support. Food parenting used by parents of young children may
not be appropriate for older children and adolescents. During a
child's early years, more guidance is needed as parents teach chil-
dren basic eating skills, promote appropriate food preferences,
and support child eating self-regulation. During the elementary
school years, when children experience a wider range of food en-
vironments, parents change their behaviors to more developmen-
tally appropriate practices to promote healthy eating in children.
During adolescence, parents continue to guide eating behaviors
by supporting autonomy in their children with the hope that the
youth will internalize the norms and values accepted within the
extended family.

A recent literature review highlighted the food parenting prac-
tices that either foster or hinder the development of healthy eating
habits in children. In younger children (preschool through kinder-
garten), the use of coercive control is common. Collectively, co-
ercive control strategies with young children have been shown to
be related to higher consumption of unhealthy foods. In contrast,
the use of structure (i.e., monitoring) and autonomy support (i.e.,
encouragement and praise) were shown to be related to healthier
child eating habits. In elementary school aged children, the use of
coercive control continued to be seen; however, the use of these
food parenting practices with child food intake appeared to show
little impact on intake. Structured activities (availability, accessi-
bility, and modeling) were associated with healthier eating in this
age group. It was expected that autonomy promotion (i.e., mode-
ling, encouragement and praise) would be used extensively with
older children and adolescents. However, our literature review did
not show the use of these practices—at least in the empirical stud-
ies we located. We will critically review the evidence supporting
associations between coercive control, structure, autonomy sup-
port, and child food intake in these age groups. In addition, we will
point to gaps in the literature and discuss where future research
should be targeted.

**Keywords:** Food parenting, healthy eating habits, autonomy support, structure, control

**Conflict of Interest disclosure:** I received speaker fees from Danone Institute International for this presentation

**Further collaborators:** Thomas G. Power

IMPROVING CHILDREN'S EATING HABITS THROUGH EATING TOGETHER

Haines, Jess.

Department of Family Relations and Applied Nutrition.
University of Guelph. Guelph. Canada.

Eating together is generally regarded as a child having a
planned meal with at least one parent. While the frequency of
eating together varies by geographic region, research suggests
that the number of meals that children report eating with their
families has been declining over the past four decades. Numer-
ous observational studies have found that eating together has a
positive sustained impact on children's dietary intake. This may

because foods eaten together as a family are healthier than those
consumed alone or outside of the home or the time spent together
as a family allows parents an opportunity to model healthful di-
tary intake and eating patterns. Observational research has also
found that regularly eating meals together is associated with lower
risk of obesity among children and adolescents. As a result of these
findings, the American Academy of Pediatrics and the European
Society for Pediatric Gastroenterology, Hepatology and Nutrition
recommends that families should regularly eat meals together as
part of childhood obesity prevention strategies. One key limitation
of these findings from observational studies is that families who
eat meals together may differ from those who do not eat together
on characteristics, such as family functioning or level of chaos in
the home, which may influence child diet and weight outcomes.
Failing to appropriately account for these potential confounders
may result in biased estimates of the impact of eating together. To
address this limitation of observational research, researchers have
begun to design and test interventions to increase the frequency of
families eating together. The focus of this presentation is to criti-
cally review the observational and intervention research on eating
together. We will present key research findings on the associations
between eating together and children's behavioural and health
outcomes. We will also discuss results from existing intervention
studies and their implications for future intervention efforts.

**Keywords:** Eating together, family meals, healthy eating, obe-
sity prevention, children

**Conflict of Interest disclosure:** I have received speaker fees from Danone Institute International for this presentation.

HOW TO CREATE A HEALTHY HOME FOOD ENVI-
RONMENT

Lytle, Leslie.

PhD. Professor. Departments of Health Behavior and Nutrition.
Gillings School of Global Public Health. University of North
Carolina at Chapel Hill. North Carolina. USA.

