with visual support. It was built upon national and international recommendations and reviewed by experts. Its application lasts 5 minutes. Each question scores 0 or 1; the higher the score, the better the food consumption quality. Besides, it allows a classification of four categories of food consumption quality according to final score (10-12: very good; 7-9: good; 4-6: low; 1-3: very low). It was applied twice with a 15-days interval between them. Spearman correlation (reproducibility) and intraclass correlation coefficient (concordance) were calculated from the total scores, and for the concordance between categories (SPSS v.20 for Windows, p<0.05 significant).

**Results:** One hundred fifty five subjects were included; the average age was 40.2 (standard deviation (SD) 7.4) years. The average of Mini-ECCA's total score was: first application 6.0 (SD 2.2), and second application: 6.3 (SD 2.3). Spearman correlation between the total scores of the first and second applications was ρ=0.713 (p<0.001) and intraclass correlation coefficient (ICC) was 0.841 (95% CI 0.779, 0.885).

**Conclusions:** Mini-ECCA's reproducibility was good (p=0.713) and its concordance was excellent (ICC of 0.841). Therefore, Mini-ECCA is a tool that, once validated, could be used in public health, to carry out focused food consumption assessments and orientation.

**Keywords:** Diet quality index, food consumption quality, reproducibility.

**Methods:** Cross-sectional study carried out in 39 schools that were randomly selected, from the national census of schools in Mexico. The foods and beverages available at schools were recorded in two school years, and their nutritional characteristics were compared to those established in the Guidelines. Linear, logistic or Poisson regression models were developed, according to the type of variable of interest, to make comparisons between the stages, within each food category.

**Results:** A broad availability of energy dense foods that are not allowed in the SFE such as cookies, desserts and sweetened beverages, was found at the schools in both stages of the study. Less than 7% of the foods and drinks were vegetables, fruits and plain water.

The food categories that met fewer of the nutritional criteria established in the Guidelines were prepared foods (fried and non-fried), as well as snacks.

**Conclusions:** No changes were observed between stages in the compliance with the Guidelines for the availability of foods in schools. These results suggest that Guidelines must be promoted and provided with legal basis, to make its accomplishment mandatory.

**Keywords:** Public policy, schools, obesity, food and beverages, Mexico

**Further collaborators:**

Juan Ángel Rivera Dommarco. PhD. Research. National Institute of Public Health. México.

144/1998

PUBLIC POLICY IN MEXICO FOR THE FIGHT
AGAINST OVERWEIGHT AND OBESITY IN
SCHOOL CHILDREN

(1)Morales-Ruán, María del Carmen; (1)Jiménez Aguilar, Alejandra;

(2)Shamah-Levy, Teresa; (1)López Olmedo, Nancy; (3)Théodore, Florence; (1)Tolentino Mayo, María Lizbeth; (1)Moreno Saracho, Jessica; (4)Bonvecchio Arenas, Anabelle.

(1)MSc. Nutritionist. Center for Nutrition and Health Research. National Institute of Public Health. México.; (2)PhD. Research. Center for Nutrition and Health Research. National Institute of Public Health. Mexico.; (3)PhD. Research. Center for Nutrition and Health Research. National Institute of Public Health. México.;

(4)PhD. Nutritionist. Center for Nutrition and Health Research. National Institute of Public Health. México.

**Background and objectives:** The excess weight in schoolchildren in Mexico is a serious health problem that has increased at an alarming rate. In 2010, the government established General Guidelines for the Dispensing or Distribution of Foods and Beverages at School Food Establishments (SFE) in Elementary Schools whose objective is to stop the epidemic of overweight and obesity.

**Objective:** To evaluate the compliance with the Guidelines during two scholar periods (2011-2012 and 2012-2013), that correspond to stages II and III of their implementation, with regard to the availability and compliance with the established criteria for the sale of foods and beverages at SFE of public elementary schools.

144/2000

PREVALENCE OF CARDIOVASCULAR RISK FAC-
TORS AMONG ECUADORIAN WORKERS AT A
PRIVATE ENTERPRISE

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

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

**Background and objectives:** Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide. Cardiovascular diseases are among the main causes of mortality in Ecuador. However, the prevalence of Cardiovascular Risk Factors (CVRF) is unknown in Ecuadorian workers. This study aimed to determine the prevalence of obesity, overweight, physical inactivity, hypertension, central obesity, dyslipidemia history, tobacco use, alcohol and low fruit and vegetable intake among Ecuadorian workers at a private enterprise.

**Methods:** A cross sectional study was conducted on 917 Ecuadorian private workers (663 men and 254 women). Surveys were conducted to obtain life style information, hypertension and dyslipidemia stories, tobacco and alcohol use; anthropometric data (waist circumference, waist/hip ratio and Body Mass Index), fruit and
vegetable intake and physical activity levels (International Physical Activity Questionnaire). Statically, descriptive statistics, chi-squared test and multiple correspondence factorial analysis were used.

**Results:** The prevalence of CVRF are: 87,9% low fruit and vegetable intake, 65.3% physical inactivity, 50% excess of weight (40.8% overweight and 9.4% obesity); 36.4% alcohol, 25.6% central obesity, 14.8% tobacco use, 14% hypertension and 6.9% dyslipidemia history. Hypertension coexisted with obesity (38.4%), overweight (15%) and central obesity (p=0,000). Overweight and central obesity increases with age (p=0,000). Being obese and lack of time are the most common barriers to practice physical activity.

**Conclusions:** There is a high prevalence of cardiovascular risk factors in apparently healthy workers at a private enterprise in Ecuador. This exposes the need of preventive strategies against cardiovascular disease at workplace by making lifestyle modifications. The preventive strategies against CVDs would help in decreasing employee absenteeism, as well as hospital and drug costs which burden the health care system.

**Keywords:** Cardiovascular risk factors, physical inactivity

**Further collaborators:** Nicole Jiménez. Savinmed

144/2009

EVALUATION OF LEFTOVERS OF PREPARATIONS WHICH MAKE UP THE MENU OF A FOOD AND NUTRITION UNIT IN THE CITY OF SÃO PAULO

(1)Toscano Ferreira, Rosana; (1)Korukian Freiberg, Clara; (2)Lyra, Carolina.

(1)MSc. Nutritionist. Nutrition of Department. São Camilo University Center. São Paulo. Brazil.; (2)Nutritionist. Nutrition of Department. São Camilo University Center. São Paulo. Brazil.

**Background and objectives:** The Food and Nutrition Unit (UAN) consists of an area dedicated to the preparation and distribution of meals, with the objective of guaranteeing the provision of balanced meals according to hygienic-sanitary and dietary standards, guaranteeing food safety since the preparation and production until distribution to the final consumer. The waste of food in a UAN occurs both in the transformation of food into ready-to-eat meals, leftovers, which are all ready-to-eat foods that have not been distributed, as in the distribution stage, interpreted as food remains. Waste reduction can bring a number of benefits to a UAN, such as reducing production costs by using less inputs and energy. The main objective of this study was to Identify the amount of leftovers from the preparations that make up a menu in a food and nutrition unit.

**Methods:** Cross-sectional, observational descriptive study with primary data collection, developed at a UAN of a financial institution located in the southern region of the city of São Paulo, administered by a service provider in the food and nutrition segment. All items belonging to the menu were weighed in the five days of collection, between May and June 2016. For the data collection, the quantities of food produced were considered, from the gender requisition of the stock, calculating if the correction factor and cooking index, besides weighing the leftovers of the days of

collection for later calculation of percentage of leftovers and grams per capita. The analysis was made according to parameters stipulated by Lanzillotti, 10% as the maximum acceptable limit, and Vaz, 7 to 25 g per capita, respectively.

**Results:** The mean total food preparation during the five days of weighing was 105.5 kg, with 26.77 kg were of leftover food, totaling a percentage of 25.37% and a mean per capita of 33g.

**Conclusions:** The average total percentage of leftovers as per capita leftovers are high when compared to those proposed in the literature.

**Keywords:** Food Waste; Food Service; Food Leftovers; Food and Collectivity.

144/2024

NUTRITIONAL QUALITY OF A SELECTED SAMPLE OF PACKAGED FOODS IN ARGENTINA

(1)Tiscornia, María Victoria; (2)Castronuovo, Luciana; (3)Allemandi, Lorena Andrea; (4)Nessier, Celeste; (5)Gijena, Julieta; (6)Ferenc, Marina; (6)Crinó, Agustina.

(1)Bsc. Nutritionist. Fundación InterAmericana del Corazón Argentina. Argentina.; (2)PhD. Sociology. Fundación InterAmericana del Corazón Argentina. Argentina.; (3)BSc. Public Health. Fundación InterAmericana del Corazón Argentina. Argentina.; (4)MSc. Nutritionist. Universidad Catolica de Santa Fe. Argentina.; (5)BSc. Nutritionist. Universidad Catolica de Santa Fe. Argentina.; (6)Student. Instituto Universitario CEMIC. Argentina.

**Background and objectives:** One of the major causes of the global increase in the prevalence of obesity, and other diet-related chronic diseases has been the increased intake of foods high in sugar, salt, and fats. This study analyzed the nutritional quality of packaged foods highly consumed or targeted to children in Argentina.

**Methods:** Data for breakfast cereals, cookies and milk desserts were collected at a major supermarket chain in Argentina in June 2016. Pictures were taken of the Nutrition Information Panel (NIP) of all products.

NIP of all products was analyzed using the PAHO and the WHO Europe Nutrient Profile (NP) Models.

**Results:** A total of 301 products were collected, 42 (14%) breakfast cereals, 209 (69%) cookies and 50 (17%) milk desserts. According to the PAHO NP model, most products (87%, n=262) showed high critical nutrient levels in at least one nutrient: 27% (n=82) were "excessive" in one nutrient, 25% (n=74) in two nutrients, 22% (n=65) in three nutrients, and 14% (n=41) in four nutrients. From the total sample, 58.8% (n=177) had excessive levels of sodium, 56.4% of saturated fats (n= 170), 53% of free sugars (n=159), 49.8% of total fats (n=150), and 2.3% (n=7) had other sweeteners. For each food category, 94% (n=196) of cookies, 92%(n=46) of milk desserts and 47% (n=20) of breakfast cereals contain elevated levels of at least one critical nutrient. For the WHO Europe NP model, most products (91%, n=292) exceeded the nutritional thresholds.

**Conclusions:** Most of the products analysed have high levels of sugars, fats and/or sodium. Policy considerations need to be
made regarding marketing regulation directed to children, the use
of nutrient and health claims and front of package warning labels,
according to the nutrient profile of products in order to inform ad-
equately to consumers empowering them to make healthy choices

**Keywords:** Nutritional quality, Food Labelling, Childhood obesity, Argentina

(1)Mujica, Maria Fernanda; (2)Navarro-Rosenblatt, Deborah; (3)Lopez-Arana, Sandra; (3)Corvalan, Camila.

(1)Faculty of Land and Food Systems. The University of British Columbia. Canada; (2)School of Public Health. University of Chile. Santiago. Chile; (3)Institute of Nutrition and Food Technology (INTA). University of Chile. Santiago. Chile.

**Background and objectives:** Previous research in Latin America shows that socioeconomic status (SES) influences dietary patterns and obesity distribution. However, it is unclear how SES impacts overall nutrition status, in a post-transitional country such as Chile. The objective of this study was to assess the relationship between nutritional status (overweight, short stature and anemia), and two key aspects of SES-income and educational level in adult Chilean population.

**Methods:** Nationally representative data of 1,413 women (20-49y) and 819 men (>49y) from the 2003 and the 2009-2010 Chilean National Health Surveys were included in these secondary analyses. Body mass index (BMI) was categorized as underweight, overweight and obesity according to WHO criteria. Overnutrition was defined as BMI ≥25 kg/m2. Short stature (height <1.49m) and anemia (hemoglobin concentration <12 mg/L) data were assessed only for women. Descriptive statistical analysis and Chi square tests were used to compare prevalence (%; 95% CI) by educational level (low=0-7 y, middle=8-12y, and high>12y) and income tertiles.

**Results:** Overweight [(34.0% (30.1%-38.2%)) in women] and [47.8% (41.5-54.1) in men] and, as well as, obesity [(27.1% (23.5%-30.9) in women] and [28.9 (23.7-34.8) in men], were high while underweight was negligible. Less educated women had higher prevalence of overnutrition (80.2%; 68.8%-88.1%) and short stature (14.9%; 8.5%-13.7%) than higher educated women (49.2%; 40.9%-57.5% and 3.7%; 2.0%-6.9%, respectively) (P<0.05 for both). Poorer women had higher prevalence of short stature (10.1%, 7.4%-13.8%) than richer women (2.2%, 1.0%-5.0%) (P<0.05). Anemia did not differ by SES. In men, nutritional status did not vary by income or educational level (all p>0.05).

**Conclusions:** In a post-transitional country such as Chile we observed SES and gender inequalities in adult nutritional status; this poses important challenges for future nutrition policies.

**Keywords:** Chile, Malnutrition, Inequalities, Obesity, Anemia

**Background and objectives:** The PROMIS program, implemented by HKI, integrated a package of preventive services with monthly screening and referral for acute malnutrition (AM). A one-month supply of small-quantity lipid-based nutrient supplements (SQ-LNS) for children 6-23 months of age served as an incentive to attend screening and behavior change communication (BCC) on nutrition, health, and hygiene. In peri-urban and urban Senegal, we assessed the feasibility of using neighborhood nutrition sites run by community volunteers as the program platform. Feasibility evaluation provides insights to improve implementation and increase potential for impact.

**Methods:** We evaluated feasibility within Bowen's (2009) seven "key areas of focus" along the program's theory of change with individual semi-structured qualitative interviews with purposively selected beneficiary mothers (n=40), volunteers (n=37), and program staff (n=12); and group free listing with 40 opportunistic groups of 5-15 beneficiary mothers.

**Results:** Results across feasibility domains showed that PROMIS was perceived as acceptable by beneficiaries and volunteers. SQ-LNS added value to the program for mothers and demand for program services was also increased by proximity of sites and effective communication on timing of services. Implementation of screening, BCC, and SQ-LNS was overall successful, however, barriers to program utilization included limited motivation, lack of interest in BCC topics, and time constraints. In an effort to reach more beneficiaries with SQ-LNS, some volunteers conducted home visits and/or dropped the requirement of screening and BCC. These modifications limited program practicality. PROMIS' design was inadequately adapted to the time constraints faced by mothers. Sites were affiliated with a health center and integration was ensured through referral of children with AM, health agent supervision and SQ-LNS management. Mothers' recollection of BCC messages revealed that child feeding and hygiene were the most salient, 75% of what they recalled was consistent with recommendations (limited efficacy).

**Conclusions:** We conclude that providing SQ-LNS without the conditionality of screening and BCC indicated a lack of understanding of the program theory of change among volunteers. However, program modifications made by volunteers to reach beneficiaries also

<footnote>(1)Zongrone, Amanda; (2)Le Port, Agnes; (1)Becquey, Elodie;</footnote>

<footnote>(3)Vanderkooy, Anna; (4)Huybregts, Lieven; (5)Diatta, Ampa D;</footnote>

<footnote>(5)Sessou, Eric; (4)Leroy, Jef; (1)Rawat, Rahul; (4)Ruel, Marie.</footnote>

<footnote>(1)PhD. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Senegal.; (2)PharmD. PhD. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Senegal.; (3)BES. Markets, Trade and Institutions (MTID). International Food Policy Research Institute (IFPRI). Senegal.; (4)PhD. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). USA.; (5)MSc. Poverty, Health and Nutrition Division (PHND). International Food Policy Research Institute (IFPRI). Senegal.</footnote>
indicated that the program delivery platform requires further adapta-
tion to a peri-urban and urban setting. Feasibility evaluation provided
valuable insights not easily obtained through other methods.

**Keywords:** feasibility study, small-quantity lipid nutrient sup-
plement, prevention of malnutrition, Senegal

**Conclusions:** FOP single stamp was create to identify nutri-
ents level in Brazilian ultra-processed foods and was based in Mul-
tiple Traffic Light system, and facilitate consumer understanding
of nutritional information. However, FOP stamp does not assur-
ance totally change in food choices.

**Keywords:** Ultra-processed foods. Nutritional Labelling.
Front-of-pack labelling. Consumer survey.

144/2029

FRONT-OF-PACK SYMBOLS AS INDICATOR
OF NUTRIENTS LEVEL IN ULTRA-PROCESSED
FOODS: A BRAZILIAN PROPOSE

(1)Thieme, Rubia Daniela; (2) Thomaz, Ana Cláudia; (3)Czajkowski Jr., Sérgio; (4)Bertoni de Oliveira, Lucimara; (4)Franco, Gabriela; (5)Marchesini, João Caetano.

(1)MSc. Nutritionist. Nutrition Department. Universidade Positivo. Brazil.; (2)Nutritionist. Master student of Postgraduate Program in Food and Nutrition. Universidade Federal do Paraná. Brazil.; (3)MSc. Advertising Professional. Business School. Department Universidade Positivo. Brazil.; (4)BSc. Nutrition Department. Universidade Positivo. Brazil.; (5)MD. Hospital Marcelino Champagnat. Brazil.

**Background and objectives:** Ultra-processed foods contrib-
ute excessively to the energy, fat, sugar and sodium intakes. Nutri-
tion information included in ultra-processed packaged foods may be
confusing. Nutrition labels and front-of-pack (FOP) food labelling
are proposed to provide more accessible and comprehensible nutri-
tion information to consumers and may help consumers to make
more healthy food choices. The objective of this study was to create a
symbol to identify nutrients level in Brazilian ultra-processed foods
and to verify consumer understanding of this information.

**Methods:** Cross-sectional study from Jun 2016 to Dec 2016 with the development of FOP food labelling, and verification of the consumer understanding of it and influence on food choice. The FOP labelling contained nutrition information for total fats, saturated fats, addition sugars, sodium and fiber in packaged beverages and foods. Heathy and unhealthy levels of each particular nutrient were based in United Kingdom and Brazilian legislation for packaged foods. A questionnaire to verify the consumer understanding of nutritional information in the symbol in FOP food labelling and the food choice was applied in a Retail Lab to participants aged >18 years recruited from an university in south of Brazil. Data was shown how means, standard deviation and frequencies.

**Results:** The FOP symbol for identification was a single stamp. The stamp was based in Multiple Traffic Light system: red, yellow and green. The text in each FOP symbol indicated the relative health value of each nutrient in the front-of-pack label: red – Be careful with your heath; yellow – Pay attention with your health; and green – Heathy choice. The questionnaire was answered by 54 individuals, 30.42 ± 13.12 years, 57.41% (n = 31) were women. All participants identified the FOP single stamp and answered that were easier to understand the ultra-processed packaged foods nutritional information with the FOP single stamp. The FOP stamp may influence 88.9% (n=48) of the participants in their food choices.

144/2033

NUTRITION OF WOMEN IN CHILE

(1)Olagnero, Gabriela; (2)Mardones, Francisco; (3)Rosso, Pedro;

(4)Passi Solar, Álvaro; (5)Torres-Robles, Romina; (6)Rozowski, Jaime;

(7)Cantwell Wood, Jennifer.

(1)Nutritionist. BSc. Research and Development. Danone Nutricia. Buenos Aires. Argentina.; (2)MD. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (3)MD. Department of Pediatrics. Pontificia Universidad Católica de Chile. Chile.; (4)BSc. MSc. Chile. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (5)Sistema de Bibliotecas. Pontificia Universidad Católica de Chile. Chile.; (6)PhD. Department of Nutrition. Pontificia Universidad Católica de Chile. Chile.; (7)Nutritionist. MsC. Family Nutrition of the Triad. LLC. Greensboro. NC. USA.

**Background and objectives:** The advanced stage of Chile's nutritional transition implies the increase of obesity prevalence, coexisting with problems caused by underweight, especially in pregnancy. The objective was to diagnose the nutritional and health status of Chilean women of reproductive age and contrasting findings with current nutritional programs.

**Methods:** A comprehensive literature review from the last 15 years, including articles published in peer-reviewed journals and official reports, produced a final list of 85 references.

**Results:** Ultra-processed foods intakes are rising. Changes in food intake play a role in obesity epidemic. Overweight and obesity prevalence are growing in pregnant women population accounting for 29% in early pregnancy, increasing the risk of perinatal complications and metabolic syndrome later in child's life. Furthermore, the beginning of obesity epidemic in the population under 6 years is well documented.

Several micronutrients and omega-3 fatty acids are cited as
deficient. Pregnancy complications including anemia, diabetes,
hypertension, cesarean section and inadequate fetal growth are
frequently found in malnourished women. Implementation of re-
cent national policies might be important to address the situation.
Those policies include micronutrient fortified food supplement
distribution to pregnant women, food labeling changes, sugar
sweetened beverages taxes, and a secondary prevention program
for overweight non-pregnant girls and women.

**Conclusions:** The current study proposes to implement poli-
cies that use a more accurate weight gain chart during pregnancy,
improves in the current fortified food supplements and include a
secondary prevention program for overweight pregnant and nurs-
ing women.
**Keywords:** Nutritional status, adult women, pregnancy, lactation.
**Conflict of Interest Disclosure:** The study was funded by
Danone Nutricia ELN.

144/2038

## THIAMINE-FORTIFIED FISH SAUCE IN RURAL CAMBODIA: VITAMIN STABILITY AND ORGANO-LEPTIC PERCEPTIONS

(1)Whitfield, Kyly C; (2)Karakochuk, Crystal; (3)Moore, Kirsten; (3)Chan, Benny; (4)Kroeun, Hou; (5)Borath, Mam; (6)Sophonneary, Prak; (2)Li-Chan, Eunice CY; (2)Kitts, David D; (7)Green, Timothy J.

