growth monitoring forms and external assessment tools. Two levels of community support groups were defined in the policy documents and integrated in the established community health strategy system; the community mother support groups (CMSGs) and mother to mother support groups (M2MSGs). Community health volunteer (CHV) were identified as implementers with supervision from the community health extension worker (CHEW). Income generating activities were encouraged as a form of incentives for CHVs.

**Results:** BFCI has been integrated successfully within the community health strategy structures. Training of over 200 TOTs and roll out of trainings to over 50% of the counties and successful
integration of nutrition sensitive programmes has been achieved. BFCI has led to successful achievement of the following; Improved exclusive breastfeeding rates upto over 80% and 65% at 3 and 6 months respectively, referral and reporting rates from 41% to 80% (MOH reports), 4 ANC attendance upto over 60% and scaling up of ART services to over 90% lower level facilities in a pilot site.

**Conclusion:** BFCI is can be effectively integrated into already existing community structures to improve feeding practices. A structured way of enhancing capacity of communities to providing services to improve infant feeding is key for success.

**Keywords:** Baby-Friendly-Community-Initiative, community-mother support groups.

(1)Luthringer, Corey L.; (2)Hoogendoorn, Annemarie; (3)Parvanta, Ibrahim; (4)Garrett, Greg S.; (5)Declercq, Bruno.

(1)MPH. Non-Key Expert. Food Fortification Advisory Services. European Commission/Technical assistance for strengthening capacities in food fortification. USA.; (2)MSc. Key Expert. Food Fortification Advisory Services. European Commission/Technical assistance for strengthening capacities in food fortification. The Netherlands.; (3)MS. Key Expert. Food Fortification Advisory Services. European Commission/Technical assistance for strengthening capacities in food fortification. USA.; (4)MSc. Non-Key Expert. Food Fortification Advisory Services. European Commission/Technical assistance for strengthening capacities in food fortification. Switzerland.; (5)DEVCO C1: Rural Development, Food Security, and Nutrition. European Commission. Belgium.

**Background and objectives:** Food fortification is a component of interventions aimed at tackling “hidden hunger” and an area in which the European Commission is increasing its support to building, improving, and sustaining programmes in low- and middle-income countries, in alignment with the priorities of the Commission’s Action Plan on Nutrition. A Global Mapping of food fortification was conducted by the Food Fortification Advisory Services to advance understanding on food fortification and biofortification, including key strategic and operational challenges, coverage and consumption trends, and impact on reducing micronutrient deficiencies. The mapping leverages the recommendations from the Global Summit on Food Fortification, held in September 2015 in Arusha, Tanzania.

**Methods:** The Global Mapping was conducted via a desk review of documentation from peer reviewed and grey literature sources in combination with a survey sent to a limited number of key stakeholders working in fortification. An analysis of the overall global status, results, and key learnings accompanies cues for future programming.

**Results:** Six key findings are articulated in the Mapping: 1) Fortification can make a significant contribution to improving public health outcomes if properly implemented; 2) A comparative advantage of fortification is its delivery through national food systems; 3) Fortification can significantly improve the micronutrient content of existing diets of populations; 4) Sustainable and transparent public-private partnerships in nutrition form the basis for fortification programmes; 5) Inappropriate programme planning and poor compliance with standards are major challenges in achieving expected impact of fortification in some settings; and 6) Monitoring and surveillance of national fortification programmes are often inadequate and should be strengthened at national and global levels.

**Conclusions:** The Global Mapping report is a resource for enhancing mobilisation and political commitment for nutrition, scaling-up actions at country level, and contributing to the generation of knowledge and evidence on nutrition and food fortification. It represents an example of donor engagement in the scientific, programmatic, and policy spaces of nutrition. It has the potential to contribute towards food and nutrition program coordination by the Commission, partner countries and international donor and implementing agencies. This will help ensure fortification programmes achieve public health objectives and support relevant sustainable development goals.

**Keywords:** Food Fortification

Biofortification

Food Systems

Multi-Stakeholder Partnerships

Monitoring

(1)Velázquez, María Consuelo; (2)Irigoyen-Camacho, Maria Esther;

(2)Lazarevich, Irina; (2)Marco, Zepeda.

(1)MSc. Full Time Professor. Health Attention Department. Metropolitan Autonomous University. Mexico; (2)Full Time Professor. Health Attention Department. Metropolitan Autonomous University. Mexico.