The home food environment is the most proximal influence
over youth eating behaviors and has a strong influence on the ha-
bituation of food practices that continue into adulthood. The home
environment includes both physical and social factors that youth
are exposed to. The physical environment includes the availability
of and accessibility to foods in the home. The provision of healthy
foods available at home and parental role modeling of healthful
eating habits increases the likelihood that youth in the family will
be willing to eat and enjoy a greater variety of healthy foods. Re-
search suggests that not only is it important for families to provide
healthy foods to their children but it is also important to help teach
children how to be more intentional about what, when, where and
how they eat. The social environment includes myriad factors that
youth are exposed to by observing and interacting with the adults
and other children living in the home. This social environment
includes role modeling by parents and other household members,
family rules around eating and meal time, and cues and reinforce-
ments for eating behavior. Creating a healthy home food environ-
ment requires a consideration of how to positively impact both the
physical and social environments of homes. Using this framework,
this session will discuss the interventions that have been tested to
positively influence the home food environment and the best prac-
tices that have emerged from the empirical literature to date. We
will also discuss the potential for future intervention efforts.

**Keywords:** Home food environment, family-based interven-
tions, obesity prevention healthy eating habits

**Conflict of Interest disclosure:** I received speaker fees from Danone Institute International for this presentation.

SSS_144/1010

MINDFUL EATING APPLIED TO SNACKING: A BEHAVIORAL APPROACH SUPPORTED BY RECENT SCIENTIFIC FINDINGS (DRAFT)

SNACKING IN DIFFERENT PARTS OF THE WORLD: A MARKER OF DIETARY ANARCHY OR A USEFUL CONTRIBUTOR TO DIET QUALITY AND WEIGHT CONTROL?

Bellisle, France.

Nutritional Epidemiology. University Paris 13. France.

The present “epidemic” of obesity has been attributed to a
growing trend for snacking (Murakami, 2015). Dietary surveys in
various parts of the world reveal that “snacks” (eating occasions at
other moments than main meals) do bring a significant amount
of energy and nutrients to the daily diet. Even in countries where
the traditional pattern of three “main meals” is maintained, most
individuals snack at least once daily. One daily snack is frequent
in France (mostly at the occasion of the traditional afternoon
“goûter”) but up to 8 or 12 habitual daily snacks have been report-
ed in Scandinavian countries (Bellisle, 2014; Lund, 2014). In the
USA, snacks have increased in frequency over the last decades and
three or more snacks a day now bring over 23% of the daily energy
in men and women (Kant, 2015). Snacks can represent between
4% (China) and more than 50% (Finland) of daily energy intake
(Lund, 2014; Duffey, 2014). Clearly, the important contribution
from snacks to the daily intake can affect body weight control
and quality of the diet. A review of the abundant literature about
snacking reveals at least two contrasting pictures (Bellisle, 2014;
Hess, 2016). In many studies, snacking is presented in a favorable
way, highlighting its contribution to the daily intake of valuable
micronutrients and the flexibility it confers to adjust the daily en-
ergy intake to fluctuating energy needs. By contrast, other reports
view snacking as a source of excessive energy intake, facilitating
weight gain, with little contribution to the quality of the diet (1).
The potential value of snacking is obviously modulated by the se-
lection of good nutritional quality foods, but also by other types of
factors, for example: eating in the absence of hunger in response
to external non-physiological cues, irregular as opposed to regular

snacking, snacking while watching television or screen. Evidence
exists that paying attention to the act of eating facilitates both sa-
tiation and satiety, perhaps by optimizing the sensory experience
of ingestion and facilitating the memory processes that contrib-
ute to inhibiting further eating. The regularity of snacks can make
them small “meals” that occur predictably in the daily schedule.
The French “goûter” ingested by all children and many adults in
the middle of the afternoon not only allows them to cope with
the very long time interval between lunch and dinner, but gener-
ates the physiological responses usually triggered by regular meals.
Physiological cues typically present at the outset of a “main” meal
(among which a small decline in glycemia) are also present at the
beginning of a regular “goûter”, preparing the organism to respond
to the nutrient load. Such physiological responses are not present
when snacking is triggered by external cues in the absence of hun-
ger. The potential beneficial effects of snacking (intake of valua-
ble micronutrients, facilitated adjustment of intake to needs) take
place when snacking is a regular, mindful eating event as opposed
to an irregular, externally triggered, impulsive behavior.