(1)Department of Applied Human Nutrition. Mount Saint Vincent University. Canada.; (2)PhD. Food, Nutrition and Health. University of British Columbia. Vancouver. Canada.; (3)BSc. Food, Nutrition and Health. University of British Columbia. Vancouver. Canada.; (4)MPH. Helen Keller International Cambodia Country Office. Phnom Penh. Cambodia.; (5)MMgt. National Sub-Committee for Food Fortification. Ministry of Planning. Phnom Penh. Cambodia; (6)MD. National Nutrition Programme of Maternal and Child Health Centre. Ministry of Health. Phnom Penh. Cambodia; (7)PhD. South Australian Health and Medical Research Institute. Adelaide. Australia.

**Background and objectives:** Background: In Cambodia and throughout Southeast Asia, potentially fatal infantile beriberi occurs because thiamine-deficient mothers produce thiamine-poor breast milk. To prevent this thiamine deficiency in breastfed infants, we developed a novel thiamine-fortified fish sauce with the aim of improving maternal thiamine intake during pregnancy and lactation. We formulated two thiamine-fortified fish sauces: low concentration (low; 2 g thiamine hydrochloride (THCI)/L) and high concentration (high; 8 g/L).

**Objective:** To test the stability of thiamine in fish sauce during typical storage and use in rural Cambodian households, and after exposure to sunlight, oxygen, and heat in the laboratory. Also, to examine consumer acceptability through sensory evaluation of thiamine-fortified fish sauces compared to a control sauce containing no thiamine.

**Methods:** Thiamine-fortified fish sauce was exposed to sunlight, oxygen, and sunlight + oxygen for up to 21 days, and heat (100°C) for up to 35 minutes. Sensory evaluation was conducted among 90 women (18-45 y) in Prey Veng, Cambodia using the Triangle Test, Paired Preference Test, and a Nine Point Hedonic Scale.

**Results:** Mean ± SD THCI in low and high fish sauce household samples was 2.3 ± 0.4 and 9.7 ± 1.0 g/L (n=53 each), respectively. Sunlight, oxygen, sunlight + oxygen, and heat exposure caused ≤10% degradation in samples. Women enjoyed the taste of all fish sauces, and only 30 (33%) correctly identified the different sample in the Triangle Test, suggesting that the fish sauces were not discernible. More than 65% of women liked the sauces (scores ≥6 on a Nine-Point Hedonic Scale).

**Conclusions:** Thiamine is stable in a fish sauce matrix, and thiamine-fortified fish sauce is acceptable to rural Cambodian consumers, highlighting the potential of fish sauce as an ideal thiamine

fortification vehicle to increase maternal thiamine intake to combat infantile beriberi.

**Keywords:** thiamine; fish sauce; fortification; stability; sensory

**Further collaborators:**
Xiu-Min Chen. PhD. Food, Nutrition, and Health. University of British Columbia. Vancouver. Canada.

Larry D Lynd. PhD. Pharmaceutical Sciences, University of British Columbia. Vancouver. Canada.

Aminuzzaman Talukder. MPH. Helen Keller International Cambodia Country Office. Phnom Penh. Cambodia.

Ly Sokhoing. MPH. Helen Keller International Cambodia Country Office. Phnom Penh. Cambodia.

144/2041

## THE ECONOMIC BURDEN OF NOT MEETING FOOD RECOMMENDATIONS IN CANADA

(1)Lieffers, Jessica; (2)Ekwaru, John Paul; (3)Ohinmaa, Arto;

(3)Veugelers, Paul.

(1)PhD. RD. Postdoctoral Fellow. Population Health Intervention Research Unit. School of Public Health. University of Alberta. Canada; (2)PhD. Biostatistician. Population Health Intervention Research Unit. School of Public Health. University of Alberta. Canada; (3)PhD. Professor. Population Health Intervention Research Unit. School of Public Health. University of Alberta. Canada.

**Background and objectives:** Healthy lifestyles (e.g., healthy eating, smoking cessation, physical activity) can often prevent chronic diseases (CD) (e.g., type 2 diabetes, cardiovascular diseases, cancers). Public health professionals have difficult choices to make when deciding on resource allocation for CD prevention programs. Estimates of the economic burden of CD due to lifestyle factors are insightful for these professionals and exist for smoking, obesity and physical activity; however, only a few estimates exist for healthy eating. The purpose of this study was to estimate the economic burden of CD attributable to not meeting food recommendations in Canada.

**Methods:** Foods identified by the Global Burden of Disease Study (GBD) as being either protective (1. vegetables; 2. fruit; 3. whole grains; 4. milk; 5. nuts and seeds) or detrimental (6. processed meat; 7. red meat; 8. sugar-sweetened beverages) in terms of CD risk were included. Risk estimates were obtained from the GBD. Usual intake distributions for these foods were obtained from the 2004 Canadian Community Health Survey 24-hour dietary recalls (n=33,932 respondents). Canada's Food Guide (or other relevant) recommendations were used. Population attributable fractions (PAF) that accounted for both independent risk factor contributions and multiple exposure levels were calculated. Annual direct health care (hospital, drug, physician) and indirect (human capital approach) costs in 2014 for relevant CDs were obtained from the National Health Expenditure Trends and Economic Burden of Illness. PAF outcomes were multiplied by these costs to estimate those attributable to diet.

**Results:** Not meeting recommendations for the eight foods is responsible for ~CAD$17.4 billion/year (direct health care costs:
~CAD$6.5 billion; indirect costs: ~CAD$11.0 billion). Males were responsible for ~2/3 of these costs. The top contributors to these costs were inadequate nuts and seeds, inadequate whole grains, excess processed meat, and inadequate fruit.

**Conclusions:** In Canada, the costs of not meeting food recommendations are similar to smoking and higher than physical activity. These findings also suggest prioritization to dietary factors such as nuts and seeds and whole grains is potentially warranted. This research will ultimately help public health professionals make better-informed decisions to improve population health, reduce health care costs and protect workforce productivity.

**Keywords:** chronic disease, burden of disease, economics, population attributable fraction

144/2042

THE RELATIONSHIP OF FOOD INSECURITY AND THE NUTRITIONAL STATUS OF MEXICAN MOTHER-CHILD PAIRS

(1)Shamah-Levy, Teresa; (2)Mundo Rosas, Veronica; (2)Morales-Ruán, María del Carmen; (2)Cuevas Nasu, Lucía; (3)Méndez Gómez-Humarán, Ignacio.

(1)PhD. Researcher. Center for Nutrition and Health Research. National Institute of Public Health. México.; (2)MSc. Nutritionist. Center for Nutrition and Health Research. National Institute of Public Health. México; (3)MSc. Statistician. Mathematics Research Center. Aguascalientes Unit. México.

**Background and objectives:** Previous studies have suggested a link between obesity and HFI (Household food insecurity); especially among adult women [8-10]. Specifically, it has been documented that women who experience food insecurity are more likely to be obese when compared with those from households with food security. HFI has been associated with overweight mothers and underweight children living in the same households. Adult obesity has been linked to both obesity and undernutrition in children.

The objective was to examine the association between HFI and child stunting risk and to determine if maternal-child overweight/obesity modifies the relationship between HFI and stunting risk.

**Methods:** We assessed the association of HFI with the nutritional status of mothers and their <11-year-old children based on data from the Mexican National Health and Nutrition Survey (ENSANUT 2012). The study included 5,087 mother-preschool child pairs and 7,181 mother school aged child pairs. HFI was measured with the Latin American and Caribbean Food Security Scale (ELCSA). We calculated the prevalence (95% CI) of each HFI category by socioeconomic characteristic and maternal-child nutritional status. Multiple logistic regressions were used to examine the associations of interest adjusting by pertinent covariates.

**Results:** There was a higher prevalence of stunting among preschool children with moderate HFI (16.2%) or severe (16.8%) (p=0.036 and p=0.007, respectively), compared with mild or no HFI (13.2 and 10.7%). A significant interaction was found between maternal obesity status and HFI on stunting among pre-

school children (p<0.05). HFI severity increased the risk of school aged children stunting among non-obese mothers but not among obese mothers.

**Conclusions:** An intriguing finding from our study is that among preschoolers HFI severity increased their risk of stunting if their mothers were not obese. However this was not the case if their mothers were obese. The double burden of malnutrition in Mexico occurs most notably among mother child pairs living with HFI. Food security government policies and programs need to take into account these complex relationships in the context of an advanced nutrition transition.

**Keywords:** Food insecurity; obesity, under nutrition; nutrition transition; Mexico

**Further collaborators:**

Marco Antonio Ávila Arcos. BSc. Center for Nutrition and Health Research. National Institute of Public Health. México.

144/2044

PREVALENCE OF UNHEALTHY LUNCHBOXES IN PERUVIAN PRIMARY SCHOOL

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

(1)Doctora en Salud Publica. Centro Nacional de Alimentación y Nutricion.Instituto Nacional de Salud. Departamento de Medicina Preventiva y Salud Publica. Universidad Nacional Mayor de San Marcos. Peru; (2)Nutricionista. Centro Nacional de Alimentación y Nutrición. Instituto Nacional de Salud. Peru.

**Background and objectives:** The consumption of unhealthy food has increased in the world and Peru.

**Objective:** To determine the prevalence of unhealthy lunchboxes in Peruvian schoolchildren at the primary level.

**Methods:** Cross-sectional study. Probabilistic sampling, stratified and multistage. The calculated sample size was 5223 students. Unhealthy lunchbox defined as the missed of a fruit, drink and healthy complement (low in sugar, salt and oil) according to Peruvian law, it was evaluated by observation. The analysis was performed using complex samples adjusted by weighting factor. It was calculated percentages, confidence interval of 95% and chi square. The formal authorization from the principal, teachers, parents were requested, additionally refer consent was requested to students ≥ 9 years.

**Results:** The 100% of children carried drinks, 68.2% food complements, 38.6% fruit y 6.4% candies. The prevalence of unhealthy lunchboxes was 94.6%. The percentage of children bringing unhealthy drinks was 89.6 and 44.7% carried unhealthy complements. In the urban area, the highest prevalence of unhealthy drink was 82.2% and 89.9% of unhealthy complements. The schoolchildren who resided in Lima Metropolitan had 33.4% of unhealthy drinks and 45.9% of unhealthy complements. Children who resided in the cost had 27.7% of unhealthy drinks and 26.8% of unhealthy complements. The drink most consumed were soda or artificial nectar (15.8%), water or sugar-free drink (10.4%), and
natural fruit soda with sugar (10.1%). The complement most consumed were the Sandwich with jams, butter, cheese, chicken, hamburger (21.6%), cookies (17.2%) and preparation make in home as Steak (14.9%) and yogurt (9.5%).

**Conclusions:** The prevalence of unhealthy lunchboxes in Peruvian schoolchildren is high, predominating in urban areas, Metropolitan Lima and the Peruvian coast

**Keywords:** Food; Fruit; Water, Drinking; School Health; Diet; Food; and Nutrition.

144/2045

NUTRITIONAL STATUS AND FAMILY SOCIOECONOMIC LEVEL OF CHILDREN ATTENDING A SELECTED SCHOOL

**Background and objectives:** The growth and development of a child and its health trajectory are closely linked to its nutritional status (NS), suggesting that the latter could reflect the family socioeconomic and cultural level. Therefore, we set out to identify the NS and the socioeconomic level (SEL) of children Basic School No. 264 of the city of San Lorenzo, Paraguay.

**Methods:** The research was framed in the Institutional Project "Healthy Child Healthy Country" of the Faculty of Chemical Sciences, which in 2015 helped school No. 264. The sample consisted of 41 students between 5 and 12 years old. We evaluated the NS of the children through the Body Mass Index for age (BMI / E) and height for age (T / E) from the WHO 2007 standart. We used the SEL index of the Mexican Association Of Market Intelligence and Opinion (AMAI). We collected the anthropometric data in the school and the socioeconomic survey we do it to the heads of the home in their respective houses.

**Results:** Children had a mean age of 9.3 ± 1.7 years, mean weight of 27.4 ± 9 kg, mean height of 121.1 ± 13.7 cm and mean BMI of 17 ± 2.7 kg / m2. According to IMC / E, 68.3% of the children were eutrophic and 24.4% were overweight or obese, while for age (T / E), 75.6% of the children were of normal height. 58.5% of the families were of the low SEL. We found that in the high NSE 73.1% of the children were eutrophic vs 60% in the low NSE, the excess weight was higher in the high NSE than in the low NSE (33.3% vs 19.2%). Finally, 6.7% of the children had low stature in the high SES vs. 3.8% in the low SES.

**Conclusions:** We found that cases of excess weight and risk of stunting coexist in children in the high NSE of the school No. 264.

**Keywords:** Nutritional status, socioeconomic level, children, double burden

**Further collaborators:**

Laura Elizabeth González Céspedes

144/2050

THE HEALTHY KITCHENS, HEALTHY CHILDREN STUDY; A COMMUNITY-BASED SCHOOL NUTRITION INTERVENTION IMPROVES DIET DIVERSITY IN PALESTINIAN REFUGEE SCHOOLCHILDREN IN LEBANON

**Background and objectives:** Palestinian refugees in Lebanon are protracted refugees with high rates of food insecurity and low diet quality. In this context we implemented a school nutrition intervention that consisted of a subsidized nutritious snack, plus nutrition education in two elementary schools. We assessed the impact of this intervention on diet diversity and nutritional status of schoolchildren receiving the intervention as compared to children attending two neighboring schools who only received the nutrition education component.

**Methods:** We collected socio-demographic and nutrition status data from 1433 students (aged 5-15y) and their parents at baseline, and 1362 at 8-months follow-up in 4 schools. Snacks were sold at a subsided price, 5 days a week in two intervention schools. We conducted a difference in difference analysis for diet diversity and hemoglobin levels of children who participated in the intervention at least 50% of the time (high-participation) as compared to those who participated less than 50% (low-participation), or who only received nutrition education (control). Analyses were adjusted for child age and gender, maternal education, household expenditure and school cluster effect.

**Results:** There were 648 children in the control group, 260 children in the low-participation group, and 454 in the high-participation group. After adjusting for co-variates, there was a significantly greater increase in overall diet diversity score in the high-participation group than in controls (p=0.016), but not in the low-participation group. However, both low and high-participation groups had higher odds of consuming meat or chicken as compared to control; OR=1.8; p=0.000 and OR= 2.1; p=0.006 respectively. The high-participation group also had higher odds of consuming dairy (OR = 1.22; p=0.000), and lower odds of consuming sweetened beverages (OR= 0.73; p=0.015) and desserts (OR= 0.57; p=0.011) than control. Both low and high-participation groups had inversely and significantly changes in hemoglobin (Δ=+1.6mg/dl) as compared to the control group (Δ = -1.0mg/dl); p=0.05.

**Conclusions:** A community-based school nutrition intervention improved diet diversity and hemoglobin levels of refugee children that had participation level above 50%.

<footnote>(1) Araujo Pino, Silvia Stella; (2) Ruiz Díaz Quintana, Edith Victoria;</footnote>

<footnote>(2) Velázquez López, Wilma Noelia; (1) Morínigo Martínez, Macarena.</footnote>

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

<footnote>(2) Nutritionist. Faculty of Chemical Sciences. National University of Asuncion. Paraguay.</footnote>

<footnote>(1) Jamaluddine, Zeina; (2) Ghattas, Hala; (3) Choufani, Jowel;</footnote>

<footnote>(4) Sahyoun, Nadine.</footnote>

<footnote>(1) M.S.Research assistant. Center for Research on Population and Health. American University of Beirut. Lebanon; (2) PhD. Assistant Research Professor. Center for Research on Population and Health. American University of Beirut. Lebanon; (3) MPH. Senior Research Assistant. Environment and Production Technology Division. International Food Policy Research Institute. US; (4) PhD. Professor. Department of Nutrition and Food science. University of Maryland. US.</footnote>
**Keywords:** Refugees, community-based, school nutrition intervention, diet diversity

**Conflict of Interest Disclosure:** This study was funded by the Nestle Foundation for the study of problems of nutrition in the world.

144/2058

BASELINE AND PROCESS EVALUATION ANALYSIS OF A RURAL NUTRITION-SENSITIVE INTERVENTION WITHIN THE FIRST 1000-DAY WINDOW OF OPPORTUNITY IN CENTRAL AMERICA AND DOMINICAN REPUBLIC, 2016-2019

(1)Perez, Wilton; (2)Roman, Ana Victoria; (3)Roldan, Evelyng; (4)Siu, Carolina.

(1)PhD. Epidemiologist. Department of monitoring and evaluation. Institute of Nutrition of Central America and Panama. Guatemala; (2)PhD. Food Science and Technology. Institute of Nutrition of Central America and Panama. Guatemala; (3)MSc. Nutritionist. Nutrition and Micronutrient Department. Institute of Nutrition of Central America and Panama. Guatemala; (4)MSc. Public Health. Direction. Institute of Nutrition of Central America and Panama. Guatemala.

**Background and objectives:** The first 1000-day window of opportunity is a crucial period for largest and efficient impact of food and nutritional interventions to reduce malnutrition in poor-resourced settings. Nutrition-sensitive interventions as agriculture have the potential to improve several determinants of food and nutrition status through the promotion of dietary diversity, household income improvement and women's empowerment. However studies that assess the impact in rural settings of Central America and Dominican Republic are lacking. In this study the aim is to determine the baseline level of food insecurity, agricultural food production capacity that will allow to generate evidence to support the implementation of an intervention focused on pregnant women and mothers with children less than 24 months old in rural areas of Central America and Dominican Republic.

**Methods:** A multi-component intervention was designed to increase agricultural management production of foods and improve family economy and to assess the impact on food and nutrition security for a three-year period, 2016-2019. Target communities were randomly selected from high-cluster of child growth retardation in seven countries. Around 850 rural families are expected to enrol. For baseline, food insecurity scale and socio-demographics factors were determined. An adequacy approach was used to evaluate the level of implementation of the project in areas of home gardening, educational activities on health and nutrition, agricultural practices, nutritional policy advocacy.

**Results:** One-third of the enrolled participants have a primary education level. Access to safe drinking water is reported in almost half of the households. Wood is the main fuel for cooking. Almost all families perform agricultural activities, but formal agricultural training to use local production for consumption is almost null.

Climate risk management training was found scarce and food insecurity affects almost one-fifth of the rural families.

**Conclusions:** Rural families in Central America and Dominican are highly vulnerable to food and nutritional insecurity. This situation may be worse in rural communities where lack of climate mitigation strategies is limited. Baseline information has been useful to design and strengthen capacities and enhance local food production of high nutritional value for self-consumption.

**Keywords:** Agriculture, 1000-day, food insecurity, intervention

**Further collaborators:**

MSc. Leopoldo Espinoza. Public Health. Institute of Nutrition of Central America and Panama. Guatemala

144/2059

A SYSTEMATIC REVIEW AND META-ANALYSIS EXAMINING THE EFFECT OF DIET ON COGNITIVE FUNCTION IN COGNITIVELY HEALTHY ADULTS

(1)McEvoy, Claire; (2)Leng, Yue; (3)Peeters, Geeske; (4)Krup, Allison;

(2)Allen, Isabel; (5)Yaffe, Kristine.

(1)PhD. Visiting Research Fellow. Department of Psychiatry. University of California San Francisco. USA; (2)1)PhD. Department of Psychiatry. University of California San Francisco. USA; (3)1) PhD. Global Brain Health Institute. Trinity College Dublin. Ireland; (4)3)PhD. Department of Psychiatry. University of California San Francisco. USA; (5)1)MD. Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics. University of California. San Francisco. USA.

**Background and objectives:** Cognitive impairment is a major public health concern due to increasing prevalence, high morbidity and rising socioeconomic burden. Modifying dietary behaviour could be a promising way to reduce age-related cognitive decline, however findings from clinical trials have reported inconsistent results. The objective of this systematic review was to examine the effectiveness of diet interventions on domains of cognitive function in adults without known cognitive impairment.

**Methods:** PubMed, EMBASE and PsycINFO were systematically searched to December 2016 to identify randomised controlled trials (RCTs) that examined the effect of diet on cognitive function or dementia events in cognitively healthy adults > 18 years. Data extraction and Cochrane risk of bias for included RCTs were performed by two independent reviewers. Standardized mean differences (95% CI) were combined, using a random-effects meta-analysis.

**Results:** Fourteen RCTs in 6370 participants (3333 diet intervention and 3037 control) were included. Diet significantly improved performance on measures of global cognition (SMD = 0.16; 95% CI 0.02, 0.30, P = 0.02), executive function (SMD = 0.11; 95% CI 0.04, 0.18, P = 0.003) and information processing speed (SMD = 0.12; 95% CI 0.05, 0.19, P = 0.001) compared to control. Significant heterogeneity (I2 = 79%) and funnel plot asymmetry was detected only for global cognition. RCTs were graded as low (n = 1,7%), moderate (n = 7, 50%) or high (n = 6, 43%) risk of bias.
**Conclusions:** The pooled analysis of available RCT data showed small positive effects of diet on non-memory cognitive domains in adults without known cognitive impairment. Further studies are required to determine the therapeutic potential of diet on rate of cognitive decline and for dementia prevention.

**Keywords:** Diet, cognitive function, meta-analysis

144/2064

GENDER DIFFERENCES IN OBJECTIVELY MEASURED PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR PATTERNS AMONG MOROCCAN CHILDREN

(1)Baddou, Issad; (1)El Harchaoui, Imane; (2)Benjeddou, Kaoutar; (3)El Kari, Khalid; (1)Saeid, Naima; (4)Elmzibri, Mohamed; (3)El Hamdouchi, Asmaa; (5)Aguenaou, Hassan.

(1)PhD Student. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco; (2)PhD Student. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco; (3)PhD. Nutrition reseracher. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco; (4)PhD. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco; (5)Prof. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.

**Background and objectives:** Physical activity (PA) in childhood plays an important role in reducing the risk of cardiovascular health diseases, diabetes and obesity in adulthood. According to this evidence, it has been recommended for children to participate in at least 60 minutes per day in Moderate-to-Vigorous PA (MVPA). The present study examined gender differences in objectively measured sedentary behavior, physical activity, and physical activity guideline attainment among Moroccan children.