**Background and objectives:** Sarcopenia is a geriatric syndrome characterized by loss of mass, strength and skeletal muscle function. When sarcopenia is associated with frailty and malnutrition; it contributes to dependence, physical disability, morbidity and mortality.

**OBJECTIVE:** To estimate the prevalence of sarcopenia, frailty and malnutrition in elderly women (aged 65 year and over) living in a nursing home in Mexico City.

**Methods:** A cross-sectional study. To identify sarcopenia, the criteria of Consensus of the European Working Group on Sarcopenia in Older People (EWGSOP) was applied. The gait speed was measured in meters/second (≤0.8 m/s = low value) the handgrip strength was measured using a dynamometer (<20 kg = low value).
To estimate muscle mass, two methods were used: 1. Calf circumference (CP) (<31 cm, low value) and 2. bioelectrical impedance analysis (BIA) (applying Janssen's formula). Fried L. criteria were used to detect frailty. To evaluate nutritional status, the Mini-Nutritional Assessment tool (MNA) was applied.

**Results:** A total of 114 elderly women, with an average age of 85 years, were studied. The prevalence of sarcopenia using BIA was 61.1% and using CP 30.7%. 50.9% of the old women had pre-frailty and 45.6% frailty. Undernutrition was detected in 3.5% and risk of malnutrition in 29.8%. Sarcopenia identified by BIA, it was associated with frailty and we observed that 46.0% of the elderly women were pre-frailty and 27.8% frailty. When sarcopenia it was identified by CP, we observed 32.1% with frailty and 62.9% with pre-frailty. The percentage of frailty was lower in those without sarcopenia (16.35%). While sarcopenia diagnosed across BIA, it was associated with nutritional status: 30.1% of the sarcopenic women presented risk of malnutrition, and 4.7% undernutrition. Using CP: 11.4% presented risk of undernutrition and 45.7% malnutrition

**Conclusions:** The prevalence of sarcopenia in very old women differs according to the method used to estimate skeletal muscle mass. The prevalence of malnutrition increases when there is fragility. The very old women living in a home car, requires intervention programs for prevent and receive an opportune therapeutic management for sarcopenia, fragility and malnutrition.

**Keywords:** Sarcopenia, Frailty, Malnutrition, Elderly

**Further collaborators:** D'Hyver C. Medical Doctor. Professor. National Autonomous University. Mexico

formations, genetic syndromes, studied intrauterine infections or cerebral palsy were excluded.

**Instruments:** Growth chart and outcomes on the rings subtest (RSubt) of the ENFEN. This subtest assesses executive functions, especially those related to planning and problem solving.

**Statistical analysis:** RSubt performance scores were divided in 2 categories: 1-4 and 5-10. Low RSubt score was defined as a score less than 4. Normal RSubt score was defined as a score >=5. Categorical data was analyzed using Chi2 or Fisher test. Significance level was set at p<0.05.

**Results:** 92 born preterm children (10-12 y/o) were studied. 31.52% were SGA (n=29) and 68.47% AGA (n=63). There were 68.96% of girls in SGA group and 52.38% in the AGA group. Mean+/-SD of BW and GA by group are shown in table 1. Table 2 shows the Chi2 results of the RSubt scores (<4 and >=5) for each group (SGA and AGA) and for each growth z score group at 1 and 2 years of life. There were no statistically significant differences between AGA children. However, the Chi2 test resulted significant for those in the SGA group (p<0.05).

**Conclusions:** Preterm SGA children are at special risk for cognitive impairment. We found that SGA in preterm (<1500g) children was associated with growth restriction at 1 and 2 years of life and lower scores in the RSubt of the ENFEN (p<0.05).

**Keywords:** Growth Trajectory - Very Low Birth Weight Infants-Executive Functions

**Further collaborators:** Gisela Gerometta, Mónica Brundi, Victoria de la fuente

**Background and objectives:** Several studies on preterm-born children have identified birth weight (BW) as a potent predictor of later cognitive functioning and academic success, with poorer outcomes in those born SGA (small for gestational age) compared with those born appropriate for GA (AGA).

The objective of the study was to compare SGA and AGA born preterm (<=1500g) children between 10-12 years old (y/o) on growth at 1 and 2 years of life and on the outcomes of the rings subtest (RSubt) of the ENFEN (Evaluación Neuropsicológica de las Funciones Ejecutivas en Niños.