**Keywords:** Snack, energy intake, diet quality, weight control, mindfulness

**Conflict of Interest disclosure:** The author is a member of scientific advisory councils for Cereal Partners Worldwide, European Food Information Council, General Mills, Nomad Foods, CreaBio, International Sweeteners Association, and European Fruit Juice Association. Over the last 5 years, she has received honoraria and travel grants from: American Beverage Association, International Life Science Institute, Mondelez, Tate & Lyle.

EATING MINDFULLY AS A SUSTAINABLE
HEALTHY BEHAVIOR: THEORY AND EVIDENCE

Kristeller, Jean.

Indiana State University. USA.

Mindful eating is a unique way of relating to the many food
choices we face every day. Our minds and our bodies can provide
us much wisdom, not only to eat in a more healthy and flexible
way, without dieting, but also to enjoy our food more – not less.
Although snacking is often identified as an undesirable aspect of
food intake, evidence suggests that regular meals can be supple-
mented by snacks within healthy parameters, particularly in re-
gard to quantity, but also related to quality of foods chosen. One of
the challenges of highly restrictive diet programs, which generally
curtail virtually all commercially available snack foods is that little
awareness is developed regarding how to eat such foods in a more
balanced, limited but sustainable way.

This presentation will provide an introduction to the basic
elements of the Mindfulness-Based Eating Awareness Training
(MB-EAT) program, including a brief introduction to the theo-
ry of mindfulness meditation and the mindful eating experienc-
es used in the program (Kristeller, 2016; Kristeller & Wolever, in
press). Core goals within the MB-EAT program, a structured 12
session manualized intervention, include heightening interocep-
tive awareness of physical hunger, taste, and fullness; heightening
awareness of non-nutritive cues for eating, including thoughts
and feelings, and external triggers such as the presence of food,
and social pressure; and mindful use of nutritional information.
Heightening awareness of taste satisfaction and taste satiety (sens-
sory-specific satiety) is a core element throughout. Multiple eat-
ing awareness exercises occur across the program, including use
of snack foods such as high energy dense foods, and participants'
personally preferred snack foods. Rather than restricting these
foods, which often results in rebound overeating, the message is
to consider how to obtain maximal pleasure from smaller, rather
than larger, quantities, and to make more mindful choices to re-
flect caloric and health needs. At the same time, healthier foods
are also presented as important alternatives, but again, in a bal-
anced rather than exclusive way.

The presentation will review research evidence from several NIH-funded clinical trials, application to a range of clinical populations, including those with binge eating disorder (Kristeller, Sheets, & Wolever, 2013; Kristeller & Wolever, 2011), type II diabetes (Miller, Kristeller, et al., 2012; 2014), and obesity-related eating patterns (Daubenmier, Moran, Kristeller et al., 2016). Our research to date suggests that individuals can bring compulsive overeating under control, improve emotional regulation related to eating, and decrease weight, and that improvement across a range of variables is associated directly with amount of mindfulness practice. The implications of this approach for helping individuals create a more balanced, sustainable, yet flexible relationship to eating and food, will be discussed.

**Keywords:** Mindful eating; MB-EAT; sensory-specific satiety; binge eating disorder; weight loss.

**Conflict of Interest disclosure:** This symposium was sponsored by Mondelez International (USA)

HOW MINDFULNESS CAN BENEFIT TO SNACK-
ING?

Cornil, Yann.

Sauder School of Business. University of British Columbia.
Canada.

The growing trend for snacking among children and adults
over the past forty years has been potentially identified as one of
the factors contributing to the obesity epidemic. Because of the
type of food being consumed (high in calorie, sugar and fat), but
also the timing of consumption (between meals) and the mode of
consumptions (for instance, while watching TV), a habit of snack-
ing represents a challenge for energy balance and body weight
control. By contrast, evidence exists that “mindfulness” can bene-
fit to snacking. Mindfulness typically increases consumers’ aware-
ness of and responsiveness to internal signals of satiety, but it also
increases food enjoyment and savoring. It can thus decrease the
occurrence of impulse-based or mindless snacking episodes, but
also promote more qualitative snacking with the aim to appreciate
the sensory quality of snacks rather than satisfying an appetitive
impulse.