**Methods:** In total, 173 children 49.1% are boys, aged between 8 to 14 years old participated in this study. To assess PA, children wore triaxial accelerometer for 7 consecutive days and had at least 4 days wearing with minimum 10 h-wearing time per day.

**Results:** Participant spent 533.16± 87.82(min/day) in sedentary behavior accounted for 62.8% of average daily wearing time. Boys were more physically active and took more steps/day than girls,(11632.88±3713.41 vs 9526.05±2870.84 min/day, p <0.001). Girls spent equal time in sedentary than boys (258.65±51.18/day vs 258.54±50.70min/day; p=0.421). Boys were eight times more likely to meet physical activity guidelines than girls (OR: 8.06, 95% CI: 4.03–16.13) p<0.0001.

**Conclusions:** Boys engaged in more physical activity and were more likely to attain guidelines than girls. These findings highlight the need for effective and sustainable strategies and programs aim-

ing to promote physical activity and to reduce sedentary behavior among Moroccan children, specially for girls.

**Keywords:** Accelerometry. Children. Physical activity. sedentary time.

144/2065

HEALTH BENEFITS AND COST SAVINGS OF TWO WEIGHT LOSS INTERVENTIONS: DIETARY COUNSELLING BY PRACTICE NURSES AND PROMOTING SMARTPHONE WEIGHT LOSS APPS

(1)Cleghorn, Christine; (2)Wilson, Nick; (3)Nair, Nisha; (4)Kvizhinadze, Giorgi; (4)Nghiem, Nhung; (3)McLeod, Melissa; (5)Blakely, Tony.

(1)PhD. Research Fellow. Department of Public Health. University of Otago. Wellington. New Zealand.; (2)MPH. Professor. Department of Public Health. University of Otago. Wellington. New Zealand; (3)MPH. Senior Research Fellow. Department of Public Health. University of Otago. Wellington. New Zealand; (4)PhD. Research Fellow. Department of Public Health. University of Otago. Wellington. New Zealand; (5)PhD. Professor. Department of Public Health. University of Otago. Wellington. New Zealand.

**Background and objectives:** Obesity is an important risk factor for many chronic diseases which cause premature death, reduce quality of life and are expensive for health systems. Dietary counselling by practice nurses and mHealth interventions are two approaches which can offer information and support to those attempting to lose weight. Here we model the effect of these two interventions on health gain (quality-adjusted life-years (QALYs)) and health system costs.

**Methods:** The modelled interventions were a mHealth promotion intervention using currently available smartphone apps and dietary counselling by dietician trained practice nurses. A multi-state life-table model was used to project all-cause mortality and morbidity rates by sex and age for the New Zealand population (including Māori, indigenous population). It includes 14 Body Mass Index related disease life-tables, where proportions of the modelled population simultaneously reside. The change in incidence in these disease life-tables flows through to impact on mortality and morbidity to change QALYs and associated health system costs.

**Results:** The smartphone app promotion intervention was estimated to generate 150 QALYs (95%UI: 100 to 210) over the lifetime of the population. It also generated US$2.7 million [m] (95%UI: 1.7 to 4.0m) in savings to the health system. Greater impacts were seen from dietary counselling by practice nurses with 1350 QALYs gained (95%UI: -230 to 3110) and cost-savings of US$22.1m (95%UI: -4.0 to 51.7m), however the uncertainty interval includes zero indicating that this intervention may not generate health gains. Those individuals receiving the intervention could expect to increase their average number of days lived in good health by approximately 1 day for the mHealth intervention and 2 days for the counselling intervention.
**Conclusions:** In this modelling study, these two weight loss interventions were associated with relatively small health gains at a population level. Nevertheless, these are likely to be cost-saving interventions, especially the mHealth one, and could therefore still form a small component of a wider obesity reduction strategy (especially if app quality and uptake increases in the future). However, other strategies to change the obesogenic environment (marketing controls, taxes/subsidies etc.) are more effective in controlling obesity in this type of developed country.

**Keywords:** Weight loss; Cost-effectiveness modelling; Smart-phone apps; Dietary counselling.

144/2069

IMPACT OF SOCIOECONOMIC FACTORS ON
THE SPANISH POPULATION'S PERCEPTION
ON BODY COMPOSITION: RESULTS FROM THE
ANIBES STUDY

(1)Partearroyo, Teresa; (2)Samaniego-Vaesken, Mª de Lourdes; (3)Ruiz, Emma; (4)Aranceta, Javier; (5)Gil, Ángel; (6)González-Gross, Marcela; (7)Ortega, Rosa M; (8)Serra-Majem, Lluis; (9)Varela, Gregorio.

(1)PhD. Pharmacist. Department of Pharmaceutical & Health Sciences. Faculty of Pharmacy. CEU San Pablo University. Soain;
(2)PhD. Nutritionist. Department of Pharmaceutical and Health Sciences. Faculty of Pharmacy. CEU San Pablo University. Madrid. Spain; (3)Nutritionist. Spanish Nutrition Foundation (FEN). Madrid. Spain; (4)PhD. Physician. Department of Preventive Medicine and Public Health. University of Navarra. Pamplona, Spain.; (5)Prof. Biologist. Department of Biochemistry and Molecular Biology II and Institute of Nutrition and Food Sciences. University of Granada. Granada. Spain; (6)Prof. Pharmacist. ImFINE Research Group. Department of Health and Human Performance. Technical University of Madrid. Spain; (7)Prof. Pharmacist. Department of Nutrition. Faculty of Pharmacy. Madrid Complutense University. Madrid. Spain; (8)PhD. Physician. Research Institute of Biomedical and Health Sciences. University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria. Spain.; (9)Prof. Pharmacist. Department of Pharmaceutical and Health Sciences. Faculty of Pharmacy. CEU San Pablo University. Madrid. Spain.

**Background and objectives:** Background: The increase in obesity prevalence is well known and many factors can play an important role in its development. The relative contributions of energy intake and expenditure to the obesity epidemic, however, remain poorly defined in Spain. Moreover, few studies in our country undertake the investigation of subject's perception on their nutritional status and its relation with socioeconomic status in the Spanish population.

**Objectives:** To analyse the relevance of perception, attitudes and socioeconomic status in relation to body composition

**Methods:** A total of 209 individuals (1,013 men, 996 women), aged 9-75 years from the ANIBES cross-sectional Study using a nationally-representative sample from the Spanish population

was studied. The following variables were investigated: age groups, gender, geographical distribution, locality size, unemployment rate, percentage of foreigners, education or economic level, anthropometric factors Anthropometry measurements (weight, height, body mass index, waist circumference, % body fat, % body water), perceived health, quality of life and diet.

**Results:** Body fat percentage (%) decreases with increasing habitat size, population density ($\chi^2$ =0,042) and socioeconomic status ($\chi^2$ =0,000). Individuals have a clearer perception of their weight ($\chi^2$ =0,000) as well as their diet ($\chi^2$ =0,000) related to body fat composition. A better health status perception is observed in subjects with lower BMI values, while higher BMI subjects declare a higher effort to improve their diets ($\chi^2$ =0,004). At normal BMI values, better perception of weight and diet ($\chi^2$ =0,000) and at lower BMIs, subjects declare higher number of hours of sleep ($\chi^2$ =0,000).

**Conclusions:** Self-reported perception on diet and health status are associated with an adequate body image in the Spanish population. In addition, subjects living in cities with higher population density and having a better socioeconomic status present lower obesity prevalence.

**Keywords:** Body Mass Index, Obesity, perception, socioeconomic status

144/2071

THE PARTICIPATION OF NUTRITIONISTS AS A
SOURCE OF INFORMATION FOR PRESS ARTI-
CLES RELATED TO OBESITY, PUBLISHED DUR-
ING THE YEARS 2008-2013 IN COLOMBIA

(1)Correa-Madrid, María Camila; (2)Isabel Cristina, Carmona Garcés; (3)González-Zapata, Laura Inés.

(1)Nutritionist. Universidad de Antioquia. Colombia.;
(2)Nutritionist. MSc Educación. Profesora Asistente. Escuela de Nutrición y Dietética. Universidad de Antioquia. Grupo de Investigación Interdisciplinaria en Educación para la Salud y Educación Nutricional. GIESEN. Universidad de Antioquia. Colombia; (3)PhD. Nutritionist. School of Nutrition and Dietetics. University of Antioquia. Medellín. Colombia.

**Background and objectives:** Overweight and obesity are a public health problem in Colombia. By 2010 one in two colombians had one of these problems. One of the functions of the mass media is to mobilize society around this topics and is very important the participation of nutritionists as a part of the nutrition education in these kind of communication channels. The aim of this paper is to describe the participation of nutritionists as a source of information supporting the publication of articles about obesity in newspapers during the years 2008-2013.

**Methods:** Cross-sectional study. 163 news were selected from two newspapers; 48 from El Espectador and 115 from El Colombiano. A descriptive analysis was performed using X2 tests to establish the relationship between the variables of interest. $\alpha$ = 0.05. SPSS v.18.
**Results:** During the study period a gradual increase in news related to obesity was found. The most used source of information in the news was scientific-academic (42.3%) and only 6.7% of the articles used nutritionist as a source. When a nutritionist was used as a source to produce the news, there is not an association between the topic and the source.

**Conclusions:** The newspaper articles related with obesity increased in Colombia. The challenge for nutritionists is to gain participation in mass media like press, in order to achieve the objectives around the prevention and control of this issue.

**Keywords:** Obesity; press; mass media; health communication.

al characters, and 2% (n=1) of breakfast cereals, 16% (n=33) of cookies and 42% (n=21) of milk desserts included premium offers.

Products with one excess nutrient (PAHO NP model) had significantly more promotional characters and premium offers (p<0.0005). Only 23% (n=9) without excess nutrients included promotional characters and 3% (n=1) included premium offers.

**Conclusions:** Promotional characters and premium offers are used to promote unhealthy food products in Argentina. Evidence-based public health policies should restrict the use of these marketing techniques on products with high levels of sugars, fats and/or sodium, especially when children are exposed to them.

**Keywords:** Childhood obesity, Marketing, Food Packaging, Nutritional Quality, Argentina

144/2072

## USE OF MARKETING TECHNIQUES ON A SELECTED SAMPLE OF FOOD PACKAGES IN ARGENTINA

(1)Allemandi, Lorena Andrea; (2)Castronuovo, Luciana; (3)Tiscornia, Maria Victoria; (4)Gutkowski, Patricia; (5)Nessier, Celeste; (5)Gijena, Julieta.

(1)BSc. Public Health. Fundación InterAmericana del Corazón Argentina. Argentina.; (2)PhD. Sociology. Fundación InterAmericana del Corazón Argentina. Argentina.; (3)BSc. Nutritionist. Fundación InterAmericana del Corazón Argentina. Argentina.; (4)BSc. Communication Science. Fundación InterAmericana del Corazón Argentina. Argentina.; (5)MSc. Nutritionist. Universidad Catolica de Santa Fe. Argentina.

**Background and objectives:** Marketing of unhealthy foods plays an important role in the rising prevalence of childhood obesity. Product packaging is a significant marketing method. The objective of our study was to investigate marketing techniques (characters and premium offers) used on food packages of a selected sample of products.

**Methods:** Data for breakfast cereals, cookies and milk desserts was collected at a major supermarket chain in Argentina in June 2016. Pictures were taken on the front, sides and back of all products, including Nutrition Information Panel (NIP) and ingredient list. We translated and adapted the internationally standardised International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) protocol. Pictures and nutrient data from the NIP were entered into a food database designed and tested for this study. For the analysis of nutritional quality we used the PAHO and the WHO Europe nutrient profiles (NP) models. Statistical analysis were conducted using R Statistical software.

**Results:** We analyzed 301 food packages: 42 breakfast cereals, 209 cookies and 50 milk desserts. Premium offers were found in 18% (n=55) of all products, 45% of this were found on the front side of the packages (n=25). Promotional characters appeared on 32% (n=95) of all products, of those 69% (n=56) appeared on the front side of the package.

In each category, 62% (n=31) of breakfast cereals, 25% (n=52) of cookies and 62% (n=31) of milk desserts featured promotion-

144/2073

## NUTRITIONAL STATUS OF THE PEOPLE ASISTED IN THE PRIMARY LEVEL HEALTH SERVICES IN MONTEVIDEO AND INLAND OF URUGUAY

(1)Elichalt, Marta; (2)Gronros, Diana.

(1)MSc. Nutritionist. Nutrition School. University of the Republic. Uruguay.; (2)Nutritionist. Nutrition School. University of the Republic. Uruguay.

**Background and objectives:** To characterize the nutritional status (NS) of the assisted population in primary care services in Montevideo and inland between April and November 2016. To compare the type and magnitude of the nutritional problems between services of Montevideo and its inland, and between services of Montevideo, according to municipal grouping based on the proportion of poor families (PF).

**Methods:** The information collected by the students in the last year of the Nutrition Degree was systematized, and they applied a survey with Google forms. The information collected was: sex, age, reason for referral, anthropometric diagnosis and service. The NS in children was assessed by anthropometric indicators and compared with WHO standard on 2006. In adults, the body mass index was used and compared with the WHO reference on 1998. The services were grouped by location considering the municipal division of Montevideo according to the proportion of FP by level of income.

**Results:** The assisted population was 1982 corresponding to 17 services. Of all, 75% were women and almost half were over 18 years of age. 50% of referral reasons were Non-Communicable Diseases. Over-malnutrition exceeded the value identified in studies at the national level in one-third of services. Deficit malnutrition varied in services between 5% and 20%. In children under 18, the prevalence of malnutrition due to deficit and excess was bigger than in other national studies. There are important differences in malnutrition due to deficit and excess in adults and children among services with a higher proportion of PF.

**Conclusions:** There are problems of excess and deficit that surpass the national data. The nutritional stage in which the user is captured and the proportion of PF are probably determinants
of the type and magnitude of the nutritional problems found in
nutritional care.

**Keywords:** nutritional care, poverty, nutritional problems

144/2075

THE EFFECT OF PEER SUPPORT ON CARDIOVASCULAR RISK FACTORS: A META-ANALYSIS

(1)McEvoy, Claire; (2)McAuley, Emma; (3)Moore, Sarah; (4)Cupples, Margaret; (5)Kee, Frank; (6)Young, Ian; (3)McKinley, Michelle;

(3)Woodside, Jayne.

(1)PhD. Centre for Public Health. Queen's University Belfast. UK;

(2)Medical Student. Centre for Public Health. Queen's University Belfast. UK; (3)PhD. Centre for Public Health. Queen's University Belfast. UK; (4)MD. Centre for Excellence in Public Health. Queen's University Belfast. UK; (5)MD. Centre for Excellence in Public Health. Queen's University Belfast. UK; (6)MD. Centre for Public Health. Queen's University Belfast. UK.

**Background and objectives:** Diet interventions are effective for prevention of cardiovascular disease (CVD) but are generally resource intensive and prohibitively expensive to scale-up for wider public health benefit. Social support provided by lay people (peer support) is an alternative low-cost approach to facilitate self-management of diet behaviour, but the effect of peer support on health outcomes is not clear. This systematic review aimed to evaluate the effect of peer support on CVD risk.

**Methods:** PubMed, EMBASE and CINAHL were systematically searched to identify randomised controlled trials (RCTs) addressing the effect of peer support on CVD risk factors including, obesity, markers of diabetes risk, blood pressure and blood lipid levels in adults > 18 years. Data extraction and assessment of bias were performed by two independent reviewers and data were pooled using a random-effects meta-analysis.

**Results:** Twenty-six RCTs were included in the review. Peer support showed significant improvements in glycaemic control (HbA1c -0.22% [95% CI -0.40, -0.04] P = 0.02) and obesity (BMI -0.83kg/m2 [95% CI -1.58, -0.07], P = 0.03) in comparison to control, with evidence of significant heterogeneity across studies (I2 = 49%, and 59% respectively) and funnel plot asymmetry. There was no significant effect of peer support on blood pressure or lipid levels. Most RCTs (n =18, 69%) were graded as high risk of bias.

**Conclusions:** Despite some evidence supporting a beneficial effect of peer support for established vascular risk factors, trials were heterogeneous with poor methodological quality, which limits the ability to draw firm conclusions. There is a need for further well-designed RCTs to evaluate the effect and sustainability of peer support on cardiovascular disease risk.

**Keywords:** peer support, cardiovascular risk factors

144/2076

ENERGY EXPENDITURE BY DOUBLY LABELED WATER COMPARED TO PHYSICAL ACTIVITY MEASURED BY TRIAXIAL ACCELEROMETER IN MOROCCAN CHILDREN

(1)Baddou, Issad; (1)El Harchaoui, Imane; (2)Benjeddou, Kaoutar; (3)El Kari, Khalid; (1)Saeid, Naima; (4)Elmzibri, Mohamed; (3)El Hamdouchi, Asmaa; (5)Aguenaou, Hassan.

(1)PhD Student. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (2)PhD Student. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (3)PhD. Nutrition reseracher. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (4)PhD. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail. Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (5)Prof. Unité Mixte de Recherche en Nutrition et Alimentation. Université Ibn Tofail.Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.

**Background and objectives:** A large numbers of methods are used for the assessment of physical activity. The ability to assess accurately physical activity (PA) in free-living conditions is extremely important in the global context of non-communicable diseases. The purpose of the study is to examine the association between physical activity Energy Expenditure (PAEE) measured using triaxial accelerometer (GT3X+) and energy expenditure (EE) measured using the doubly labeled water (DLW) method in free-living of 11-14y old Moroccan children.

**Methods:** Total Energy Expenditure (TEE) was measured in 21children over a fourteen-day period during the school year. Physical activity was measured simultaneously using accelerometry over seven consecutive days. TEE was also calculated from the Actigraph using a published equation.

**Results:** 21 children (mean z-score BMI (-0.45± 1.47 kg/m2), mean age (12.10± 0.80 year) participated in this study. TEE measured using (DLW) was significantly higher than TEE estimated by accelerometry ((10.03± 2.14 MJ /day) vs (8.12± 1.08 MJ /day); p <0.001), also PAEE measured using (DLW) was significantly higher than PAEE estimated by accelerometry (3.66 ± 1.59 MJ /day) vs (1.95 ± 0.87 MJ/ day) ; p <0.001). Positive correlation between DLW outcomes and physical activity intensity measured by accelerometry was only observed with light intensity physical activity, specifically with PAEE (Rho =0.468 (p=0.025)) and PAL (Rho =0.621 (p=0.002)).

**Conclusions:** PAL and PAEE were influenced by time spent in light-intensity activities. This study suggests that in this sample of children, light activity seems to contribute mainly to free-living PAEE and PAL. Further studies to assess these variations are needed particularly in low- and middle-income countries.

**Keywords:** Accelerometry, Doubly labeled water, Energy expenditure, Physical activity
# NUTRITIONAL INTERVENTION PROGRAM "PANI" OF BENEFICIARY CHILDREN ATTENDING THE REGIONAL HOSPITAL OF CONCEPCIÓN

(1)Nuñez, Ninfa; (2)Sanabria, Marta; (3)Aguilar, Gloria; (3)Sanchez, Raquel; (3)Arguello, Brunilde.

(1)MsC. Paraguay; (2)Universidad Nacional de Asuncion. Paraguay;

(3)Universidad Nacional de Caaguazu. Paraguay.

**Background and objectives:** Introduction: Anti-hunger programs have proven to be effective tools for reducing the prevalence of child malnutrition. There are just a few researches of results about patients beneficiaries of the national anti-hunger program.

**Objective:** To evaluate the effect of anti-hunger program "PANI" in anthropometric and biochemical indicators in children of 4 months to 5 years old, at risk of malnutrition and malnourished attending the regional hospital of Concepcion when entering the program versus six months of intervention.

**Methods:** Material and method: Quasi - experimental design. Showing: 195 children under the age of five beneficiaries attending clinics at the regional hospital of Concepcion. Variables studied: Weight, height, sex, origin, maternal age, maternal education, practice of exclusive breast feeding, parasites, presence of fluent and clear water and basic sanitation. Score z weight/age, z weight/size and z height/age (WHO Standards). Biochemical indicators of Hb, VCM and ferritin. Parametric and non parametric measures were used. It was considered p<0,05.

**Results:** 51,8% were male. The average of age were 22,9 months ( 4 - 59 m). 61,2% were under five years old, teen mothers 12,8% , with less than six years of study 18,5%, prevalence of exclusive breast feeding 10,3%. The prevalence of malnutrition on admission was 17,9% . The severe malnutrition was 4,6% , at risk of malnutrition are 66,2%, with acute malnutrition are 10,8% with chronically malnutrition 28,7%. It was observed a significant decrease in prevalence with malnutrition after six month of treatment, of 15,6% vs 4,4% (p<0,01), prevalence at risk of malnutrition had decreased from 72,6% to 27,6% after six month of treatment. At the admission anemia was recorded 64%) Hb 10,5 g/dL±1,27DE, VCM 74,2 ± 9,03, Ferritin 30,5 ug/L ± 23,58. At the sixth month of treatment was an improvement without anemia 37% vs 55,6% . Finally regarding adherence to regular monitoring (6 visits) 42, 6% irregular (≤5) 44, 6%, neglect 12,8%.

**Conclusions:** In Concepcion is found a statistically significant decrease of the parameters, anthropometric and biochemical at the sixth month of treatment of the anti-hunger program.

**Keywords:** nutritional program, children, malnutrition, anemia

# NUTRITION AND HEALTH CLAIMS ON A SELECT-ED SAMPLE OF FOOD PACKAGES IN ARGENTINA

(1)Tiscornia, María Victoria; (2)Castronuovo, Luciana; (3)Allemandi, Lorena Andrea; (4)Gutkowski, Patricia; (5)Nessier, Celeste; (6)Gijena, Julieta.