**Methods:** 92 born preterm (<1500g) children between 10-12 y/o (53 girls, 39 boys) were studied. Children with congenital mal-

<footnote>(1) Vivas, Silvana; (2) Dinerstein, Alejandro; (2) Solana, Claudio; (2) Aspres, Norma; (3) Granovsky, Gustavo; (2) Casale, Marita; (2) Conti, Roxana; (2) Cúneo Libarona, María Lucrecia; (2) Shapira, Iris.</footnote>

<footnote>(1) Psicopedagoga. Educational Psychology in Ramón Sarda Maternity Hospital. Argentina.; (2) Medical doctor. Ramón Sarda Maternity. Argentina; (3) Phonoaudiologist. Ramón Sarda Maternity Hospital. Argentina.</footnote>
# MATERNAL VITAMIN D SUPPLEMENTATION DURING PREGNANCY AND LACTATION TO PROMOTE INFANT GROWTH IN DHAKA, BANGLADESH (MDIG TRIAL): A RANDOMIZED CONTROLLED TRIAL

(¹)Roth, Daniel; (²)Mahmud, Abdullah Al; (³)Morris, Shaun; (⁴)Zlotkin, Stanley; (⁵)Gernand, Alison; (⁶)Tahmeed, Ahmed; (⁷)Islam, M Munirul; (⁸)Papp, Eszter; (⁹)Korsiak, Jill; (¹⁰)Willan, Andrew.

(¹)MD. PhD. Clinician Scientist. Centre for Global Child Health. The Hospital for Sick Children. Canada; (²)MSc. MPH. Scientist. Nutrition and Clinical Services Division. International Center for Diarrheal Disease Research. Bangladesh. Bangladesh; (³)MD. MPH. Clinician Scientist. Division of Infectious Diseases. The Hospital for Sick Children. Canada; (⁴)MD. PhD. Senior Scientist. Centre for Global Child Health. The Hospital for Sick Children. Canada; (⁵)PhD. MPH. Nutritional Scientist. Department of Nutrition. Pennsylvania State University. USA; (⁶)MD. PhD. Senior scientist. Centre for Nutrition and Food Security. International Center for Diarrheal Disease Research. Bangladesh. Bangladesh; (⁷)MBBS. PhD. Scientist. Nutrition and Clinical Services Division. International Center for Diarrheal Disease Research, Bangladesh. Bangladesh; (⁸)MSc. PhD. Research Manager. Centre for Global Health. The Hospital for Sick Children. Canada; (⁹)MSc. Data Analyst. Centre for Global Health. The Hospital for Sick Children. Canada; (¹⁰)PhD. Clinical Trials Methodologist. Ontario Child Health Support Unit. The Hospital for Sick Children. Canada.

**Background and objectives:** Infant linear growth faltering is a significant public health problem in South Asia. Low length-for-age z-scores (LAZ) are associated with adverse physical and neurocognitive outcomes in childhood. Linear growth faltering often begins early in infancy, suggesting that prenatal factors have a significant impact on postnatal growth. Vitamin D regulates bone mineral homeostasis and growth plate activity and is, therefore, a key candidate nutrient involved in fetal and infant linear growth.

**Methods:** In a randomized controlled dose-ranging maternal vitamin D supplementation trial in Dhaka, Bangladesh, 1300 women were enrolled in mid-pregnancy (17-24 weeks gestation) and allocated into one of five treatment arms, receiving 1) placebo, 2) 4,200 IU/week, 3) 16,800 IU/week, or 4) 28,000 IU/week vitamin D in the prenatal period and placebo in the postpartum period, or, 5) 28,000 IU/week vitamin D in the prenatal and 28,000 IU/week vitamin D in the postpartum period. Infants underwent weekly morbidity evaluation until 6 months of age and anthropometric and clinical evaluation at 3-month intervals until 1 year of age. Laboratory analyses were performed at enrollment, 30-weeks gestation, delivery, and 3 and 6 months of age. The primary outcome was mean length-for-age Z score (LAZ) at 1 year of age. Secondary outcomes included pregnancy/birth outcomes and infant morbidity.

**Results:** Of 1300 women enrolled, 64% were vitamin D deficient (25-hydroxyvitamin D<30 nmol/L) at baseline. There were 20 stillbirths, 29 infant deaths, and 86 other losses to follow-up, such that 1165 (90%) infants completed anthropometric follow-up

at 1 year of age. The effects of maternal vitamin D supplementation during pregnancy and lactation on infant LAZ, other anthropometric indices, and various clinical outcomes will be presented.