We know that satiety is only marginally influenced by the actu-
al quantity of energy being ingested, and is largely driven by a vast
array of cognitive factors, including consumption norms, visual
perception of food quantity, and monitoring of eating (Cornil
2017). Hence, behavioral research has shown how purposeful
changes in food marketing and environments can promote pos-
itive eating behaviors like mindful snacking, and more general-
ly decrease food intake without reducing satiety or satisfaction
(Chandon and Wansink 2012; Wansink and Chandon 2014). Small
changes in package shape and dinnerware size can have a large
impact on consumers' perception of food volumes, and therefore
increase the perceived (but not the actual) amount of food being
eaten (Krishna 2006; Van Ittersum and Wansink 2012). Size labels
(for instance, labeling the same portion size "large" rather than
"normal") and assortment sizes (for instance, adding an "extra
large" or an "extra small" option in the choice set) influence con-
sumption norms, and can thereby impact the satiating power of a
snack for the same actual quantity (Aydinoglu and Krishna 2011;
Sharpe, Staelin, and Huber 2008). Also, subtle cues can encourage
better monitoring of eating and limit mindless eating sequences,
leading to faster satiation—for instance, inserting potato chips of
different colors at regular intervals in a tube of chips as a way to
“segment” consumption (Geier, Wansink, and Rozin 2012).

Growing research inspired by mindfulness techniques has also
shown that encouraging consumers to focus on the sensory char-
acteristics of foods can increase eating enjoyment while reducing
calorie intake (Tapper 2017). This is because a higher sensory focus
increases awareness of and responsiveness to satiation cues, and in
particular to “sensory-specific satiety”, which predicts that the first
few bites of a food are the most pleasurable, then pleasure declines
with each subsequent bite. Hence, positioning a snack food as a
way to emphasize its multisensory qualities (taste, aromas, tex-
ture) can increase the appeal of smaller portion sizes (Cornil and
Chandon 2016). This shows that mindfulness techniques applied
to foods can be a viable alternative to health warnings in order to
encourage consumers to snack more healthily, while preserving—
and even enhancing—the pleasure of eating.

**Keywords:** Mindfulness, snacking, portion size, satiety

**Conflict of Interest disclosure:** Yann Cornil has received funding from the Social Sciences and Humanities Research Council of Canada, from the University of British Columbia, from INSEAD, and from Institut Benjamin Delessert for his research.
## STUDY OF THE CONTRIBUTIONS IN BREAD RELATED TO THE CONTRIBUTION OF FORTIFICATION LEVEL OF IRON IN WHEAT FLOUR

(1)López, Ximena; (2)Geria, Rodrigo; (3)Salazar, Karen; (3)Arqueros, Valeria; (3)Gonzalez, Miluzka; (3)Benavides, Clara; (3)Trejo, Maricela.

(1)Master en Ciencia y tecnología de los Alimentos. Universidad de Valencia. España.; (2)Ingeniero Químico; (3)Ingeniero en Alimentos.

Flour Fortification is a very old Public Health Program in Latin America, even beginning in Chile in 1958, after the countries of North America. Although some countries have joined just a few years ago, there are already 33 countries in the Region that are fortifying wheat, corn and rice flour. Mostly wheat and corn flour are subscribed as Public Fortification programs and are monitored by the Ministries of Health of each country.

The objective of this work is to have a vision of the levels of iron found in the bread from Flour Fortification. This work will be carried out in five countries: Mexico, Ecuador, Peru, Argentina and Chile, where 180 samples will be obtained from typical high-consumption bread that is sold in bulk in the most populated and representative urban sectors of the capital area.

Once the bread samples were obtained, the iron tracer was selected as an indicator that the flour used was fortified. The analytical determination of Iron used is by Atomic Absorption Spectroscopy. A methodology based on the Official Method A.O.A.C. 999.10. In this way, we wish to show in a very simple way, what is the actual benefit of iron and establish what its contribution means on the health of people.

**Keywords:** Food fortification; iron deficiency; public health; Monitoring

**Conflict of Interest disclosure:** This symposium was sponsored by Granotec Foundation (Chile)

## EPIDEMIOLOGY OF MICRONUTRIENT DEFICIENCY IN LATIN AMERICA, PUBLIC HEALTH SIGNIFICANCE

Morán, Javier.

Catholic University of Murcia (UCAM). Spain.

We reviewed at this conference the epidemiology of micronutrient deficiency in Latin America with special reference to the iron deficiency and how these deficiencies have a great impact in terms of public health.