(1)Bsc. Nutritionist. Fundación InterAmericana del Corazón Argentina. Argentina.; (2)PhD. Sociology. Fundación InterAmericana del Corazón Argentina. Argentina.; (3)BSc. Public Health. Fundación InterAmericana del Corazón Argentina. Argentina.; (4)BSc. Communication Science. Fundación InterAmericana del Corazón Argentina. Argentina.; (5)MSc. Nutritionist. Universidad Católica de Santa Fe. Argentina; (6)BSc. Nutritionist. Universidad Católica de Santa Fe. Argentina.

**Background and objectives:** Nutrition and health claims have been documented to influence consumers perceptions of products and their purchase decisions. We assessed the use of nutrition and health claims according to the nutritional quality of products.

**Methods:** Data for breakfast cereals, cookies and milk desserts was collected at a major supermarket chain in Argentina in June 2016. Pictures were taken on the front, sides and back of all products, including Nutrition Information Panel (NIP) and ingredient list. We translated and adapted the internationally standardised International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) protocol. Pictures and nutrient data from the NIP were entered into a food database designed and tested for this study. For the analysis of nutritional quality we used the PAHO and the WHO Europe nutrient profiles (NP) models. Statistical analysis were conducted using R Statistical software.

**Results:** Claims were analyzed for 301 food packages: 42 breakfast cereals, 209 cookies and 50 milk desserts. Of the total, 40% (n=119) had nutrient claims, most claims (73%-n=87) appeared on the front of package. Health claims featured on 9% (n=26) of packages and, of those, 27% (n=7) appeared on the front. For each category, nutrient claims appeared on 71% (n=30) of breakfast cereals, 50% (n=25) of milk desserts and 31% (n=64) of cookies and health claims appeared in 55% (n=23) of breakfast cereals, 2% (n=1) of milk desserts, and 1% (n=2) of cookies. From the total number of products that exceed the WHO Europe NP model thresholds (n=273), 36% (n=99) had nutrition claims and 4% (n=10) had health claims (p<0.0005). From the total number of products that had excess in at least one critical nutrient (n=262) according to the PAHO NP model, 37% (n=97) had nutrition claims and 3.8% (n=10) had health claims (p<0.0005).

**Conclusions:** Many products that exceeded the thresholds of the selected Nutrient Profile Models had at least one nutrition or health claim. This suggests that, to prevent misleading consumers perceptions of nutritional quality of foods, the regulation of nutrient claims should be revised, so that only products with appropriate nutrient profiles are allowed to display them.

**Keywords:** Nutrition claims, Health claims, Food Packaging, Nutritional Quality, Public Policies
VITAMIN D DEFICIENCY, SOCIO-ECONOMIC STATUS AND DIETARY HABITS OF SCHOOL AGE CHILDREN IN RURAL OF MOROCCO

(1)Benjeddou, Kaoutar; (2)El Hamdouchi, Asmaa; (2)Rabi, Baha;

(1)Saeid, Naima; (2)Raji, Fatiha; (3)Barkat, Amina; (2)El Kari, Khalid;

(3)Aguenaou, Hassan.

(1)PhD. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center for Energy Science And Nuclear Techniques. (African Regional Cooperative Agreement for Research/International Atomic Energy Agency). Rabat. Kénitra. Morocco; (2)Dr. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center for Energy Science And Nuclear Techniques. (African Regional Cooperative Agreement for Research/International Atomic Energy Agency). Rabat. Kénitra. Morocco; (3)Prof. Joint Research Unit in Nutrition and Food. Ibn Tofail University. National Center for Energy Science And Nuclear Techniques. (African Regional Cooperative Agreement for Research/International Atomic Energy Agency). Rabat. Kénitra. Morocco.

**Background and objectives:** Micronutrients deficiencies can affect the growth and development of children. In Morocco many clinical studies showed that vitamin D deficiency is a public health problem. Very few foods naturally contain vitamin D and foods that are fortified with vitamin D can't satisfy human vitamin D requirement. The aim of this study is to determine vitamin D, socio-economic status and dietary habits of schoolchildren in a rural region of Morocco.

**Methods:** In an observational study, 191 school children aged 7-9 years selected from 3 primary schools. Weight, height, age and sex were recorded. Fasting blood samples were taken to assess vitamin D as serum [25(OH) D] concentration and questionnaires were used to determine socio-economic status and food frequency.

**Results:** Vitamin D deficiency was prevalent in schoolchildren; 65.8% of subjects had a 25 OHD <75 nmol/l and a median equal to 73.1nmol/l (Q1=65.9nmol/l and Q3=89.6nmol/l). The majority of families were illiterate. Dietary habits of deficient children showed that 21.6% consumed eggs, 3.4% fish, 5.2 %yogurt and 0.9% cheese at least once per day.

**Conclusions:** This study showed that among the school children in Morocco, the prevalence of vitamin D deficiency is very high and their diet is very poor in foods rich in vitamin D and thus can't satisfy children's growing needs.

**Keywords:** Micronutrient, Growth, Vitamin, Deficiency, Fortified.

PHYSICAL ACTIVITY LEVELS AND PHYSICAL ENVIRONMENTAL FACTORS ASSOCIATED WITH SEDENTARY BEHAVIOR IN MOROCCAN SCHOOLCHILDREN

(1)El Hamdouchi, Asmaa; (2)Baddou, Issad; (2)El Harchaoui, Imane;

(2)Benjeddou, Kaoutar; (3)El Menchawy, Imane; (2)Saeid, Naima; (4)El Mzibri, Mohammed; (4)El Kari, Khalid; (5)Aguenaou, Hassan.

(1)PhD. Researcher in nutrition. Unité Mixte de Recherche Nutrition et Alimentation. CNESTEN and Université Ibn Tofail. URAC39. Regional Designated Center of Nutrition Associated with AFRA/IAEA. Rabat. Morocco; (2)PhD student. Unité Mixte de Recherche Nutrition et Alimentation, CNESTEN- Université Ibn Tofail URAC39. Regional Designated Center of Nutrition Associated with AFRA/IAEA. Rabat. Morocco; (3)PhD. Unité Mixte de Recherche Nutrition et Alimentation. CNESTEN- Université Ibn Tofail URAC39. Regional Designated Center of Nutrition Associated with AFRA/IAEA. Rabat. Morocco; (4)PhD. Researcher. Unité Mixte de Recherche Nutrition et Alimentation. CNESTEN- Université Ibn Tofail URAC39. Regional Designated Center of Nutrition Associated with AFRA/IAEA. Rabat. Morocco; (5)PhD. Nutrition Researcher. Unité Mixte de Recherche Nutrition et Alimentation. CNESTEN- Université Ibn Tofail URAC39. Regional Designated Center of Nutrition Associated with AFRA/IAEA. Rabat. Morocco.

**Background and objectives:** The school is an important setting for physical activity. Identifying determinants of sedentary behaviour and in particular those that are modifiable is a necessary step to develop effective interventions targeted at reducing sedentary time. This study is the first one of its kind in Morocco using objective method to assess sedentary time among children. The aim of this study was to synthesize the current evidence base on the determinants of sedentary behaviour specifically in school children.

**Methods:** 100 children aged between 8-14 years old (mean age =11.28±1.35years, 50% of boys) were recruited from different public schools. Moderate to Vigorous Physical Activity (MVPA) and sedentary time were measured by accelerometers GT3X+. Obesity was defined by the WHO reference body mass index (BMI)-for-age. School environment was assessed by adapted questionnaire.

**Results:** 21% of children were overweight. Boys accumulated more minutes of MVPA compared with girls. 56% of boys vs 16% of girls meet the recommendation of at least 60 minutes/day (p<0.0001). Children spent an average of 477.68 ±127.15 min/day in sedentary time. The most frequently available outdoor facilities for children across schools were soccer fields and playgrounds for other games. However, those areas are poorly equipped and most of them are built from cement. All schools programmed only 60 min per week of physical education. Also in the neighborhood surrounding the school, there aren't free/low cost facilities (recreation centers, clubs), there is a lack of outdoor playgrounds, cycle facilities, inaccessible sidewalks around schools caused by street vendors.

**Conclusions:** This study demonstrated that there is a gender difference in time spent in MVPA. Girls were less active compared with boys, and also that physical school environment factors can
influence children's physical activity levels and sedentary behavior, for example, school neighborhood and design, transport system and also reduced time of physical education per day. Our findings suggest that there is a need to design school environmental changes to promote physical activity in schoolchildren.

**Keywords:** School environment, children, sedentary, triaxial accelerometer, physical activity.

(1)Uzokwe, Chinwe; (2)Landman, Jacqueline; (2)Nestel, Penelope.

(1)MSc. Public Health Nutritionist. Department of Human Nutrition and Dietetics. Michael Okpara University of Agriculture Umudike. Nigeria.; (2)PhD. Nutritionist. Faculty of Medicine. University of Southampton. United Kingdom.

**Background and objectives:** Child undernutrition continues to be a public health problem in Nigeria. Because few studies indicate the determinants of malnutrition among under-5s re-analysis of nationally representative data could help inform programme planning to meet the national target to reduce stunting and wasting by 20% and 10%, respectively by 2018. This study aimed to find determinants of stunting and wasting among 0-59 months old children in Nigeria.

**Methods:** A secondary data analysis of the 2011 Nigeria Multiple Indicator Cluster Survey (MICS) including all 25,192 children aged 0-59 months old surveyed. The prevalence of stunting was defined as height-for-age $\le -2SD$ and wasting as weight-for-height $\le -2SD$ of the WHO Growth Reference Standards. The UNICEF conceptual framework of malnutrition was used to build the logistic regression models, following chi-square tests on the MICS measures of the immediate, underlying or basic causes of undernutrition.

**Results:** The study confirmed that 35.8% and 10.2% of the children were stunted and wasted, respectively. Girls (12%, 15%), children who were no longer being breastfed (20%, 47%), absence of recent episodes of fever (12%, 21%), increase in maternal age (22-35%, 4-30%) and in duration of maternal education (14-36%, 13-18%) and households with higher wealth index (2-63%, 4-27%) were all at reduced risks of stunting and wasting. However, non-Christian children (47-48%, 18-49%) and children residing in the Northern Nigeria (55-64%, 11-39%) had increased risks of stunting and wasting. Children with no birth certificate had increased (23-28%), absence of diarrhoea episodes (15%) and household animals (19%) were associated with a reduced risk of stunting. Households with fewer toddlers ($\le 2$ under-5s) and $\ge 36$ months-old were associated with a reduced risk of wasting.

**Conclusions:** Interventions to reduce child undernutrition should target children $\ge 36$ months-old. They should also include strengthening of the Maternal and Child health system and health workers, improving the educational level of women especially

in the Northern Nigeria and financial empowerment of women. Every State of the Federation should also develop a costed plan of action on nutrition to tackle the problem in their states.

**Keywords:** Stunting, wasting, determinants, children, developing countries

(1)Garcia Chavez, Claudia Gabriela; (2)Sánchez-Bazán, Karina;

(3)Barquera, Simon.

(1)MSc. Nutricionist. Center for Nutrition and Health Research. National Institute of Public Health. México.; (2)MPA. Center for Nutrition and Health Research. National Institute of Public Health. México.; (3)PhD. Center for Nutrition and Health Research. National Institute of Public Health. México.

**Background and objectives:** In November 2015, a group of researchers and nutrition professionals who are members of the SLAN [Latin America Society for Nutrition], sent the current Chair of the SLAN a request to take urgent action on conflict of interest in this society. This due to a critical concern for cases of inappropriate industry influences in the development of academic nutrition events. These measures should allow the research agenda and priority issues to be generated in discussions free of commercial influence. In order to clarify SLAN's relations with industry, the COI-SLAN committee has prepared Guidelines for Prevention and Management of Conflict of Interest [LPGCDI-SLAN].

**Methods:** Through the collaboration of some SLAN members representing a number of countries, such as Chile, Mexico, Guatemala and the United States, a consensus was reached to determine the guidelines through which the SLAN could be governed, with some Experts on the subject, established the guidelines for the management of conflict of interest of the SLAN (LGCDI-SLAN).

**Results:** The relationship of the food industry with professional groups are common and have become notorious and problematic in population health and nutrition. The SLAN, recognizes that health professionals and the organizations with which they collaborate have relationships with actors that could represent interest that conflict with the SLAN principles.

**Conclusions:** The LPGCDI-SLAN provide guidelines for identifying and proceeding with the CDIs that are presented around the Society. Being the first document on its kind, it will serve as a basis for strengthening this critical area for the health sciences.

**Keywords:** Conflict of interest, SLAN, nutrition

**Further collaborators:** Conflict of interest-SLAN committee: PhD. Ricardo Uauy, PhD. Rafael Pérez-Escamilla, PhD. Reynaldo Martorell, PhD. Manuel Ramírez, MSc. Deborah Navarro.
# PARENTAL INFLUENCE ON THE SCHOOL CHILDREN'S EATING BEHAVIOR, PHYSICAL ACTIVITY, AND SEDENTARY ACTIVITY: A DETERMINANT FOR CHILDHOOD OBESITY IN CHINA

(1)Zhang, Juan; (2)Lyu, Yuebin; (3)Zhai, Yi; (4)Li, Weirong; (5)Feng, Xiaoqi;

(6)Thomas, Astell-Burt; (7)Seo, Dong-Chul; (8)Jiang, Yu; (9)Liu, Yuanli;

(10)Shi, Xiao-Ming.

(1)PhD. Epidemiologist. Behavioral Scientist. Associate Professor. Peking Union Medical College & China Academy of Medical Science. China; (2)MD. Epidemiologist. National Institute of Environmental Health. China CDC. Beijing. China.; (3)PhD. Nutritionist. Division of NCD Control and Community Health. China CDC. Beijing. China.; (4)MS. Epidemiologist. Beijing Friendship Hospital. Capital Medical University. Beijing. China;

(5)PhD. Epidemiologist.School of Health and Society .University of Wollongong. NSW. Australia; (6)PhD. Epidemiologist. Associate Professor.School of Health and Society. University of Wollongong. NSW. Australia; (7)PhD. Epidemiologist. Behavioral Scientist. Department of Applied Health Science. Indiana Unversity. Bloomington. USA.; (8)PhD. Epidemiologist. Professor. Associate Dean. School of Public Health. Peking Union Medical College. Beijing. China.; (9)PhD. Professor. Dean. School of Public Health. Peking Union Medical College. Beijing. China;

(10)PhD. Epidemiologist. Professor. Director. National Institute of Environmental Health. China CDC. Beijing. China.

**Background and objectives:** In China, childhood obesity is becoming a significant public health problem. Family with high SES may increase purchasing power of obesogenic goods or control over of children's time which may amplify the children's risk for obesity. We investigated whether parent's educational attainment affect the eating behaviour, physical activity and sedentary activity for weekday and weekend among children.

**Methods:** A national school-based survey was conducted in China. A total of 11,439 fourth to six grade school children, 11,439 of their fathers or mothers were sampled using a multistage cluster random sampling method. Height and weight was measured for children and self-reported height and weight was collected for parents. Questionnaire collected information on eating behavior, physical activity and sedentary activity for weekday and weekend. Logistic regression models were used to describe the association between educational attainment of parents and children's weight status, eating behavior, physical activity and sedentary activity for weekday and weekend.

**Results:** Approximately 20% of fourth to six grade school children in urban areas and 12.6% in rural areas were overweight and obese, and 8.5% in urban areas and 4.7% in rural areas were obese. Children whose parents had higher SES were more likely to be overweight or obese, regardless of the weight status of parents (P<0.05). More than one parent having a high school level or above was positively related to healthy eating behaviours among children and negatively related to high-calorie eating behaviours (P<0.05), but associations with consuming western fast food once a day were positive in rural areas (P<0.05), and association with

sedentary activity on weekend, i.e., homework, indoor extracurricular activities were positive both in urban and rural areas.

**Conclusions:** Results highlight the relevance of investigating eating behaviours, physical activity, and sedentary activity for weekday and weekend. Compared with environmental factor, knowledge and eating behaviours appear only minor effects on the rising of childhood obesity in China. In addition to continued focus on school-based intervention, target parent support for weekend physical activity and sedentary activity may be health promotion priorities. Effective intervention should take academic performance into account.

**Keywords:** childhood obesity, eating behaviour, physical activity, sedentary activity. Parental control.

**Further collaborators:** Lloyd Kolbe. Professor of School Health. Department of Applied Health Science. Indiana University. Bloomington. Indiana.

# CHARACTERIZATION OF THE CONSUMPTION OF LIQUID BEVERAGES IN INHABITANTS OF MEDELLIN, COLOMBIA

(1)Deossa Restrepo, Gloria Cecilia; (2)Deossa Restrepo, Gloria Cecilia;

(3)Restrepo, Luis Fernando; (4)Rodríguez, Holmes.

(1)Nutritionist dietitian. Specialist and master in food science and human nutrition. Professor. School of nutrition and dietetics. University of Antioquia. Medellin. Colombia.; (2)Nutritionist dietitian. Specialist and master in food science and human nutrition. Professor. School of nutrition and dietetics. University of Antioquia. Medellin. Colombia.; (3)Statistician. Specialist in statistic and Biomathematics. Associate professor. Research group GISER. Faculty of agricultural sciences. University of Antioquia. Medellin. Colombia; (4)Agricultural engineer. PhD. Assistant Professor Faculty of Agricultural Sciences. University of Antioquia. Group GISER. Colombia.

**Background and objectives:** Background: To evaluate the consumption of liquid and the amount of them consumed per day, is important for health professionals, to design policies that relate to a better well-being of the community in this aspect, in order to prevent diseases that can be derived of inadequate intake of liquids. Objective: To compare between both sexes, the taste for the consumption of different types of drinks and the quantity consumed per day. The study was conducted in inhabitants of Medellin Colombia in over 18 years of age

**Methods:** We used multivariate analysis of variance (MANOVA) with canonical orthogonal type contrast, multiple correspondence analysis with indexed hierarchical classification, one-dimensional and two-dimensional frequency analysis.

**Results:** A significant difference was detected between sexes in the taste to consume aromatic drinks, and dietary soda (p<0.05), No difference was detected (p>0.05) in the amount of fluid consumed per day by sex.

**Conclusions:** The main conclusion is that more than 80% of those surveyed like to consume water frequently and claim to
# DEFINING AN ANTHROPOMETRIC AND PHYSICAL ACTIVITY PROFILE FOR VENEZUELAN POPULATION: PRELIMINARY RESULTS FROM THE LATIN AMERICAN STUDY OF NUTRITION AND HEALTH (ELANS)

(1)Herrera-Cuenca, Marianella; (2)Méndez-pérez, Betty; (3)Martín-Rojo, Joana; (4)Landaeta-Jimenez, Maritza; (5)Castro-Morales, Vanessa.

(1)MD, ScD. Center for Development Studies. (CENDES) Central University of Venezuela. Fundación Bengoa para la Alimentación. Venezuela; (2)ScD. Antropologist. Bio Antropology Unit. Central University of Venezuela. Venezuela; (3)ScM Statistitian. Inmunology Institute. Central University of Venezuela. Venezuela; (4)ScM MD. Bengoa Foundation for Food and Nutrition. Venezuela; (5)ScB. Antropologist. Bio Antropology Unit. Central University of Venezuela. Venezuela.

**Background and objectives:** Nutrition status is important for the wellbeing of the population and physical activity (PA) is an important component of a healthy lifestyle. Evidence about the benefits have been well documented. The aim of this study is to identify an anthropometric and physical activity profile for Venezuelan population, as part of the Latin American Study of Nutrition and Health (ELANS).

**Methods:** A randomized representative sample of 1131 subjects ages between 15-65, underwent through anthropometric evaluation: weight, height and an adapted version of long IPAQ was applied. Descriptive statistics, contingency tables to compare BMI, Vigorous activities and MET categorization were performed. Chi sq test was also performed to identify differences between genders.

**Results:** 33.4% of the population was overweight and 28.3% was obese. There were no significant differences on BMI values among different socioeconomic status. The bus is the most relevant public transport used by Venezuelans (67%) and 40.2% report using cars and motorcycle. According to SES it is important to highlight the use of individually owned vehicles among low SES (38.1%) and of those 12.5% are motorcycles. Sedentary behaviors reported that 92.4% of the sample perform seated activities of which the most important were: watching TV (92.1%), talking to friends (80.5%), use the telephone (74.8%) and reading (47.2%) being the most important watching TV on most days of the week. Regarding the perception of security of the surroundings, 75.4% reported insecurity in the neighborhood. Comparison between categorizations BMI and vigorous activity shows a Chi square significant values (p= 0.001 in men and p=0.029 in women) and comparison table show a trend for normal BMI on those individuals who perform vigorous PA, a higher BMI is observed on those who do not. Comparison between BMI and MET categorization shows differences among men but not in women, showing a trend for men with higher BMI to report moderate or low MET categories while, men with normal BMI show a higher MET values.

**Conclusions:** This study shows the need for implementation of public policies that promote physical activity for Venezuelan population.

**Keywords:** Venezuela, Physical activity, Anthropometry, Health Profile

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

**Further collaborators:** The ELANS study group

# THE MODELLED EFFECT OF BIOFORTIFIED CROPS ON NUTRIENT ADEQUACY OF CHILDREN AND WOMEN IN BANGLADESH AND GUATEMALA

(1)Talsma, Elise Francina; (2)Borgonjen-van den Berg, Karin; (2)Peletier, Julie; (2)Leyva, Perla; (2)Brouwer, Ingeborg.

(1)PhD. Scientist Human Nutrition. HarvestPlus. International Institute for Tropical Agriculture (CIAT). Cali. Colombia; (2)Division of Human Nutrition. Wageningen University. the Netherlands.