**Conclusions:** The impact of the current findings on maternal vitamin D supplementation on infant length and maternal and infant health outcomes in Bangladesh will be discussed. The significance of the findings for current maternal vitamin D supplementation guidelines will be discussed.

**Keywords:** vitamin D, pregnancy, nutrition, infant health, bone growth

**Further collaborators**

Farhana Khanam Keya, Minhaz Mohsin, Kelly Murphy, Lisa Pell, Prakesh Shah, Shaila Sharmeen Shanta, Joy Shi, Rosanna Weksberg.

# FREQUENCY OF VITAMIN D DEFICIENCY IN OUR OBESE PATIENTS

Vera, Matilde Elizabeth.

MSc. Nutrition. Argentina.

**Background and objectives:** The objective of the present study is to determine the frequency of vitamin D deficiency in obese patients

**Methods:** Methodology: A cross-sectional observational, descriptive study with an analytical component, performed in 40 patients of the Integral Management Unit of the Obese Patient of the Hospital de Clínicas from June 2015 to May 2016. Variables: socio-demographic, clinical data, 25- Hydroxy-Vitamin D and relation between them. The data collected were loaded in Microsoft Excel® version 2007 and analyzed using Epiinfo 7 version February 2011

**Results:** The mean age was 40 ± 11 years (19-59), mostly women (88%), who work Office (30%), residents of the Central area (68%). The medical diagnosis was predominantly Hypertension (62%) and Type 2 Diabetes (29%), with predominance of obese type II and III with 40% and 38%, respectively. 40% have vitamin D deficiency (≤20ng / ml) and 40% deficiency (21-29 ng / ml) and 20% adequate. The environment, 9 miles, being higher in women. The most frequent risk factor was 55% of the non-exposed subjects with the lowest vitamin D value (μ18 ± 9). Of those with deficiency, 50% had grade II obesity and in those with good results, 75% were grade III.

**Conclusions:** Almost half of the obese studied had vitamin D deficiency, more affecting those with type II obesity

**Keywords:** obesity, vitamin D, vitamin D deficiency, Paraguay.

**Further collaborators:** Dr. Rafael Figueredo
## WHO GUIDELINES ON FEEDING COMPLEMENTARY FOODS TO 6-24 MONTH OLD CHILDREN: DEMOGRAPHIC & HEALTH SURVEY (DHS) DATA FROM CAMEROON, EGYPT, INDONESIA AND THE PHILIPPINES

(1)Marriott, Bernadette P.; (2)Nasarre, Patrick; (3)Lee, Fu-Shing; (4)Poole, Ann; (5)Boan, Andrea D.; (6)Wallingford, John C.

(1)PhD. Director. Nutriton Section. Division of Gastroenterology. Department of Medicine. Medical University of South Carolina. Charleston. SC. USA.; (2)PhD. Medical University of South Carolina. Charleston. SC. USA; (3)PhD. Statistician. Nutrition Section. Department of Medicine. Medical University of South Carolina. Charleston. SC. USA; (4)MSc. Nutrition Section. Department of Medicine. Medical University of South Carolina. Charleston. SC. USA; (5)PhD. Department of Pediatrics. Medical University of South Carolina. Charleston. SC. USA; (6)PhD. Nutrition Scientist. President. Nutrispectives Inc. Seattle. WA. USA.

**Background and objectives:** The World Health Organization (WHO) recommends complementary foods with sufficient diversity to meet nutritional needs that are measured by four solid food feeding indicators (FI). Earlier studies have reported associations between meeting the FI and economic status or maternal education. Our purpose was to determine if meeting the WHO FI was associated with country economic status measured by Gross Domestic Product (GDP).

**Methods:** We assessed complementary feeding practices of children 6-24 months of age and their family socio-demographics and lifestyle factors using comparable Demographic and Health Survey (DHS) data and the WHO FI, among four countries of similar economic status: Egypt, Indonesia, Philippines, and Cameroon (World Bank: GDP= 6,600; 5,200; 4,700; 2,400 USD/capita, respectively).