**Background and objectives:** Guatemala and Bangladesh are countries were micronutrient deficiencies are high and biofortified crops with higher concentration of micronutrients are currently being introduced to reduce these deficiencies. With this study we aimed to assess the effect of the replacement of currently consumed crops with biofortified crops on nutrient adequacy by formulating food based dietary guidelines for women and children in Bangladesh and Guatemala.

**Methods:** We used two existing data sets with 24 hour recall data from Bangladesh and Guatemala. Target groups were: infants 6-8 months, infants 9-11 months, infants 12-23 months and lactating women for Guatemala; children 24-35 months, children 36-48 months and their mothers for Bangladesh. Optifood, a linear programming tool, was used to model and compare the food based dietary recommendations with and without the replacement of the biofortified crops in reaching nutrient adequacy (> 70% of recommended nutrient intake) for 13 nutrients.

**Results:** When adding biofortified crops to the diet, reaching nutrient adequacy was not reached for children 6-23 months in neither Bangladesh nor Guatemala. For children 24-48 months in Bangladesh, only nutrient adequacy for vitamin A was reached with biofortification, although vitamin A was not a problem nutrient for older children in Bangladesh or in any age group in Guatemala. For children 36-48 months in Bangladesh as well as their caretakers, biofortification ensured adequacy for zinc.
**Conclusions:** Biofortification is able to ensure nutrient adequacy for vitamin A and zinc in children older than 24 months as well as for zinc in adult women. For children under 24 months of age the intake of crops that could be biofortified is insufficient to result in better nutrient adequacy when biofortified crops are consumed. An increased intake of biofortified crops or other food-based-interventions are needed to ensure nutrient adequacy.

**Keywords:** Linear programming, Nutrient adequacy, Biofortification, Guatemala, Bangladesh

## CHARACTERIZATION OF SODIUM KNOWLEDGE AND ITS USE IN FOOD IN HABITANTS OF MEDELLIN COLOMBIA CITY

(1) Velasquez, John Edinson; (1) Velasquez, John Edinson; (2) Deossa Restrepo, Gloria Cecilia; (3) Restrepo, Luis Fernando.

(1) Nutritionist dietitian. School of nutrition and dietetics. University of Antioquia. Medellín, Colombia.; (2) Nutritionist dietitian. Specialist and master in food science and human nutrition. Professor. School of nutrition and dietetics. University of Antioquia. Medellín, Colombia.; (3) Statistician. Specialist in statistic and Biomathematics. Associate professor. Research group GISER. Faculty of agricultural sciences. University of Antioquia. Medellín, Colombia.

**Background and objectives:** The knowledge of sodium, its uses and implications for health, are of interest to health entities, in order to design information campaigns about the suitable use of this mineral, which lead to a healthy life style to preserve health and prevent appearance of non-communicable chronic diseases. **Objective:** to evaluate and to compare then knowledge and use of sodium in daily food, in adults of both sexes in Medellín Colombia.

**Methods:** The size of the sample was constituted by 322 persons randomly selected in the city of Medellín Colombia, whose ages ranged between 18 and 50 years of age. We used multivariate analysis of variance (MANOVA) with canonical orthogonal type contrast, multiple correspondence analysis with indexed hierarchical classification, Z method comparison tests, frequency analysis.

**Results:** Significant difference was detected between the knowledge of the sexes, related to the risks that brings to the health the excess in the consumption of sodium, in the knowledge of dietary salt and hypertension, noting that is the female sex which demonstrated to possess a greater knowledge

**Conclusions:** The main conclusion is that the people surveyed know what sodium is and know the recommendation for its use, however, they add salt to the preparations before testing them, and they also consume food sources of sodium as concentrated broths, sausages and packet soups.

**Keywords:** Hypertension, cardiovascular risk, salt, sodium.

## CONSUMER AWARENESS AND PERCEPTION OF SWEETENERS INFLUENCES FOOD AND BEVERAGE DECISIONS

(1) Samuel, Priscilla; (2) Okonneh, Ashi.

(1) PhD. Global Stevia Institute. Oak Brook. IL. USA.; (2) BA. Research Insights. Marketing and Innovation. PureCircle Ltd. Oak Brook. IL. USA.

**Background and objectives:** Non-nutritive sweeteners are gaining substantial interest among consumers. Heightened interest for healthier lifestyles and continued concerns with rising obesity in adults and children, have food manufacturers actively looking for ways to reduce sugar and calories. To determine consumer perception of sweeteners and factors that motivate food choice, online surveys were conducted across several countries.

**Methods:** Data for Mexico (January 2017) and India (March 2016) are provided. Surveys were designed to be nationally representative and included a male/female split of 505/495 in Mexico and 520/480 in India. Most responses were on a scale of "very much agree" to "very much disagree."

**Results:** Results show that participants in Mexico and India reported high levels of concern around sugar intake with 74% and 84% very/somewhat concerned, respectively. Awareness was higher in Mexico versus India with 76% vs. 35% of participants responding "yes" when asked if aware of stevia. For those aware of stevia, 78% and 83% indicated a very/somewhat positive overall impression, in Mexico and India, respectively. When asked if they agreed or disagreed with whether sweeteners (i.e., stevia, sugar, sucralose, & aspartame) were "good for a healthy lifestyle", "natural" or "great tasting", stevia ranked highest on all three. In Mexico, 75% either completely/somewhat agreed that stevia is "good for a healthy lifestyle" versus 46% who agreed the same for sugar, 45% for sucralose, and 38% for aspartame. In India, 88% completely/somewhat agreed that stevia is "good for a healthy lifestyle" versus 47% for sugar, 51% for sucralose, and 40% for aspartame. Among parents with children at home, 85% versus 80% of parents in Mexico and India, respectively, indicated that were very/somewhat concerned about the level of sugar in foods/beverages they give their children. When asked, how likely these parents would be to purchase foods/beverages with stevia for their children, over 60% of parents in both Mexico and India indicated that they would either definitely/probably purchase foods or beverages with stevia.

**Conclusions:** As individuals and families pursue healthy lifestyles, sweeteners like stevia can play a pivotal role.

**Keywords:** consumers, stevia, awareness, sugar, children

**Conflict of Interest Disclosure:** Dr Priscilla Samuel heads the Global Stevia Institute which is supported by PureCircle Ltd.

Ashi Okonneh works at PureCircle Ltd which funded the insights research.
# FORTIFICATION OF THE WHEAT FLOUR IN MOROCCO: CHANGE OF THE ELEMENTARY IRON BY THE NAFEEDTA

(1)Aguenaou, Hassan; (2)Rahmani, Mohammed; (3)El Ammari, Laila; (4)Sahaba, Mahjoub; (5)Lhoussaine, Saad; (6)Izem, Abdellatif; (7)Labzizi, Saloua; (8)El Hajjab, Amina.

(1)PhD. Nutritionist. Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofail University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA). Morocco; (2)PhD. Institut Agronomique Hassan II. Rabat. Morocco; (3)PhD. nutritionist. Ministry of Health. Morocco; (4)PhD. Institut de Formation de l'Industrie Meunière. Morocco; (5)PhD. Laboratoire Officiel d'Analyse et de Recherche Chimique. Morocco; (6)PhD. Fédération nationale de la minoterie. Morocco; (7)PhD. Ministry of Health. Morocco; (8)PhD. Office National de Sécurité Sanitaire des produits Alimentaires. Morocco.

**Background and objectives:** In Morocco, Iron Deficiency Anaemia is 32% among children that are less than 5 years old with 58% of them having ferritin levels less than 12 µg/l. This anaemia is 33% among women in childbearing age, 37% among pregnant women, and 18% among men. The consumption of the wheat flour in Morocco is 365 g / p / d of flour. To fight against this iron deficiency, the wheat flour was fortified with 45mg iron / kg of flour (in the form of electrolytic elementary iron). Unfortunately ten years after this fortification, the iron status of the Moroccan population did not improve. So in Morocco we realized a feasibility study of the fortification of the flour by another iron type, the NaFeEDTA which seems more bioavailability and insensible in chelators, such as the tannins of the tea.

**Methods:** We have fortified wheat flour with 80 ppm NaFeEDTA. We carried out the feasibility study of fortification under Moroccan culinary conditions. We supplied the premix containing 80 ppm of NaFeEDTA and 1 ppm of vitamin B9 to 30 industrial mills to determine the range of analyzes in order to put in place the legislation for quality control. We analyzed 60 samples (30 samples with fortified flour and 30 samples with non-fortified flour).

**Results:** The addition of NaFeEDTA and folic acid to the flour did not alter the technological quality of the flour. The organoleptic qualities of the flour were not altered. The range of analysis varies between 22 mg / kg and 49 mg / kg (mg iron / kg flour)

**Conclusions:** This study of bioavailability showed the possibility of the change of elemental iron by the NaFeEDTA without altering the technological quality and the organoleptic quality of the flour. A bioavailability study of NaFeEDTA under Moroccan culinary conditions is under way in partnership with the IAEA.

**Keywords:** Fortification, wheat flour, Morocco, elementary iron, NaFeEDTA

# EFFECTS OF A FEEDING AND NUTRITION PROGRAM IN SCHOOL CHILDREN IN MEXICO CITY

(1)Cuevas Nasu, Lucía; (2)Shamah-Levy, Teresa; (1)Gómez Acosta, Luz María; (3)Méndez Gómez-Humarán, Ignacio; (4)Hernández Ávila, Mauricio.

(1)MSc. Nutritionist. Center for Nutrition and Health Research. National Institute of Public Health. Mexico.; (2)PhD. Researcher. Center for Nutrition and Health Research. National Institute of Public Health. Mexico.; (3)MSc. Statistician. Mathematics Research Center. Aguascalientes Unit. Mexico.; (4)PhD. National Institute of Public Health. Mexico.

**Background and objectives:** In Mexico obesity is the most frequent problem among children and adolescent populations, the increasing in overweight and obesity (OW+Ob) prevalence has been a main concern mostly in individuals from 5 to 11 years old. Data from National Health and Nutrition survey (ENSA-NUT-201) shown a National prevalence of 34.9% and a slightly greater (35.2%) in Mexico City.

**Objective:** To assess education and nutrition components of SaludArte program in participant schools during 2013-2015.

**Methods:** A three cohort comparative study was used consisting on 1283 school children from 144 schools. Two panels were defined: complete and continuous time. Information about food intake, feeding behaviors, food preservation and hygiene, physical activity (PI) and anthropometry was obtained. A differences in differences method for effect estimates was applied, logistic-multinomial and logistic regression models were also used.

**Results:** Effects attributable to the program were as follows: better personal hygiene (p=0.045), better nutrition knowledge's (p=0.003), physical activity (p=0.002 2013-2014; p=0.032 2015) and fiber Intake (p=0.064). Disagreeing with the expected, suggest intake was significant, (p=0.012 continuous time and; p=0.037 complete time).

**Conclusions:** Findings shown better hygiene practices among the program beneficiaries, this is related with positive effects over the health because decreases infections risk and thereby morbidity costs associated with infections. SaludArte had positive effects over some components, however it is necessary to consider the learned lessons in order to institutionalize the program and give it permanence.

**Keywords:** Schools, program evaluation, food intake, physical activity, Mexico

**Further collaborators:**

Marco Antonio Ávila Arcos. BSc. Center for Nutrition and Health Research. National Institute of Public Health. Mexico.
## AVAILABILITY OF PORK AND BEEF IN SOUTH AMERICAN COUNTRIES THROUGH THE PERIOD OF TIME FROM 1961 TO 2010

(1)Arboleda, Luz Marina; (2)Restrepo, Luis Fernando.

(1)Nutritionist dietitian. PhD in social Sciences Coordinator of the Socio-anthropology on Food Research Group School of Nutrition and Dietetics. University of Antioquia. Colombia; (2)Statistician. Specialist in statistic and Biomathematics. Associate professor. Research group GISER. Faculty of agricultural sciences. University of Antioquia. Medellin Colombia.

**Background and objectives:** The knowledge related with the bovine and swine production is of vital interest by part of governmental and private bodies to plan the alimentary supply referred to this products, to design strategies that let the elaboration of plans of action to prospect better a country in this place.

**Objective:** make a comparative analysis related with the supply of beef and pork, and the quantity of energy, protein, and fat per person for each day that they give in countries in South America in the period of fifty years (1961-2010).

**Methods:** The General linear model was used, employing the multivariate analysis of variance (MANOVA) technique, with a canonical contrast of orthogonal type, analysis of principal components, explorative and descriptive analysis of unidimensional style, taking into account the base of information coming from the FAO.

**Results:** Argentina shows a highly important difference in the availability of beef for its population with respect to the rest of South America (p<0.0001). Paraguay is the country with the highest availability of pork for its population. The country with the lowest participation of sources of beef and pork is Peru.

**Conclusions:** there is a great divergence between dome countries of South America in the quantity of the supplies of meat from the bovine and the swine, which impacts in the availability of energy resources, protein, and fat for the population.

**Keywords:** beef, pork, availability, consumption, South America.

## ASSOCIATION OF MODIFIABLE CARDIOVASCULAR RISK FACTORS WITH METABOLIC SYNDROME (MS) IN ADOLESCENTS

(1)Souza, Paula; (2)Correia, Marcelo; (3)Lorenzo, Andrea; (4)Moreira, Annie Seixas Bello.

(1)Nutritionist. Post Graduation on Nutrition, Health and Food Sciences. Universidade do Estado do Rio de Janeiro. Brazil; (2)MSc. Statistical. Biostatistcs core. Instituto Nacional de Cardiologia. Brazil; (3)PhD. Cardiologist. Education and Research Coordination. Instituto Nacional de Cardiologia. Brazil; (4)PhD. Nutritionist. Education and Research. Instituto Nacional de Cardiologia. Professor. Universidade do Estado do Rio de Janeiro. Brazil.

**Background and objectives:** The prevalence of overweight and obesity has increased in alarming proportions worldwide, affecting even the youngest age groups and bringing with it the early appearance of several clinical complications due to metabolic disorders. The aim of this study is to assess the presence of modifiable cardiovascular risk factors (MCRF) in adolescents with and without metabolic syndrome.

**Methods:** Multicenter, cross-sectional study using data from the ERICA study (BMC Public Health (2015)15:94). The sample consists of 7,404 adolescents, aged between 12 and 17 years, enrolled in public or private schools of 4 Brazilian municipalities, whose weight of the stratification represents 900,120 adolescents (Cad. Saúde Pública, Rio de Janeiro, 31(5):1-10). Adolescents were classified as metabolically healthy (MH) and metabolically unhealthy (MU) according to the established metabolic syndrome (MS) criteria and an analysis was made on the presence of MCRF in this population. Parametric and non-parametric tests were performed with the studied variables. The analyses were performed using Stata software version 13 and R version 3.3.1.

**Results:** The mean age found was 14.4 years, 50% were female, 69.6% studied in public schools and 2.2% presented MS. Among the MCRF evaluated, 47.5% were sedentary, 26% had altered LDL-c, in 43% of cases CRP was altered, 4.3% had abnormal hemoglobin A1c and 11% presented altered HOMA-IR. According to the MS classification, 33.6% of the MH normal weight presented more than one risk factor, 100% of the MU normal weight presented between two and three risk factors, 61.7% of the MH obese presented more than one risk factor and 81.5% of the MU obese presented more than one risk factor.

**Conclusions:** The present study draws attention to the number of adolescents who presented up to five MCRF associated or not with the MS criteria. The dimension and impact of health problems related to obesity and the presence of cardiovascular risk factors in this age group are of great magnitude, and it is urgent to adopt public health measures to prevent obesity and promote a healthy lifestyle.

**Keywords:** Adolescent, metabolic syndrome, risk factors.
# COMPREHENSIVE INTAKE ASSESSMENT OF TRANS FATTY ACIDS AMONG THE PORTUGUESE POPULATION - RESULTS FROM THE NATIONAL FOOD, NUTRITION AND PHYSICAL ACTIVITY SURVEY 2015-2016

(¹)Torres, Duarte; (²)Lobato, Liliane; (³)Severo, Milton; (⁴)Macedo-Correia, Daniela; (⁵)Oliveira, Andreia; (⁶)Casal, Susana; (⁷)Lopes, Carla.

(¹)PhD. Faculty of Nutrition and Food Sciences. University of Porto. Portugal; (²)MSc. Nutritionist. Faculty of Nutrition and Food Sciences of the University of Porto. Portugal.; (³)PhD. Data Scientist. EPIUnit - Institute of Public Health of University of Porto. Portugal.; (⁴)BSc. Data Scientist. EPIUnit - Institute of Public Health of University of Porto. Portugal.; (⁵)PhD. EPIUnit - Institute of Public Health of University of Porto. Portugal.; (⁶)PhD. Requimte-LAQV and EPIUnit - Institute of Public Health of University of Porto. Portugal.

**Background and objectives:** WHO/FAO recommends that intake of trans fatty acids (TFA) should be restricted to less than 1% of total daily energy intake. Limited information is available on the actual TFA intake.

The present work aims to describe TFA usual intake, and to identify the main sociodemographic factors associated, among the Portuguese population; to estimate the contribution of different food categories to TFA intake.

**Methods:** Distribution of TFA intake was assessed combining individual food consumption with food TFA concentration datasets. Individual food consumption data was obtained from a national representative sample of 5819 individuals (www.ian-af.up.pt). Food diaries or 24h recalls (if > 10 yrs) were face-to-face applied twice. All reported food items were described using the FoodEx2 system. The content of TFA in foods was extracted from the Portuguese Food Composition Table (PFCT). When applicable, TFA levels presented in the PFCT were substituted by current levels, recently reevaluated and published.

The usual TFA intake was estimated using Statistical program for age-adjusted Dietary assessment (SPADE). A weighted generalized linear model was used to measure the effect of the several exposures on TFA intake.

**Results:** Median TFA intake among the Portuguese population was 0,43% of energy intake (0.9 g/day). Intake of TFA exceeding 1% of energy intake was estimated to occur in 8, 14, 4 and 7% of the observations in children, adolescents, adults and elderly, respectively. Foods containing TFA produced during manufacturing (fats and oils, pastry and snack products, etc) contributes with 42% to the total TFA intake.

TFA intake (g/day) among young adults (18-40 yrs), middle adults (41-64 yrs) and the elderly (65-84 yrs) was significantly lower [β=-0.49, 95%CI=(-0.80, -0.18), β=-0.64, 95%CI=(-0.98,-0.30) and β=-0.67, 95%CI=(-1.02,-0.32), respectively]; those more educated [β=0.40, 95%CI=(0.24,0.55)] and living in Lisbon [β=0.24, 95%CI=(0.05,0.44)] or Madeira Island [β=0.28, 95%CI=(0.11,0.45)] had significantly higher TFA intake.

**Conclusions:** TFA intake among the general Portuguese population can be considered low. A relevant proportion of adolescents are consuming more than 1% of energy from TFA. However, it should be noted that ruminant derived products are the main contributors to TFA intake. Younger age, higher education and residence in Lisbon or Madeira regions were positively associated with TFA intake.

**Keywords:** Trans fatty acids, Intake assessment, Individual food consumption, National food consumption survey

**Conflict of Interest Disclosure:** No conflict of interest to declare. This Survey has received funding from the EEA Grants Program, Public Health Initiatives (PT06 - 000088SI3).

# DIETARY AND ENVIRONMENTAL TOXIC EXPOSURE IN AN AGRICULTURAL CORE POPULATION OF THE PROVINCE OF CÓRDOBA, ARGENTINA

(¹)Montedoro, Franco; (²)Butinof, Mariana; (³)Aballay, Laura; (³)Pou, Sonia Alejandra; (⁴)Eandi, Mariana; (⁵)Fernandez, Ricardo; (⁶)Díaz, María del Pilar.

(¹)Bachelor in Science. Chair of General and Nutritional Epidemiology. School of Nutrition. Faculty of Medical Sciences. National University of Cordoba. Argentina.; (²)Ph.D. of Medicine and Surgery. School of Nutrition. Faculty of Medical Sciences, National University of Cordoba. Argentina; (³)Ph.D. of Health Sciences. School of Nutrition. Faculty of Medical Sciences. National University of Cordoba. Argentina; (⁴)Bachelor in Science. School of Nutrition. Faculty of Medical Sciences. National University of Cordoba. Argentina; (⁵)Md. Faculty of Medicine. Catholic University of Cordoba. Argentina; (⁶)Ph.D. in Statistics Applied to Biological Sciences. School of Nutrition. Faculty of Medical Sciences. National University of Cordoba. Argentina.

**Background and objectives:** Argentina have the major world crop production per capita. To achieve these results, the following production model is applied: genetically modified seeds, direct seeding and intensive use of pesticides. Environmental exposures are multiple and complex; diet and toxic, such as pesticides, participate in the modulation of the occurrence of chronic diseases with high impact in Public Health, being a healthy diet, a protective factor against its occurrence. Aims: To identify the dietary patterns and exposure to pesticides in a local population of the agricultural core zone of the Pampa Húmeda Argentina

**Methods:** A population-based study was conducted in a random sample of subjects older than 18 years of age, in Monte Buey, Córdoba Province, Argentina, throughout 2015 to 2016 (n=416). A standardized questionnaire was administered, investigating environmental, sociodemographic and lifestyle characteristics. Potential sources of exposure to agricultural pesticides were identified and geo-referenced: deposits of agricultural machinery, pesticides and silos, proximity of housing to cultivated fields, among others. A validated food frequency questionnaire was used to investigate the usual qualitative and quantitative food consumption. Descriptive statis-
tics and Factorial Analysis of Principal Components were identified for the identification of food patterns using Stata13 software.

**Results:** Of the total number of subjects studied, 50.4% were women, mean age (SD) was 46.6 (14.7) years. About 60% completed secondary or higher education; 49% had an average socioeconomic level and 21% high level. Four dietary patterns, known as “Prudent” (AB vegetables, fruits, oils), “Meat” (red fat meats), “Glucose” (refined grains and sugars) and “Beverages” (alcohol and teas) were identified. Also, 32%; 48 per cent and 37 per cent of households were within 500 m of cultivated fields sprayed with pesticides, agricultural machinery and pesticide and other agricultural inputs, respectively.

**Conclusions:** There was evidence of a positive change in food selection towards a healthier, more prudent pattern, as a measure of self-care, by the exposed population. However, it is necessary to work on public policies that aim at sustainable production modes by reducing the level of exposure described, accompanying the acquisition of healthy habits.

**Keywords:** food patterns - pesticides - environmental exposure - agricultural core.

**Background and objectives:** The ecosystems of Pacific Island countries, e.g., atoll islands of Melanesia and Polynesia, are rich in terrestrial and marine biodiversity that would likely support sustainable diets. Yet many of these Small Island Developing States (SIDS) are experiencing extensive loss of biodiversity and degradation of natural resources, and the nearly-11 million inhabitants have some of the highest rates in the world of obesity and associated chronic diseases. They are particularly precarious in their vulnerabilities to various manifestations of climate change and other anthropogenic and natural phenomena affecting agriculture, fisheries, food trade. The question to be answered is this: is it possible to have 'sustainable diets' in these Pacific Island States?

**Methods:** National, regional and UN-compiled data sets from the sectors/disciplines of nutrition, health, agriculture and the environment will be interrogated, along with indicators developed to characterise sustainable diets in selected ecosystems of Pacific Island countries. Tonga, Fiji, Kiribati and Tokelau Islands are used as the test environments.

**Results:** Diets are laden with high fat/high sugar imported convenience foods with the consequences of high rates of obesity, diabetes, heart disease, and shortened life expectancy. At the same time, highly nutritious traditional foods are neglected and underutilised. Some solutions to the problems are beyond the direct control of SIDS (e.g., rising sea levels), but many, including modifications to practices and policies have yielded, and could further yield, immediate benefits, e.g., conservation of local food biodiversity through sustainable use, benefiting the environment and improving nutrition.

**Conclusions:** Multi-sectoral policies and actions informed by the Sustainable Development Goals (especially Goal 2 and its targets), Aichi Targets, UN Decade of Action on Nutrition, and regional commitments, are needed. Although the recommendations from this review are based on four Pacific SIDS, there is potential relevance to at least 22 Pacific Island countries and territories, other SIDS around the world, and to low-lying coastal areas in non-island countries that share similar ecosystems and food/nutrition-related vulnerabilities.

**Keywords:** sustainable diets, ecosystem, nutrition, obesity, biodiversity

**Further collaborators:**

Researchers from the Secretariat of the Pacific Communities, University of the South Pacific, Caritas (NZ) and FAO sub-regional office for the Pacific

**Background and objectives:** The current nutritional situation among indigenous people from Ngabe Bugle group is affected by increased under nutrition and overweight rates among children under five years. The objective of this study was to determine the nutritional status and food patterns in children under five years of an indigenous group in Panama, the Ngabe Bugle group.

**Methods:** This is a cross-sectional follow-up study of 110 children under five years whom are beneficiaries of “Chi Nugue Kwin – healthy and happy children” Project implemented by Nutre Hogar, a national NGO working with indigenous people. We ran descriptive analysis including socio-demographics, anthropometric and 24 h recall assessments from January to March 2016.

**Results:** The mean±SD of HAZ and BAZ were -2.31±0.96 and 1.44±1.42, respectively, and 55% were girls. The prevalence of moderate Stunting (<-2 SD HAZ) was 46% and 19% presented

<footnote>(1)Burlingame, Barbara; (2)Eme, Paul; (3)Foliaki, Sunia; (4)Kim, Nick;</footnote>

<footnote>(5)Douwes, Jeroen.</footnote>

<footnote>(1)PhD. Professor. College of Health. Massey University. New Zealand; (2)PhD scholar. College of Health. Massey University. New Zealand; (3)MD. Research Fellow. Centre for Public Health Research. Massey University. New Zealand; (4)PhD. Senior Lecturer. School of Public Health. Massey University. New Zealand; (5)PhD. Director. Centre for Public Health Research. Massey University. New Zealand.</footnote>

<footnote>(1)Auón, Aneth; (1)Álvarez, María Fernanda; (2)Rios, Israel; (2)Valdés, Victoria.</footnote>

<footnote>(1)Nutritionist. Nutrition and Dietetic Department. Medicine School. University of Panama. Panama City. Panama; (2)MSc. Nutritionist. Nutrition and Dietetic Department. Medicine School. University of Panama. Panama City. Panama.</footnote>
severe (<-3 SD). According with BAZ, 19% presented overweight (>2 SD BAZ) and 8% was classified as obese (>3 SD BAZ). The reported food patterns was predominantly composed by starch (grains, cereals, and sugar). Low consumption of high value animal protein was observed. As well as a scarce consumption of fruit or vegetables.

**Conclusions:** Children under five in this analysis are affected by double burden of malnutrition and presented low food diversity based in starch and simple sugar. Comprehensive and multi sectorial nutritional interventions are needed to improve the nutritional situation among children under five years in Panamanian indigenous areas.

**Keywords:** Stunting, Malnutrition, Overweight, Obesity, Indigenous people.

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## PATHWAYS TO ACHIEVING DIETARY VITAMIN A ADEQUACY AMONG YOUNG CHILDREN: AN APPLICATION OF AN ECONOMIC OPTIMIZATION MODEL IN CAMEROON

(1)Vosti, Stephen; (2)Engle-Stone, Reina; (3)Kagin, Justin; (4)Luo, Hanqi;

(5)Tarini, Ann; (6)Brown, Ken.

(1)PhD. Department of Agricultural and Resource Economics. University of California. Davis. USA.; (2)PhD. Department of Nutrition. University of California. Davis. USA.; (3)Kagin's Consulting. Vacaville. California. USA.; (4)PhD Candidate. Department of Nutrition. University of California. Davis. USA.;

(5)MSc. Ann Tarini International Public Health Consulting. Montreal. Quebec. Canada.; (6)MD. Bill & Melinda Gates Foundation. Seattle. Washington. USA.

**Background and objectives:** National efforts to reduce vitamin A deficiency (VAD) among children need to be more efficient and fiscally sustainable, but vulnerable children must be protected during programmatic transitions. GAVA has proposed a framework that provides guidance for transitions, but data and tools are needed to inform program choices.

**Methods:** The Micronutrient Intervention Modeling (MINIMOD) tool is used to explore transitional pathways for VA programs. We predict dietary VA adequacy using national dietary data and lives saved using LiST. An economic optimization model links benefits and costs, and identifies alternative 10-year pathways for enhancing efficiency while protecting vulnerable children. We modeled, year-by-year, one possible pathway: a) lagged improvements in an existing VA oil fortification program, b) lagged development of a VA-fortified bouillon cube program, and c) maintaining VA supplementation via Child Health Days (CHD) when/where the prevalence of inadequate VA intake is >10%.

**Results:** Program costs and impacts vary across Cameroon's macro-regions (South, North, and Cities). In the South, where inadequate VA intake was lowest, after 4 years, the combined oil and cube programs achieve inadequate intake < 10%; cost after year 4 is $336k/year. During the 3-year transition period, VAS protects

children at risk of VA-related mortality; total cost of program investments and CHD is ~$1.5m per year and 1913 child deaths are averted. If two biomarker surveys confirm resolution of VAD, as proposed by the framework, CHD are discontinued in the South in year 7, yielding ~$1.3m per year savings. The scenario is similar for the Cities macro-region. However, in the North, where VAD is more severe, combined oil and cube fortification programs do not reduce VA dietary inadequacy below 10%; other VA programs are needed or CHD need to be maintained indefinitely.

**Conclusions:** Depending on the nature and extent of VA deficiencies, well-planned and well-managed food fortification programs have the potential meet VA dietary intake requirements of young children. Vulnerable children need to be protected until investments in fortification programs mature. In some areas, currently available fortification programs will not meet VA dietary intake needs; new programs need to be developed.

**Keywords:** VA deficiency. VA fortification. VA supplementation. MINIMOD. Cameroon

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## TOXIC FOOD ENVIRONMENT INSIDE AND AROUND PUBLIC PARKS IN MEXICO CITY

(1)Medina, Catalina; (2)Hernández, Annel; (3)Tolentino Mayo, María Lizbeth; (4)Rincon-Gallardo, Sofía; (5)Nieto, Claudia; (5)Barquera, Simon.

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

**Background and objectives:** According to the Mexican National Institute of Statistic and Geography (INEGI), more than 60% of people attend public parks. Urbanists state that offering food in public spaces increases the participation. However, energy-dense food availability and advertising is linked with obesity. The aim of the study is to characterize the toxic food environment inside and around public parks of Mexico City.

**Methods:** Trained interviewers performed the evaluation of the inside and around food supply and advertising of 33 parks in Mexico City. Data collection was made using a Mexican context questionnaire. Food availability was defined as those foods sold inside and around the parks. Around was defined as the circumference of the parks. Parks were mapped using three different databases including local (Roji Guide), Google and INEGI maps and were classified according to their dimensions into three typologies: 1) metropolitan (>0.01 km2), 2) local (0.003 a 0.01 km2), and 3) district (0.0004-0.003 km2).

**Results:** Information of 5.9% metropolitan, 36.4% linear and 12.1% district parks of Mexico City was collected. Overall, 39.4% of the food kiosks were located inside the parks, whereas 78.8% were around. The most prevalent food inside corresponds to sweet snacks
(19.7%), followed by chips (18.2%); while around parks were found traditional Mexican fast food (fried tortilla with meat/chicken/pork/ beans) in restaurants (16.9%) and street vendors (16.1%). In total, 3% of the parks have food advertising inside and 15.7% around.

**Conclusions:** While parks are the most popular public spaces to perform physical activity in Mexico City, our results show that most of the available food inside and around the parks is energy-dense food. In addition, 3% of the parks have food advertising inside. Regulatory guidelines are needed to promote healthy environments, because the beneficial contribution on health of these spaces could be attenuated by the high availability and advertising of energy-dense foods.

**Keywords:** Parks, energy-dense food, food environment

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NEW CHILEAN LABELLING LAW AND SCHOOL SNACKS: CHILDREN PERCEPTION

(1)Quintiliano Scarpelli Dourado, Daiana; (2)Capdevila, Daniella;

(2)Gajardo, Valentina; (2)Melivilu, Paula; (3)Cortés, Andrea.

(1)PhD. University of Development (UDD). Chile; (2)Student. Nutritionist. University of Development (UDD). Chile; (3)MsC. Nutritionist. University of Development (UDD). Chile.

**Background and objectives:** In Chile with the aim of reducing prevalence of child obesity and create healthy environments the Law 20,606 was created, by the Ministry of Health (MINSAL). It was implemented its first stage in June, 2016 and labels the package of foods/products with "High in" black signs when they exceed the limits of critical nutrients (sugar, sodium, saturated fats and calories).

The objective of the study was to verify the impact of the new labeling on the perception and nutritional quality of the snacks consumption during the school day of adolescents from a subsized school in Santiago, Chile.

**Methods:** A crossover study with qualitative approach was done. The nutritional status was evaluated and clasified according to Z-score reference (WHO, 2007). The children filled a weekly snack form specifying the eaten snack. These snacks were clasified according to the presence of the "black signs" according to the nutritional limits of the law. An interview was performed to know what they think about the black signs and if the presence of them impacted on their decision to eat/drink the product. A descriptive analysis was done and the Kruskal-Wallis test was applied considering the significance level of 5%. The Stata 13 software was used. Perception answers were transcribed and analyzed by the iterative method.

**Results:** We evaluated 48 adolescents (12-14y) of both sexes, being 60,4% females; 58,5% were overweight. 530 snacks were consumed in this period, being only 7,5% without black signs and 35,3% with 3 or 4 black signs. No significant difference in the snacks quality and nutritional status were observed. Perception evidences showed that the adolescents (89,7%) have the knowledge about the problem of obesity in Chile and why some foods/products are receiving the black signs. 75% mencionated that the foods

without signs are healthier, but the presence of the black signs only affected the decision of consumption and acquisition of 8,3%.

**Conclusions:** The presence of black signs did not impact in the adolescent snack selection. but it is important to mention that they recognized that it is easiest to understand the nutritional information with the "black signs".

**Keywords:** Nutritional Status, snacks nutritional quality, Chilean law 20,606.

144/2175

FOOD AND NUTRITION EDUCATION AS CORE ELEMENT OF SCHOOL FOOD AND NUTRITION PROGRAMMES IN LATIN AMERICA AND THE CARIBBEAN

(1)Rios-Castillo, Israel; (2)Salamanca, Anabell; (3)Kazi, Nabeeha;

(4)Henderson, Savanna; (5)Hernandez-Garbanzo, Yenory; (6)Rivas, RoseMarie; (7)Rojas, Jorge.

(1)MSc. Nutritionist. Regional Nutrition Officer for Latin America and the Caribbean. Food and Agriculture Organization. Sub Regional Office for Mesoamerica. Panama City. Panama;

(2)Humanitas Global - Humanitas Global Development. San Salvador. El Salvador; (3)President & CEO. Humanitas Global - Humanitas Global Development. Washington. USA; (4)Humanitas Global - Humanitas Global Development. Washington. USA;

(5)PhD. Nutritionist. Nutrition Officer. Food and Agriculture Organization of the United Nations. Headquarter. Rome. Italy; (6)Nutritionist. Food and Agriculture Organization of the United Nations. San Salvador. El Salvador; (7)Humanitas Global - Humanitas Global Development. La Paz. Bolivia.

**Background and objectives:** Food and Nutrition Education (FNE) is defined as any combination of educational strategies implemented at different levels, whose objectives are to assist individuals in achieving sustainable improvements in their feeding behavior and practices. It is believed that the School Food and Nutrition Programmes (SFNPs) should include FNE in their interventions to create a long-range impact, and not only provide food assistance. The objective of this study was to identify and review successful practices and programmes that may be expanded/ replicated in other countries in Latin America and the Caribbean (LAC).

**Methods:** During the first phase of this study, a desk audit per LAC country was performed to understand experiences at SFNP and FNE levels. An in-depth review was implemented during the second phase to better assess and understand the experiences of countries with active FNE, which may serve as an example for other countries in the LAC region. The countries reviewed included: Brazil, Costa Rica, El Salvador, Mexico, Peru, the Dominican Republic, and Trinidad and Tobago.

**Results:** Overall, findings from this study support robust insights from FNE programs that call for more effective and responsive policies, programs and funding streams to strengthen school-based efforts. Development of a policy framework is needed.
ed to sustain FNE and national malnutrition and hunger plans and strategies. Aspects of FNE such as feeding and hygiene are includ- ed in school curricula, but FNE as a core educational subject is not present in most countries in the region. FNE is most effective when promoted and integrated throughout the school environ- ment. This includes the regulation of school kiosks to offer nutri- tious and local food, adequate physical activities, and presence of pedagogical school gardens.

**Conclusions:** An effective FNE policy requires that a communication agenda, an implementation methodology, and technical support be provided to central as well as local governments. Its adoption and activation also require that an item be allocated for it in the public budget.

**Keywords:** Nutrition Education, School, Nutrition Policy, Nutrition, Latin America

(1)Ocampo, Heilen; (2)Castillo, Alejandra; (3)Tolentino Mayo, María Lizbeth.

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

**Background and objectives:** Nowadays, large quantities of food and beverages are made with modifications in its composition, so it is necessary to establish nutritional specifications that must be subject to these products. 'Nutrition claim' means any claim which states, suggests or implies that a food has particular beneficial nutritional properties. Analyze of nutrition information in packaging of sweet and salted biscuits, of nutrition claims available in Mexico City According to the official Mexican standard 086-SSA1-1994 (NOM-086).

**Methods:** There were photographed 977 biscuits packaging available in 51 supermarkets in Mexico City, on December 1st 2015 to March 31st 2016. Biscuits are classified in two groups: sweet biscuits (N=883), and, salted (N=98). It was used as an inclusion criteria all those packages of biscuits that showed at least one nutrition claim on the front face of the product. To find out if it meet the nutritional specifications of the NOM-086 were analyzed nutrition claims per serving/100g and using as parameters the classification of the following denominations: fat free (<5g per serving), sugar free (<0.5g per serving) and energy free (<5 calories per serving). A descriptive analysis was made out using the SPSS v. 23.

**Results:** Of the 977 Biscuits, only 37.9% had nutrition claim; of which 17.9% of the packaging presented 2 nutrition claims and 4.5% had 12 nutrition claims. In comparison sweets biscuits had more nutrition claims than salted (86.5% and 13.5%, respectively).

The nutrition claims identified were: "fat free" 39.2%, "sugar free" 31.9% and "energy free" 7.3%. Only 12.3% met the parameters according to their nutrient content to submit nutrition claims. Of the products who carried a nutrition claim and that do not meet the nutritional parameters, to contain higher values to the permitted was 98% "fat free", 84% "sugar free" and 99.7% "energy free".

**Conclusions:** There is a need to update and monitor the implementation of the regulation for the use of nutrition claims presented in industrialized cookies, as it may be a determined factor in the choice of food. This would contribute to the various strategies implemented to reduce the high prevalence of overweight and obesity in Mexico.

**Keywords:** Nutrition, claim, NOM-086, biscuits

(1)Gómez Salas, Georgina; (2)Ramírez, Andrea; (3)Sheik, Amed;

(4)Chinnock, Anne; (5)Nogueira Previdelli, Agatha.

(1)MSc. Nutritionist. Department of Biochemistry. School of Medicine. University of Costa Rica. Costa Rica; (2)Bch. Nutritionist. Department of Biochemistry. School of Medicine. University of Costa Rica. Costa Rica; (3)Bch. Nutritionist. Department of Bichemistry. School of Medicine. University of Costa Rica. Costa Rica; (4)PhD. Nutritionist. School of Nutrition. University of Costa Rica. Costa Rica; (5)PhD. Nutritionist. Dacultade de Ciencias Biologicas e da Saude. University of Sao Judas Tadeu. Brazil.

**Background and objectives:** Invisible, but still very common in developing countries, micronutrient deficiencies can lead to serious health consequences. Hypovitaminosis can reduce the ability to combat diseases, diminish cell and organ function and affect the development of children and wellbeing of adults and elderly. The study aimed to estimate the prevalence of inadequate micronutrient intake in an urban Costa Rican population and to identify individuals at risk of nutritional deficiency.

**Methods:** ELANS is a multicenter cross-sectional study including a representative sample of urban population from eight LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela). In Costa Rica, 798 participants (15-65 years old) provided two 24-h dietary recalls. Nutritional data was entered into the Nutrition Data System for Research (NDS-R) software, after a harmonization process between local foods and NDS-R database, and adjusting for mandatory micronutrient fortification of sugar, rice, wheat flour and corn flour and milk. The rates of prevalence of inadequate micronutrient intake were estimated according to gender and age group, using the EAR (Estimated Average Requirement) method as cut off points.

**Results:** High prevalence (>95%) of inadequate intake of vitamin D, E and Calcium was observed in both genders. The prevalence of inadequate intake of vitamin A, riboflavin and niacin
were 39.8%, 24.6% and 16.5%, respectively. Lower prevalence was found for iron (3.3%), thiamin (7.8%), cobalamin (10.2%) and folate (13.9%). For all analysis, vitamins and minerals inadequacy was higher for women than men, with exception of riboflavin and vitamin A. For niacin, cobalamin, calcium and thiamin the prevalence of inadequate intake was greater in older groups (p<0.005).

**Conclusions:** Vitamin and mineral intake among urban Costa Rican population were lower than recommended, with a tendency of a greater inadequacy rate in older groups. Healthy eating that facilitate meeting the EAR from a variety of foods most be encourage to improve this situation.

**Keywords:** Vitamins. Minerals. Costa Rica. Inadequate intake

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

**Further collaborators:** ELANS Study Group

144/2194

FREE SUGARS AND EXCESS WEIGHT IN CHILDREN AND ADOLESCENTS FROM LATIN AMERICA: A SYSTEMATIC REVIEW

**Background and objectives:** Free sugars (FS) contribute to increasing the energy density of the diet and may promote a positive energy balance, its high intake has been associated with excess weight (EW). Our aim was to identify the association between FS consumption and EW in children and adolescents from Latin America.

**Methods:** We conducted a systematic review of research articles published between 2005 and 2016. We searched VHL, PubMed and Embase databases since August 26 until September 30 of 2016. The primary variables were children and adolescents, Latin America countries, consumption of FS (Soda, Fruit drinks, Sugar-sweetened beverages, Sweets, Sugary foods), weight gain, overweight and obesity. There was no restriction according to type of study. Articles written in English, Spanish and Portuguese were included. Data Extraction: The Selection of studies, data collection and quality assessment were performed independently by two trained reviewers.

**Results:** Fourteen of one hundred and seventy-five articles were eligible for systematic review, A single article could have as-

sociated more than one variable. Distribution according to type of study: Descriptives: four, Cross sectional: eight, Prospective: one, Cases and controls: one. Nine of the included articles were made in Brazilian population. The measurement of the association between soda consumption and anthropometric indicators related to EW was the highest number of positive associations (p< 0,05). For all food categories containing FS, there were 9 positive and 2 negative associations (p <0.05) with EW indicators, in 12 occasions no association was reported.

**Conclusions:** The articles found present heterogeneous results respect to the association between FS consumption and EW in children and adolescents of the region. The type of research that has been carried out in Latin America does not allow to infer causal associations between these variables.

**Keywords:** Child, adolescents, body weight, dietary sugar, free sugar.

144/2198

NUTRITIONAL STATUS AND MONITORING COVERAGE BY THE FOOD AND NUTRITION SURVEILLANCE SYSTEM IN THE STATE OF MATO GROSSO DO SUL, BRAZIL

(1)Ferraz Moreira, Naiara; (2)Carvalho, Viviane Camila; (1)Martins, Rita de Cássia.