**Results:** The percent of children meeting the WHO guidelines did not parallel GDP. Cameroon had significantly fewer children meeting all four of the solid food FI (p<0.01) than the other countries, yet children in Cameroon were significantly more likely to be fed with meat, vitamin A rich foods, and fruits than children in Egypt (p<0.01). While Philippines had a lower GDP than Egypt and Indonesia, it had a higher percentage of children meeting all four FI's (p<0.01) and mothers completing secondary school or higher education. In terms of food groups overall, more than 80% of the children in all 4 countries received grain-based foods with between 45% and 70% of children having been fed with fruit. Higher maternal education was a significant predictor of meeting the FI specifically for food diversity in Egypt, Indonesia and Cameroon, while working outside the home was a significant predictor of meeting this FI only for women in the Philippines and Indonesia (p<0.01). Overall, a higher family asset index was associated with meeting the FI for food diversity alone among all countries (p<0.01).

**Conclusions:** Among these four countries, maternal educational achievement appears to be a better predictor of general complementary feeding practices than country GDP.

**Keywords:** complementary feeding, WHO guidelines, DHS

## ENERGETIC CONTRIBUTION OF ULTRA-PROCESSED PRODUCTS TO THE FOOD LISTFROM DE DIET OF ADULTS IN NORTHEAST OF BRAZIL

(1)de Oliveira Lyra, Clélia; (2)de Lima Motta, Virginia Williane; (3)Vale, Diôgo; (4)Pereira Santos, Camila Dayze; (3)Freitas Da Silva Pereira, Ingrid; (2)Garcia Germoglio, Rebecca; (3)De Araujo Cabral, Natalia Louise; (3)Freire Pequeno, Nila Patrícia; (5)Viana Bagni, Ursula; (5)Vieira Cunha Lima, Severina Carla.

(1)PhD Professor. Nutrition Departament. Federal University of Rio Grande do Norte. Brazil; (2)BSc. Post-Graduation Program of Nutrition. Federal University of Rio Grande do Norte. Natal. Brazil; (3)MSc. Post-Graduation Program of Public Health. Federal University of Rio Grande do Norte. Natal. Brazil.; (4)BSc. Post-Graduation Program of Public Health. Federal University of Rio Grande do Norte. Natal. Brazil.; (5)PhD. Professor. Nutrition Department. Federal University of Rio Grande do Norte. Natal. Brazil.

**Background and objectives:** The ultra-processed products are formulations of industrial sources of dietary energy and nutrients, likefree sugars and salt, saturated fat or trans fats, plus additives including those designed to intensify sensory impact. They typically contain little or even no intact food. Recent studies have shown significant associations between the food consumption of ultra-processed food products with non-communicable diseases (NCDs), in all ages.

The aim of this study was to verify the energetic contribution of ultra-processed food products on a food list in adults, in Northeast of Brazil.

**Methods:** The food list was obtained by food records using data from a nationwide survey, the Pesquisa de Orçamentos Familiares 2008-2009 (POF), in a population sample of Northeast of Brazil in age between 20 and 59 years. Data on pregnant and lactating women have not been included. To construct the list was opted for the methodology of relative percentage of contribution of each food item from Block et al. The foods classifications based on the extent and purpose of their processing, was used the NOVA system of food classification.

**Results:** The list was constituted by 97 foods that contributed up to 90% of the energy consumption. Ultra-processed (n=30) food products contributed together with 11,4% of the energy from the list of food consumed. The food that most contributed to energy was margarine (n = 15;% = 1,23), followed by the crackers (n = 19;% = 1,03%). Were part of the contributions, foods like cookies and stuffed, soft drinks and fast foods.

**Conclusions:** The ultra-processed food products have an important contribution in the energetic consumption of adults in the northeast of Brazil. This results demonstrated the need for public policies aimed at the promotion of healthy eating. For these public policies aimed at the promotion of healthy eatingbe successful, it is important to recognise the conflict of interests between the ultra-processed products food market and public health. To tackle the NCDsit is necessary that there should be a strengthening of the regulatory capacity of the State in the production and marketing of food.

**Keywords:** food list; food processing; noncommunicable diseases;nutrition; feeding behaviour.
(1)Zonis, Luciana Noemi; (2)Indart Rougier, Paula; (2)Favieri, Andrea Lorena; (3)De Gregorio, Maria Jose; (4)Rausch Herscovici, Cecile; (5)Kovalskys, Irina.

(1)BSc. Nutritionist. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Argentina; (2)BSc. Nutritionist. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina; (3)BSc. Sociologist. Department of Anthropological Sciences. University of Buenos Aires. Argentina; (4)PhD. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina; (5)MD. Nutrition and Health Area. ILSI Argentina (International Life Sciences Institute). Buenos Aires. Argentina.