(1)PhD. Nutrtonist. Faculty of Health Sciences. Federal University of Grande Dourados (UFGD). Brazil.; (2)Bachelor student. Faculty of Health Sciences. Federal University of Grande Dourados (UFGD). Brazil.

**Background and objectives:** The Food and Nutrition Surveillance System (SISVAN) aim to characterize the nutritional status and food consumption among all population groups in Brazil. According SISVAN results, decisions could be formulated to develop health promotion policies and programs. This study aimed to evaluate nutritional monitoring by the SISVAN, in the different lifecycles in the State of Mato Grosso do Sul, Brazil, in 2015.

**Methods:** It is a descriptive study with secondary data from SISVAN. The 79 municipalities of the State were included, divided into 11 micro-regions. Population coverage was estimated based on the number of people enrolled in SISVAN and the population estimated by the Brazilian Institute of Geography and Statistics (IBGE). In order to classify the nutritional status, we adopted the WHO references for the following anthropometric indexes: children and adolescents (sex- and age-specific BMI z-scores), adults and elderly individuals (age-specific BMI).

**Results:** The percentage of general population coverage was considered low (10.4%) ranging from 5.3% to 20%. According the age groups, the coverage was higher among children (23.3%) and lower among elderly individuals (2.7%). Regarding nutritional status, the prevalence of underweight was 5.1% for children, 3.0% for adolescents, 2.5% for adults and 11.8% for elderly population. Overweight (including obesity) was found to be high for all age groups, mainly for adults and elderly individuals, as follows: children (14.2%), adolescents (9.1%), adults (66%), and elderly (54%).

<footnote>(1)Ortiz Calderón, Sarah Lucia; (1)Arroyave Zuleta, Luisa Fernanda;</footnote>

<footnote>(2)González-Zapata, Laura Inés.</footnote>

<footnote>(1)BSc. Nutritionist. School of Nutrition and Dietetics. University of Antioquia. Colombia; (2)PhD. Nutritionist. School of Nutrition and Dietetics. University of Antioquia. Medellín. Colombia.</footnote>
**Conclusions:** The prevalence of underweight was high among children and elderly. Obesity were especially high among all age groups, mainly for adults and elderly. Therefore, the population coverage for the SISVAN was considered low. The SISVAN should be effectively implemented in the basic care to develop health promotion programs.

**Keywords:** Nutritional Surveillance, Nutritional Status, Age groups.

144/2206

EVALUATION OF INDUSTRIAL FOOD AND BEVERAGES NUTRITION CLAIMS AVAILABLE IN SUPERMARKET IN MEXICO CITY

**Background and objectives:** The high prevalence of obesity is the result of changes in the power supply. The consumption of industrialized products is increasing. The information you provide on your packaging is not conducive to the population. Evaluate the compliance of nutrition claims in industrialized foods and beverages in relation to Official Mexican Standard 086-SSA1-1994 (NOM-86), which specifies changes in the nutritional composition of a product.

**Methods:** In 2015, 659 food and beverage products were photographed in 11 Supermarkets in Mexico City. The evaluated categories were beverages (N = 173), sweet snack (N = 81), salty snack (N = 98), dairy products (N = 211), breakfast cereals (N = 10). Food and beverages were analyzed by the NOM-086, to evaluate the correct use of nutrition claims. The evaluation of the nutrition claims was made with the nutritional specifications of the NOM-086, having as parameter of the following classification: "low sodium" (≤140 mg / lot), "low fat", "energy free", through a descriptive analysis

**Results:** 42% of the products presented a nutrition claim in the frontal packing. However, 2% of the products met the requirements according to their nutritional content to carry the nutrition claim. However, of the products complying with NOM-086, 46.4% contain the claims: "low in sodium", 37.6% "low in fat", 15.9% "sugar free" and 5.76% "energy free". In the salty snack group 90.8% of the nutrition claims presented in the products did not comply with the normativity required by the greater quantity of nutrients than those specified in the standard. In products that presented the claim "no sugar" in the sweet snack category 98.8% does not meet the specifications of NOM-086. On the other hand, in the foods and beverages that contain the nutrition claim "energy free" only in the category of drinks 22% complied with the requirement

**Conclusions:** The results showed the need to evaluate and monitor, through an independent body, the proper use of the nutrition claims, that appear in the front of industrialized foods and

beverages. The actions implementation applies to contribute the correct use of NOM-086 to avoid confusing and incorrect information in the food and beverage industry.

**Keywords:** Label, Nutrition-claim, Low-sodium, Low-fat, Sugar-free

144/2217

TERRITORIAL INEQUALITIES IN THE AVAILABILITY OF FOOD IN THE MUNICIPALITY OF RIO DE JANEIRO, BRAZIL

**Background and objectives:** Food environment can be defined as the set of physical, economic, political and socio-cultural environments as well as opportunities and conditions that influence food choices. Understanding the community food environment, characterized by availability and access to food, is important to help understand the food and nutritional security scenario to which populations are exposed. Objective: The study describes the food environment in the city of Rio de Janeiro, identifying the inequalities in food availability.

**Methods:** The addresses of food markets and establishments that sell food and meals, licensed and registered in the Health Surveillance Information System (VISAN) of the municipality until 2013 were collected and georeferenced. The 21 types of establishments were classified into three groups: G1) those that sold mainly healthy foods (e.g. food markets); G2) those that sold healthy and unhealthy foods (e.g. supermarkets and restaurants); G3) those that sold mainly unhealthy foods (e.g. fast foods). The following indicators, according to the groups, were constructed to evaluate the food environment of the 33 administrative regions (AR) of the municipality: 1) proportion of establishments (group); 2) density of establishments (group). Food environment was characterized by means of the construction of maps with the location of the establishments (groups) and the presentation of maps with the indicators considering the average income per capita of the AR.

**Results:** There was a higher proportion of G2 establishments (min: 53%, max: 88%, mean: 72%), followed by G3 (min: 1%, max: 30%, mean: 20%) and G1 (min:0%, max: 42%, mean: 8%). We observed inequality of healthy foods availability, since the RA with better income were also those ones that showed the highest density of G1 and G2 establishments.

**Conclusions:** The low availability of establishments that sold healthy foods suggests the predominance of an obesogenic envi-

<footnote>(¹)Castillo, Alejandra; (¹)Ocampo, Heilen; (¹)Rodríguez, Julio;</footnote>

<footnote>(²)Tolentino Mayo, María Lizbeth.</footnote>

<footnote>(¹)Nutritionist. Health and Nutrition Research Center. National Insitutute Public Health. Mexico.; (²)MSc. Nutritionist. Health and Nutrition Research Center. National Insitutute Public Health. Mexico.</footnote>

<footnote>(¹)Pereira de Castro Junior, Paulo Cesar; (²)Araújo Nobre, Aline;</footnote>

<footnote>(³)Rugani Ribeiro de Castro, Inês; (⁴)de Oliveira Cardoso, Letícia.</footnote>

<footnote>(¹)PhD student. Nutritionist. National School of Public Health. Oswaldo Cruz Foundation. Rio de Janeiro. RJ. Brazil; (²)PhD. Researcher. Scientific Computing Programme. Oswaldo Cruz Foundation. Rio de Janeiro. RJ. Brazil; (³)PhD. Nutritionist. University professor. Institute of Nutrition. Rio de Janeiro State University. Rio de Janeiro. RJ. Brazil; (⁴)PhD. Nutritionist. Researcher. National School of Public Health. Oswaldo Cruz Foundation. Rio de Janeiro. RJ. Brazil.</footnote>
ronment in the municipality, especially in poorer areas, pointing
out the need for public supply policies that guarantee food and
nutritional security of the population.

**Keywords:** Food environment, inequality, indicators, socio-spatial analysis

**Conclusions:** Overall, food insecurity increased among house-
holds enrolled in a supplementary feeding program for young
children, but varied according to baseline status and season of
program enrollment and exit. More work is needed to understand
the dynamics of household food insecurity in the context of a SFP.

**Keywords:** supplementary feeding program, household food insecurity

144/2220

CHANGES IN HOUSEHOLD FOOD INSECURI-
TY BETWEEN ENROLLMENT AND EXIT FROM
A BLANKET SUPPLEMENTARY FEEDING PRO-
GRAM FOR CHILDREN 6 – 23 MONTHS OLD IN
BURKINA FASO

(1)Langlois, Breanne; (2)Nikiema, Laetitia; (1)Cliffer, Ilana; (3)Suri, Devika; (4)Shen, Ye; (5)Webb, Patrick; (5)Rogers, Beatrice.

(1)MPH. Friedman School of Nutrition Science and Policy. Tufts University. USA.; (2)MD, MPH. Department of Public Health. Institut de Recherche en Science de la Santé. Burkina Faso.;

(3)MPH, MS. Friedman School of Nutrition Science and Policy. Tufts University. USA.; (4)MSPH. Friedman School of Nutrition Science and Policy. Tufts University. USA.; (5)PhD. Friedman School of Nutrition Science and Policy. Tufts University. USA.

**Background and objectives:** In a cluster-randomized tri-
al aimed to assess the effectiveness of four supplementary foods
in the prevention of child malnutrition, we assess beneficiaries'
household food insecurity between program enrollment and exit.

**Methods:** Children participating in a blanket supplementary feeding program were recruited on a rolling basis between August 2014 and June 2015. This is a preliminary, descriptive analysis of household food insecurity among participating households. Data were collected at baseline and households' exit from the program to capture socioeconomic characteristics including household food insecurity, based on the Household Food Insecurity Access Scale (HFIAS). A categorical variable representing combinations of seasons of program enrollment and exit was created: dry/dry, rainy/dry, dry/rainy, and rainy/rainy. Descriptive statistics of change in HFIAS score (endline – baseline) were calculated and stratified by baseline HFIAS category and season of program enrollment and exit.

**Results:** A total of 6,092 children were enrolled. Of these, 5,236 completed the program of food supplementation and 5,206 were included in analysis. At baseline and endline, respectively, 43% and 35% of households were food secure, while 15% and 18% were severely food insecure. Mean HFIAS scores were 3.81±4.82, and 4.31±4.95 at baseline and endline, respectively, with an overall increase in food insecurity of 0.51±5.94 units. Disaggregated by season of baseline and endline, mean changes varied: dry/dry 0.36±5.76, n=1066; rainy/rainy 1.89±5.42, n=170; rainy/dry -1.65±6.17, n=890; dry/rainy 1.10±5.82, n=3080. Households that were food secure or mildly food insecure at baseline had an increase in food insecurity at endline, on average, while households that were moderately or severely food insecure at baseline had a decrease in food insecurity at endline, on average.

144/2221

NUTRITIONAL STATUS OF THE PEOPLE ASISTED
IN THE PRIMARY LEVEL HEALTH SERVICES IN
MONTEVIDEO AND INLAND OF URUGUAY

(1)Elichalt, Marta; (2)Gronros, Diana.

(1)MSc. Nutricionist. Nutrition School. University Republic.
Uruguay.; (2)Nutricionist. Nutricion School. University Republic.
Uruguay.

**Background and objectives:** To characterize the nutrition-
al status (NS) of the assisted population in primary care services
in Montevideo and inland between April and November 2016. To
compare the type and magnitude of the nutritional problems be-
tween services of Montevideo and it's inland, and between servic-
es of Montevideo, according to municipal grouping based on the
proportion of poor families (PF).

**Methods:** The information collected by the students in the last year of the Nutrition Degree was systematized, and they applied a survey with Google forms. The information collected was: sex, age, reason for referral, anthropometric diagnosis and service. The NS in children was assessed by anthropometric indicators and compared with WHO standard on 2006. In adults, the body mass index was used and compared with the WHO reference on 1998. The services were grouped by location considering the municipal division of Montevideo according to the proportion of FP by level of income.

**Results:** The assisted population was 1982 corresponding to 17 services. Of all, 75% were women and almost half were over 18 years of age. 50% of referral reasons were Non-Communicable Diseases. Over-malnutrition exceeded the value identified in studies at the national level in one-third of services. Deficit malnutrition varied in services between 5% and 20%. In children under 18, the prevalence of malnutrition due to deficit and excess was bigger than in other national studies. There are important differences in malnutrition due to deficit and excess in adults and children among services with a higher proportion of PF.

**Conclusions:** There are problems of excess and deficit that surpass the national data. The nutritional stage in which the user is captured and the proportion of PF are probably determinants of the type and magnitude of the nutritional problems found in nutritional care.

**Keywords:** nutritional care, poverty, nutritional problems
## SUPPLEMENTATION OF HUMAN MILK AND ITS OSMOLALITY

(1)Nascimento Alves Ferreira, Isabella; (2)Valente Mendes Soares, Fernanda; (3)Carioca da Costa, Ana Carolina; (4)Reis Novak, Franz;

(5)Lopes Moreira, Maria Elisabeth.

(1)Ms. Biomedical Scientist. Fernandes Figueira Institute (FIOCRUZ). Rio de Janeiro. Brazil; (2)PhD. Nutritionist. Fernandes Figueira Institute. Brazil; (3)PhD. Statistic. Fernandes Figueira Institute. Brazil; (4)PhD. Pharmaceutical. Fernandes Figueira Institute. Brazil; (5)PhD. Doctor. Fernandes Figueira Institute. Brazil.

**Background and objectives:** Human milk is the ideal food for newborns. However, due to the increased nutritional need for preterm infants, human milk is often insufficient as an exclusive source of nutrition to meet its nutritional needs. As a result, it is often necessary to add fortifiers and/or vitamins in the milk offered to them. These products, however, do not only increase nutrients, but also osmolality, which can lead to health problems such as necrotizing enterocolitis.

Considering the need to understand the effects of physical and chemical factors on human milk, this study aims to analyze the variations of the osmolality in human milk samples, according to their nutritional and vitamin supplementation, and also to different preparation times and temperatures.

**Methods:** Prospective, quantitative and experimental study. Samples of human milk, supplemented with FM85®, Enfamil HMF® and vitamins protovit plus®, viter c® and mineral fersil®, collected at the Human Milk Bank of Fernandes Figueira Institute (FIOCRUZ), after the signing of a free and informed consent form by donors. The samples were analyzed in triplicate at the following moments: in up to 5 minutes; after 20 and 40 minutes; every hour until the completion of 8 hours; after 12 and 24 hours, at room temperature and also under refrigeration at 6 °C. The results of the osmolality determinations were obtained automatically using a digital Osmometer (Advanced Instruments A+, model 3320) calibrated according to the recommendations of the manufacturer.

**Results:** The samples with the FM85® fortifier and with the vitamin protovit plus® were the ones that presented the highest osmolalities, surpassing the value recommended by the American Academy of Pediatrics (AAP), in the different periods of time and temperature. Samples with higher concentrations of vitamins and fortifiers presented proportionally higher values of osmolality.

**Conclusions:** Increased osmolality was observed with respect to time and temperature. Some samples of human milk did not meet the safety specifications recommended by AAP. It was evidenced the need to elaborate protocols for the supplementation of human milk, in order to maintain control of its osmolality when added with additives and fortifiers, ensuring that it remains at levels that can be tolerated by the newborns.

**Keywords:** Human milk; Osmolality; Newborns; Fortifiers; Food Safety

## EMERGING ENVIRONMENTAL FACTORS IN CHILD STUNTING GLOBALLY

Ly, Stephanie.

PhD student. Community Health Sciences. UCLA Fielding School of Public Health. Los Angeles. California. USA.

**Background and objectives:** Linear growth stunting in children is considered a form of chronic malnutrition. However, nutritional interventions have modest effects on height. The World Health Organization (WHO) estimated that 171 million, or 23.8% of the world's children are stunted. Emerging research has implicated environmental exposures leading to poor intestinal health, which reduces nutrient absorption and growth hormone production. The condition is known as environmental enteric dysfunction (EED) and is onset by constant exposure to fecal pathogens with a possible link to mycotoxins created by mold species. A systematic review was conducted on EED and mycotoxins on stunting to understand current knowledge and novel areas for research expansion.

**Methods:** Specific search terms were used to conduct a systematic review in WHO Library and PubMed public databases. Next, duplicates were removed and remaining full-text articles were screened for eligibility. The criteria for article inclusion included: primary research, publication between 2011-2016, translatability to humans, and focus on the main topics of research interest.

**Results:** A total of 302 articles were found after the initial search, 191 articles remained after duplicates, and 23 articles met eligibility criteria. Among the final articles included in the review, 12 focused on EED and 11 on mycotoxins in stunting. EED etiology was confirmed in constant exposure to fecal pathogens in diverse underserved populations. EED interventions used micronutrient supplements, autoimmune treatments, and behavioral trials. None of the interventions significantly alleviated EED or stunting. Among mycotoxin-focused articles, studies found that aflatoxin affected linear growth and mycotoxin prevalence was established in new populations. Mycotoxin interventions tested absorbents for food and replaced contaminated maize in households with both studies showing promising results. Pathways linking mycotoxin exposure to EED was also articulated in recent articles.

**Conclusions:** Primary research conducted in the last five years have yielded modest impacts on stunting resolution but have expanded knowledge. Novel pathways between EED and mycotoxins have been implicated in linear growth and highlight the unmet need for continued etiologic and interventional research. A majority of studies was conducted in low- and middle-income country settings, which highlights the lack of access to adequate sanitation infrastructure and implications on stunting.

**Keywords:** review, stunting, environment, enteropathy, mycotoxins
BODY IMAGE PERCEPTION AND ITS RELATION-
SHIP WITH SCHOLASTIC ACHIEVEMENT CHILE-
AN ADOLESCENTS

(1) Villagrán Silva, Francisca Marión; (2) Orellana Zapata, Yasna;

(3) Almagià Flores, Atilio; (4) Ivanovic Marincovich, Daniza.

(1)MSc. Professor of Biology and Master in Nutrition and Food. Institute of Nutrition and Food Technology (INTA). University of Chile. Santiago. Chile; (2)PhD. Statistics. Institute of Nutrition and Food Technology (INTA). University of Chile. Santiago. Chile.; (3)Mrs. Biology. Institute of Biology. Laboratory of Physical Anthropology and Human Anatomy. Catholic University of Valparaiso. Valparaiso. Chile.; (4)MSc. Science in Nutrition. Institute of Nutrition and Food Technology (INTA). University of Chile. Santiago. Chile.

**Background and objectives:** During the last decades, an increase in sedentary lifestyle, poor dietary practices, overweight and obesity in adolescents, resulting in changes both in body image and perception which can affect scholastic achievement (SA). The aim of this study was to evaluate the relationship between scholastic achievement in the University Selection Test (PSU) of Language (PSUL) and Mathematics (PSUM) with the Body Image Perception (BIP) in Chilean adolescents.

**Methods:** A representative and proportional sample of 33 educational establishments was randomly selected, in the Metropolitan Region, Chile. During 2013, 418 school-age children of the 4st grade of high school, of both sexes, 43.1% were males (n = 180) and 57% females (n = 238) participated. The subjects consent was obtained according to Declaration of Helsinki to undergo anthropometric measurements of weight and height to calculate BMI. BIP was assessed by Stunkard (1990) method which was validated for adolescents (Cortés et al., 2009), showing 9 male and female body silhouettes, ranging from very thin to more robust each silhouette has assigned its corresponding BMI from 17 kg/m2 to 33kg/m2: Underweight (silhouette 1), Normal (silhouettes 2-5), overweight (silhouettes 6-7) and obesity grade 1 and grade 2 (silhouettes 8-9). The calculated difference between BMI actual and perceived, obtaining three categories: Overestimation (they look fatter than they are), Adjusted Perception and Underestimation (they look thinner than they are). The socioeconomic strata (SES), using the Graffar modified method. SA was measured using the 2013 PSU both PSUL and PSUM, provided by the Department of Education of the Ministry of Education. Statistical analysis of the data was performed using the STATA 13 software.

**Results:** 25.8% of men tended to overestimate their perceived BIP, and 39.6% of women underestimated (p <0.0001). There was evidence of significant differences in PSUM in women (p <0.05) and in the low-SES adolescents (p <0.05) who underestimated their perceived BIP. They obtained the lowest PSUM scores in both groups.

**Conclusions:** The self-report survey is a good indicator BIP approach the nutritional status of adolescents and a new factor that could be influencing SA. Grants FONDECYT 1100431 and 1150524.

**Keywords:** Scholastic Achievement, Socioeconomic Factors, Nutritional Status, Body Image Perception.

PERCEPTIONS OF PRICE AND STORE AVAILABILITY OF FRUIT AND VEGETABLE AND THEIR ASSOCIATIONS WITH FRUIT AND VEGETABLE INTAKE AMONG ADULTS IN FOUR SOUTH AMERICAN CITIES

(1) Elorriaga, Natalia; (2) Gutierrez, Laura; (3) Chaparro, Raúl Martín;

(3) Melendi, Santiago; (4) Poggio, Rosana; (5) Ponzo, Jacqueline; (6) Lanas, Fernando; (7) Mores, Nora; (8) Rubinstein, Adolfo; (9) Irazola, Vilma.

(1)MSc. BSc. Nutritionist. South American Center of Excellence in Cardiovascular Health. Institute for Clinical Effectiveness and Health Policy. Escuela de Nutrición. Universidad de Buenos Aires. Argentina.; (2)BSc. South American Center of Excellence in Cardiovascular Health. Institute for Clinical Effectiveness and Health Policy. Argentina.; (3)MD. South American Center of Excellence in Cardiovascular Health. Institute for Clinical Effectiveness and Health Policy. Argentina.; (4)Rosana Poggio. MD. MSc. PhD. South American Center of Excellence in Cardiovascular Health. Institute for Clinical Effectiveness and Health Policy. CONICET. Argentina.; (5)MD. MSc. Universidad de la República. Uruguay.; (6)MD. MSc. Universidad de La Frontera. Chile.; (7)MD. Secretaría de Salud. Municipalidad de Marcos Paz. Pcia Buenos Aires. Argentina.; (8)MD. MSc. PhD. South American Center of Excellence in Cardiovascular Health. Institute for Clinical Effectiveness and Health Policy. CONICET. Argentina.; (9)MD. MSc. South American Center of Excellence in Cardiovascular Health. Institute for Clinical Effectiveness and Health Policy. CONICET. Argentina.