**Background and objectives:** Overweight (OW) at early ages is a vulnerable condition due to the effect of tracking adiposity during infancy and adolescence. The goal of this study was to identify the main determinants in a sample of first grade children attending at public schools in Buenos Aires.

**Methods:** This analysis includes the baseline assessment of the MiniSALTEN Study (obesity prevention program developed in 12 Public Schools in Bs As, Argentina). Data was collected from June to November 2015. All first grade children and their mothers were invited to participate. Data of intake was collected face to face with a 24 h recall for both mother and child, for the last one, the information was completed by the research team, at school. Weight and Height was measured and BMI calculated. Socio demographic information, including socioeconomic level (SEL) was collected. Time of sleep (in hours) was collected during one week. Intake data was analyzed with a software (NDS-R, Nutrition Data System). All analyses were performed with SPSS for Windows. Multivariate logistic regression model was used to find the most predictive variables associated with overweight and obesity. The final models are reported using odds ratios (ORs) and their 95% confidence intervals (CI) and p-value.

**Results:** Final sample was composed by 205 dyads. Children's mean age was 6.68 y. The prevalence of overweight was 26,3 % and obesity 22 %. Significant factors associated with overweight and obesity were Mother's BMI (OR: 1.09, CI 1.03-1.153, p-value: 0.003) and low SEL (OR: 2.279, CI: 1.224-4.242, p-value: 0.009). Were also analyzed energy (OR:1.00, CI: 1.00-1.001, p-value: 0.160), added sugars (OR: 0.983, CI: 0.95-1.018, p-value: 0.345), average daily time of sleep (OR: 1.071, CI: 0.7-1.639, p-value: 0.752), birth weight (OR: 1.183, CI: 0.712-1.965, p-value: 0.517) and exclusive breastfeeding up to 6 months (OR: 1.319, CI:0.730-2.385, p-value:0.359). Non of them shawed association with children's BMI.

**Conclusions:** Argentina is a developing country with one of the highest prevalences of children's overweight in Latin America. Both mother's adiposity and poverty (main determinants) are environmental preventable conditions to tackle obesity at early ages.

**Keywords:** Childhood obesity, Diet, Risk factors, Multivariate analysis.

**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

(1)Della Líbera, Beatriz; (2)Baião, Mirian; (3)Barros, Denise; (2)Santos, Marta; (4)Araújo, Roberta; (5)Saunders, Cláudia.

(1)PhD. Nutritionist. Curso de graduação em Nutrição. Faculdade Redentor. Brazil.; (2)PhD. Nutritionist. Departamento de Nutrição Social e Aplicada. Universidade Federal do Rio de Janeiro. Brazil.; (3)PhD. Nutritionist. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Brazil.; (4)MSc. Nutritionist. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Brazil.; (5)PhD. Nutritionist. Departamento de Nutrição e Dietética. Universidade Federal do Rio de Janeiro. Brazil.

**Background and objectives:** Maternal morbidity is strongly associated with neonatal mortality. Adequate prenatal care, with early detection and intervention during risk situations, as well as good quality care during labour, are key health indicators related to mother and child, with the potential to further reduce the effects of the main causes of maternal and neonatal mortality. The aim of the study was to assess the impact of a prenatal nutritional care programme on perinatal outcome in the context of primary health care.

**Methods:** That's a non-randomized controlled clinical trial developed in a unit care in Rio de Janeiro, Brazil. 284 pregnant women were allocated into one of two groups: an intervention group (IG; n = 122), comprising pregnant women who received the intervention of nutritional care through collective consultations with a nutritionist, and a control group (CG, n = 162) consisting of pregnant women who did not receive the intervention.

**Results:** There was a higher proportion of pregnancy complications (p=0.000) and abnormal total gestational weight gain (p=0.031) in the CG. In the final model, it was found that belonging to the CG (adjusted OR=4.721; CI 95%=1.009-22.090) and living with four or more people in the household (adjusted OR=2.692; CI 95%=1.021-7.101) were predictors of pregnancy complications, while belonging to the CG (adjusted OR=2.354; CI 95%=1.063-5.213) and starting prenatal care after 16 weeks (adjusted OR =8.509; CI 95%=1.023-70.784) were determinants of abnormal pregnancy weight gain.

**Conclusions:** These findings reinforce that the prenatal nutritional care programme contributed to improving the health of pregnant women.

**Keywords:** Pregnancy. Nutrition programmes. Prenatal nutrition.