**Background and objectives:** Sufficient intake of fruits and vegetable (FV) has been associated with a reduced risk of chronic diseases and body weight management. South American (SA) diet is characterized by low intakes of FV. There is growing evidence, from developed countries, that consumer nutrition environment is an important determinant of dietary behavior. We investigated the perceptions about FVs availability and price in local food stores and their associations with FV's intake among adults in the following cities: Bariloche, Marcos Paz (Argentina), Temuco (Chile) and Canelones (Uruguay).

**Methods:** We examined data of 5009 men and women, aged 40-80y, participating in the CESCAS (Centro de Excelencia en Salud Cardiovascular del Cono Sur) I Study, a population-based prospective cohort. Perception about the store consumer nutrition environment was measured using the Perceived Nutrition Environment Measurement Survey (NEMS-P) and FV intake with a Food Frequency Questionnaire. Linear and logistic multivariate regression analyses were conducted to assess associations between the perceived environment and FV consumption (mean intake and frequency of ≥5 servings/d) adjusting for sex, age, city, education and perceived food insecurity.

**Results:** Average FV intake was 2.5 servings/d; only 7.5% reached ≥5 servings/d. Fifty-two per cent of participants strongly agreed that in their neighborhood "it is easy to buy FV", "the fresh produce is of high quality", and "there is a large selection of fresh FV". However, 71% reported that FV were expensive or very
expensive. Adjusting for covariates, those with better perceptions about FV store availability reported a slight difference in FV intakes (difference: + 0.28 servings/d, 95%CI: 0.19;0.36) and more frequently reached ≥5 servings/d (OR:1.40, 95%CI: 1.17;1.76). Price's perceptions were not associated with FV consumption.

**Conclusions:** Half of the participants had positive perceptions about FV availability, quality and large selection in local food stores, and that was independently associated with higher FV consumption. Most of the adults had a negative perception about price of these foods, however, that perception wasn't significantly associated with FV intakes. This information contributes to the knowledge of nutrition consumer environments in SA and their relation with diet behaviors. Comparisons with in-store audit measurements will help to further develop interventions to promote healthy diets in the region.

**Keywords:** Consumer Nutrition Environment, Fruit and vegetable, Diet, Price, South America

**Further collaborators:** Gabriela Leton. Universidad del Comahue. Bariloche. Argentina.

## COMPLIANCE OF FOOD AND BEVERAGE MESSAGES WITH THE NUTRITIONAL CRITERIA OF THE ADVERTISING REGULATION IN OPEN TELEVISION IN MEXICO

(1)Tolentino Mayo, María Lizbeth; (2)Hernández, Elizabeth; (3)Bahena, Liliana; (4)Théodore, Florence; (5)Velasco, Anabel; (4)Rivera, Juan; (4)Barquera, Simon.

(1)Instituto Nacional de Salud Pública; (2)MSc. Nutriotinist. Instituto Nacional de Salud Pública. Mexico; (3)MEd. Nutritionist. Instituto Nacional de Salud Pública. Mexico; (4)PhD. Instituto Nacional de Salud Pública. Mexico; (5)MSc. Nutritionist. Instituto Nacional de Salud Pública. Mexico.

**Background and objectives:** It has been well documented that overweight and obesity are multifactorial diseases. Food and beverage (F&B) advertisements, particularly directed to children are one of such factors that influence food preferences, and consumption. In July 2014, the Government Guidelines of advertising of F&B to children on TV and movie theatres were implemented in Mexico. The Guidelines established nutritional criteria, restriction of time schedules and program genres (excluding soap operas, sports, news and programs directed to audiences above 12 years of age), where products with low nutritional value were restricted to be advertised towards children younger than 12 years of age.

The aim of this study was to observe the pattern of F&B advertisements within children's peak viewing time, time restriction schedule, and different program genres before and after the Guidelines were implemented.

**Methods:** From January 2013 to February 2015, programs were recorded from the four major Mexican television networks nationwide. A total of 20 recordings per channel were taken prior and after the Guidelines were implemented. Overall 2,533 hours

were recorded and coded. All F&B products were categorized either as core or non-core, according to their nutrient content

**Results:** From all of the identified advertisements (n=91,913) 18.1% were of F&B. During the restricted hours, after the implementation of the regulation, a reduction in the amount of F&B advertisements from 45.9 to 41.3% was shown; furthermore, there was a reduction in non-core F&B advertisements from 77.9 to 73.3%, nevertheless, this reduction did not happened in all the categories of F&B. For example: the group that increased the number of advertisements during the regulated hours was savory snacks (foods added salt or fat); their prevalence was 5.7% before guidelines and 8.3% after guidelines. Other groups that increased the percentage of advertisements was sweet breads, cakes, muffins, high fat savory biscuits, pies, pastries, and rice pudding, from 7.2% to 10.6% after the regulation

**Conclusions:** According to the obtained data, it is observed that the general population, especially children and adolescents in particular are exposed to a great quantity and variety of non healthy food and beverages advertisements, and their message is reinforced several times during TV hours

**Keywords:** obesity, advertisement, regulation, children, non-healthy-food

## EFFECT OF EXCESSIVE GESTATIONAL WEIGHT GAIN DURING PREGNANCY ON DAUGHTER'S BREAST DENSITY AT THE END OF PUBERTY ON-SET

(1)López Fernández, Ana; (2)Pereira, Ana; (2)Corvalan, Camila;

(2)Garmendia, María Luisa; (2)Uauy, Ricardo.

(1)Nutritionist. Institute of Nutrition and Food Technology. University of Chile. Santiago. Chile.; (2)MD. PhD. Institute of Nutrition and Food Technology. University of Chile. Santiago. Chile.

**Background and objectives:** Breast density (BD), is one of the most important risk factors for breast cancer (BC). The relationship between maternal gestational weight gain (GWG) and BD in their daughters have not been explored.

The Institute of Medicine (IOM) 2009 established recommendations for GWG according to pre gestational body mass index (BMI). Thus our aim is to assess the association between excessive GWG according to IOM recommendations and daughter's breast composition (% of fibroglandular volume (%FGV) and absolute fibroglandular volume (AFGV) at the end of puberty onset (Tanner B4).

**Methods:** We included 341 girls from an ongoing cohort of 400 low-income Chilean girls born in 2002-2003 and their mothers. Maternal GWG was self-reported by questionnaire (year 2007) and in 2010 we performed digital mammography for measuring BD. In daughters, we collected data on anthropometry (weight and height) and breast composition by DXA at Tanner B4. %FGV and AFGV is derived considering a two-compartment model of adi-
pose and fibro-glandular tissue using a software developed at the University of California San Francisco; test-retest precision was 2.8%. Crude and adjusted (BMI z-score at B4, age at menarche, maternal schooling and maternal breast density) Odds Ratio (OR) and 95%CI were estimated to assess the relation between excessive GWG according to IOM 2009 and 80th percentile of %FGV and AFGV.

**Results:** Mean GWG was 13.7 kg (SD=7.0). A larger proportion of women with excess weight before pregnancy exceeded the recommended GWG compared to women with normal pre-gestational weight (58.8% vs 31.8% respectively). We did not observe an association between excessive GWG and %FGV; however, women who had excessive GWG their daughters had higher levels of AFGV (OR adjusted: 2.10; 95% CI 1.18 - 3.77) at B4.

**Conclusions:** Daughters of women who had excessive GWG according to IOM had higher AFGV. This could be explained by metabolic and hormonal exposure in utero, which could be modifiable at early life reducing BC risk in adulthood. Funding: WCRF 2010/245.

**Keywords:** Breast Density, Pregnancy Weight Gain, Breast Cancer.

(1)Dias, Juliana Furtado; (2)Batista, Carolina de Araujo; (3)Pereira, Alessandra Pereira; (4)de Aquino, Luana Azevedo; (4)Santos, Claudia Roberta Bocca; (4)Leão, Leila Sicupira Carneiro de Souza; (5)Franco, Amanda da Silva.

(1)PhD. Professor. Departamento of Aplicated Nutrition. Nutrition School. Rio de Janeiro Federal State University. Brazil; (2)Graduation Student. Nutrition School. Rio de Janeiro Federal State University. Brazil; (3)Professor. UNIRIO. Rio de Janeiro. Brazil.; (4)PhD. Professor. Departament of Nutrition and Public Health. Nutrition School. Rio de Janeiro Federal State University. Brazil; (5)PhD. Professor. Veiga de Almeida University. Rio de Janeiro. Brazil.

**Background and objectives:** The characterization of the food environment helps to identify factors that can influence food behavior and is considered a promising strategy to promote healthy eating habits. Thus, this study has objective was to describe the food environment of the campuses of a public university in Rio de Janeiro, Brazil.

**Methods:** The data collection took place was performed during the second semester of 2016 in establishments located on university campuses, totaling 1 snack bar and 4 establishments of the mixed type. The instrument used for the data collection was proposed and validated by Franco (2016) for analysis of the universal food environment. There was preview approval by the Ethics Committee and with consent of all the responsible for the establishments in the analyzed university.

**Results:** The nutritional information wasn't found at the analyzed establishments. Only the fruit in natura was marketed at all establishment, raw and cooked vegetables and veggies was offered

by 80% and 60%, respectively, and 75% offered leguminous; a 100% of snack bars offered pastry and sandwiches. The products with the highest averages of different types were candy or chewing gum (8±7.1), soft drinks (9±3.7), chocolates and chocolates bar (8 ± 7.1), crackers (8 ± 12.3) and cookies (7±9.1). Sandwiches, snacks and other products with low nutritional value, had lower average price fruit or fruit salads; and sweetened drinks (like soda and natural guarana) also presented average price less than natural fruit juice.

**Conclusions:** The university's food environment hinders access to healthy feeding, presenting several barriers on college campuses.

**Keywords:** Food environment. University. Beverages. Foods. Price.

(1)Carmona Garcés, Isabel Cristina; (2)Diaz-Garcia, Juliana; (2)Correa-Madrid, María Camila.

(1)Nutritionists. MSc en Educación. Profesora Escuela de Nutrición y Dietética. Universidad de Antioquia. Grupo de Investigación Interdisciplinaria en Educación para la Salud y Educación Nutricional. GIESEN. Nutricionista Grupo Éxito. Colombia.;

(2)Nutritionist. Grupo Éxito. Colombia.

**Background and objectives:** Grupo Éxito, is the biggest private employer in Colombia, with an amount of 42.000 employees, contemplates in its Nutrition Policy the promotion of a healthy work place, which aims contribute to the integral health of its employees through programs of health promotion and disease prevention. One of the actions implemented within this strategy is the program that delivery fruit in the office, began in 2015. The aim of this paper was analyze a change perception in the consumption of fruits in the employees who were impact by the program in its first year.

**Methods:** Cross-sectional study. A total 2,399 employees were qualified to answer the survey during two weeks on the company's virtual platform. The survey includes next variables: daily fruit consumption, portions of fruit consumed per day, origin of the fruit consumed, change perception of the amount of fruit consumed since the beginning of the program. A descriptive analysis was performed using X2 tests to establish the relationship between the variables of interest. α = 0.05. SPSS software v.23.

**Results:** 282 employees answered the survey, 11.8% of the qualified employees. 78.7% reported consuming fruit daily, of these 30.9% consume one serving daily, 33.0% two portions, 17.7% three portions and 17.0% four or more servings per day. The consumption of fruit comes mostly from the program offered by the company, followed by the home and finally from other sources such as retail. About the increase in fruit consumption, 64% of surveyed mentioned that their consumption increased with the program. A significant relationship was found between the increase of fruit consumption and the implementation of the program (p = 0.0087).
**Conclusions:** The companies can implement small actions such as facilitating access and availability of fruits in the workplace, promoting an adequate diet and providing environmental support for the achievement of healthy eating habits.

**Keywords:** Fruit, Workplace, Health, Strategies, Health Promotion.

**Conflict of Interest Disclosure:** This research project is funded by Grupo Éxito. The opinions expressed are those of the authors and do not necessarily represent the views or recommendations of their Affiliations.

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PREVALENCE OF EXCLUSIVE BREASTFEEDING IN CHILDREN ACCOMPANIED BY SISVAN-WEB IN THE MUNICIPALITY OF DOURADOS-MS BETWEEN YEARS OF 2008 TO 2015

(¹)Alonso Balthazar, Emilia; (²)Spoladore Rego, Ariane.

(¹)PhD. Nutritionist. Federal University of Grande Dourados - Faculty of health science - Course Nutrition. Brazil; (²)Nutritionist. Brazil.

**Background and objectives:** Not breastfeeding (BF) in the first years of life has been raising infant morbidity/mortality rates. Therefore, official governmental must monitor this practice.

SISVAN - WEB (NUTRITIONAL SURVEILLANCE SYSTEM- WEB) was created in 2008 in Brazil in order to facilitate the health follow-ups registrations of Unified Health System's users, attended at basic health Unit. This system allows public access to reports that contains the Diagnosis of the users' health.

This study's objective was to evaluate the prevalence of Exclusive Breastfeeding (EBF) at Dourados - MS (Brazil) by the SISVAN-WEB, among children aged 0 to 6 months between the years of 2008 and 2015.

**Methods:** It was analyzed public reports of food consumption from 2008 to 2015. In these reports it was evaluated the distribution of EBF children during the health care attendance and the distribution of EBF children according to the BF duration. Data from the Basic Care Information System (SIAB) were also analyzed to assess the total number of children under six months of age registered at basic health Unit.

**Results:** Analyzing the results it was possible to verified that the year 2010 was the period with the most prevalence of EBF (98,78% of 492 children), and the lowest prevalence was in 2008 (43,48% of 23 children). The prevalence of BF in Dourados city have indicators considered good by the World Health Organization (WHO), with the exception of 2008. The SISVAN-WEB, in this period, was able to analyze on average 39% of the children registered by the basic health units. The data also showed that the majority of children were being breastfeed by a period of one month (8%).

**Conclusions:** Although the numbers show that the city of Dourados-MS has good levels in EBF according to WHO indicators, the results were hampered, due to the lack of Of SISVAN_

WEB data. Oftentimes the workers from units health, doesn't fill the data base due the lack of knowledge of its importance. In Brazil there is a need in promoting BF, since many mothers stop breastfeeding due to difficulties and the need for better understanding about breast milk importance.

**Keywords:** breastfeeding; SISVAN-WEB; basic health units

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USE AND PERCEPTION OF THE NUTRITION LABELING OF PACKAGED FOODS AND BEVERAGES IN MEXICO

(¹)Tolentino Mayo, María Lizbeth; (²)Rincon-Gallardo, Sofía;

(³)Bahena, Liliana; (⁴)Rios, Victor; (⁵)Rivera, Juan; (⁶)Barquera, Simon.

(¹)MSc. Instituto Nacional de Salud Publica. Mexico; (²)MSc. Nutriotinist. Instituto Nacional de Salud Publica. Mexico; (³)MEd. Nutritionist. Instituto Nacional de Salud Publica. Mexico; (⁴)MSc. Universidad Autonoma Metropolitana. Mexico; (⁵)PhD. Instituto Nacional de Salud Publica. Mexico; (⁶)PhD. Instituto Nacional de Salud Publica. Mexico.

**Background and objectives:** Nutrition labeling has been recognized as a tool that influences food choices towards healthier; furthermore, it promotes reformulation of processed foods. The aim of this study was to document the use and perception of the information of different nutrition labels (Guideline Daily Amounts GDA, nutrition information table, list of ingredients, logos and claims) displayed in packaged foods and beverages of Mexico.

**Methods:** Data was taken from a national representative survey. The semi-structured labeling questionnaire was previously piloted and validated with population from different socio-economic status, age groups, and regions of the country. The questionnaire consisted of 16 items. The first two questions were related to the knowledge about the daily calorie consumption of a normal healthy adult in a single day. The other questions were related to the knowledge, reading, use, comprehension and perception of the displayed information in the packaged food and beverages, when choosing a food product at the sale point. Answers were reported in a Likert scale.

**Results:** The survey collected data from 8,667 persons older than 20 years. From which, 52.3% were women, 26.7% were from the group of 20 to 29 years, and 16.9% of 60 years and older. From the total or participants 89.7% knows how to read.

At the national level, 76.3% (IC95%, 73.5,78.8) of the population did not know or did not respond how many calories they are supposed to consume, and 7.2% (IC95%, 6.1,8.6) responded that less than 500 calories.

At the national level, from the total of the population that knows how to read 40.6% (IC95% 38,43.3) reported reading the nutrition labeling of packaged foods and beverages. The percentage of the population that read the nutrition information displayed in the back of the package of processed foods is higher than the percentage of people that disclaimed reading the front of the package labeling (71.6% vs 55.9%) (p<0.05).
**Conclusions:** It is important to identify and apply a version of the front of the package labeling that is more susceptible of been understood and used by a larger sector of the population. This version must be implemented as a public health strategy.

**Keywords:** Nutrition, labelling, processed-foods, beverages

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ASSESSING BENEFICIARIES' APPROPRIATION
OF A MULTIFACETED CASH TRANSFER PRO-
GRAM IN NORTHERN TOGO THROUGH COM-
PREHENSIVE MIXED METHODS

(1)Briaux, Justine; (2)Seye, Moustapha; (3)Carles, Sophie; (4)Kameli, Yves; (5)Fortin, Sonia; (5)Rollet, Pascaline; (6)Martin-Prével, Yves; (7)Becquet, Renaud; (8)Savy, Mathilde.

(1)MSc. Team IDLIC. UMR 1219. Inserm. Bordeaux Population Health Research Center. University of Bordeaux.F-33000 Bordeaux. France; (2)PhD. Laboratoire de Recherche sur les Transformations Economiques et Sociales. LARTES. IFAN. Cheikh Anta Diop University. Dakar. Senegal.; (3)PhD. UMR 204. Nutripass. Institut de Recherche pour le Développement. IRD. UM. Supagro. Montpellier. France.; (4)MSc. UMR 204. Nutripass. Institut de Recherche pour le Développement. IRD. UM. Supagro. Montpellier. France.; (5)MSc. UMR 204. Nutripass. Institut de Recherche pour le Développement. IRD. UM. Supagro (IRD). Montpellier. France.; (6)MSc. MD. PhD. UMR 204. Nutripass. Institut de Recherche pour le Développement. IRD. UM. Supagro (IRD). Montpellier. France.; (7)MSc. PhD. Team IDLIC. UMR 1219. Inserm. Bordeaux Population Health Research Center. University of Bordeaux. F-33000 Bordeaux. France.; (8)MSc. PhD. UMR 204. Nutripass. Institut de Recherche pour le Développement. IRD. UM. Supagro (IRD). Montpellier. France.

**Background and objectives:** A pilot cash transfer (CT) program was implemented in the two regions of Togo concentrating the worst nutritional outcomes. The intervention, which aimed at improving child's nutrition and health, combined Behavior Change Communication activities (BCCA) with a monthly cash transfer given to women during the "1,000 days period". A process evaluation was performed to understand beneficiaries' perception and utilization of the program.

**Methods:** Qualitative data, encompassing semi-structured interviews (n=60), focus groups (n=15) and non-participant observations of CT's payments and BCCA (n=40) were collected 8 months after the program's start on a purposive sampling of beneficiaries. Quantitative data were also collected on cash utilization from 400 beneficiaries, after 2 years of intervention. All data were collected in local dialects by experienced surveyors. Qualitative data were fully translated, transcribed and analyzed by thematic content using NVivo®. Descriptive statistics were produced using R-3.3.3®.

**Results:** Beneficiaries were globally satisfied with the intervention. They particularly appreciated BBCA-CT's synergy that enabled them to acquire knowledge and apply it in practice. They

mainly spent CT to meet their child needs: 91% of women declared using CT to buy them food and 68% to cover their health expenditures. This conformist utilization, in line with the program objectives, resulted from a strong social pressure. Despite this tight control, money was not always exclusively used by women nor devoted to children. Nearly 20% of beneficiaries regularly shared half of their CT, mainly with their spouse. Moreover, 30% of women who usually received money from their husband no longer benefited from it since they have entered the program. Another potential adverse effect of CTs lies in birth encouragement: 36% of women thought that CT may promote births, of which 70% said that CT personally encouraged them to have a child. Some women considered pregnancy as a way to continue receiving the CT. More farsighted women anticipated their program's exit by sparing some of their CTs or by initiating income-generating activities (40%).

**Conclusions:** Using mixed-methods enriched our understanding of beneficiaries' appropriation of the intervention, a crucial aspect that will help decoding program's "black box" and explaining its impact.

**Keywords:** cash transfer program, mixed methods, nutrition, process evaluation, Togo

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DIGITAL MESSAGING INTERVENTION TO PRO-
MOTE APPROPRIATE FEEDING PRACTICE

(1)Hossain, Elora; (2)Kazi Mohammed, Mahmood; (3)Jahan, Nauruj;

(4)Afsana, Kaosar.

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

**Background and objectives:** In Bangladesh preparing, serving and feeding children with bare hands is a common practice. Complementary feeding may not promote optimum childhood growth if consuming contaminated foods result in repeated bouts of illness. Proper health education is the only way to raise awareness among the community. So using video content for education is revolutionary approach to disseminate care education and emergency management to the underprivileged community through mobile phones for improving knowledge and practice. BRAC's mHealth programme is a comprehensive community based health care focusing on urban reproductive, maternal, neonatal, child and adolescent health. The purpose of the abstract is to demonstrate the achievement of digital nutritional interventions of the programme of 2016.

**Methods:** Video messages were implemented in four urban areas of Dhaka by community health workers through smart phones to educate and demonstrate about feeding and hygiene practice to mother of children under 5 years of age. Data were collected by Community Health worker's through observational checklist.