We also review the interest of the fortification of new food matrices that allow the fortification to be carried out to all the population and particularly to children and adolescents.

**Keywords:** Food fortification; iron deficiency; public health
**Conflict of Interest disclosure:** This symposium was sponsored by Granotec Foundation (Chile)

## NUTRIENT PROFILING STRATEGIES IN LATIN AMERICA AND ITS INFLUENCE ON THE CONTROL OF MICRONUTRIENT DEFICIENCY

(1)Gil, Ángel; (2)Soto-Méndez, María José.

(1)PhD. Prof. Department of Biochemistry and Molecular Biology. Institute of Nutrition and Food Technology. Centre of Biomedical Research. University of Granada. CIBERobn. Spain.; (2)Ph.D. Scientific Coordinator. Fundacion Iberoamericana de Nutrición. Granada. Spain.

The increasing of overweight and the obesity epidemic, in addition to the increase of diet-related non-communicable diseases, are among the main consequences of dietary changes, in conjunction with the physical inactivity of the populations.

Within the context of interest of the Latin American countries, already affected by obesity and non-communicable chronic diseases, but still experiencing the problems of undernutrition and micronutrient deficiencies, governments and regional organizations have promoted actions of generating comprehensible, suitable, accurate and standardized information on the content of food products in order to allow the consumer to make healthier choices, promoting the consumption of more complete foods; all these actions can be reached by implementing Nutrient Profiling models.

The definition of Nutrient Profiling was proposed by the WHO in 2015 as "the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health".

There are nutrients classified as of public health relevance, some of them because of their harmful effects and high consumption (e.g. total fat, saturated fatty acids, trans fatty acids, sugars and sodium), and others for their positive effects on health but not reaching the daily recommendations (e.g. dietary fiber, unsaturated fatty acids, vitamins and minerals [vitamin D, iron, calcium, zinc, potassium]).

One of the first approaches of Nutrient Profiling was the regulation of claims; now the use has extended to other actions, for example, nutritional education conducted by health professionals, and be a guideline for consumers and assist them to make "healthier" decisions against a wide variety of products offered in the market, nutrient profiling strategies have also increased privately and publicly to establish industrial food labeling using graphs or representative symbols (logos) on the products to communicate nutritional information to the consumer or to label products as "healthy" food.

Several countries in Latin America, such is the case of Mexico, Costa Rica, The Caribbean, Ecuador, Peru, Bolivia, Brazil, Argentina and Chile, have developed initiatives that involve the use of Nutrient Profiling, as recent as 2016 a regional model of Nutrient Profiling was generated by the Pan-American Health Organization to be taken as basis for local policies in different countries.
Whether the nutrient profiling would be positively adapted by the countries taking into account the relevance of food groups, their role in the diet and the contribution of the nutrients to the overall diet of a population or a particular group within a population is an arising question.

The creation of nutrient profiling should respond to a systematic, transparent and logic methodological process, ideally agreed between the different sectors of each country or region involved (governmental organizations, public bodies, food industry and consumers' organizations). The proper use of Nutrient Profiling could lead to the Latin American consumers to select products that let them reach their micronutrient requirements and promote a more balanced diet.

**Keywords:** Nutrient Profiling, Public health. Nutrient information. Nutritional claims.

**Conflict of Interest disclosure:** The present symposium has been sponsored by Granotec

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# UNITED FOR HEALTHIER KIDS: A PROGRAM TO HELP PARENTS ESTABLISH HEALTHIER EATING AND LIFESTYLE HABITS

## UNITED FOR HEALTHIER KIDS PROGRAM EXPERIENCE- IS IT ON TRACK TO ACHIEVE ITS GOALS: COUNTRY EXPERIENCES FROM PAKISTAN AND MEXICO

Das, Jai.

MD. Senior Instructor. Division of Women and Child Health. Aga Khan University. Karachi. Pakistan.

The multi-level United for Healthier Kids program (U4HK), initiated and catalyzed by Nestlé, is intended to provide families with children under 12 years with new tools to inspire and enable dietary and behavioral change and focused on six behaviors. It was launched in countries around the world with each country choosing the behaviors and activities that apt to the local context. We will discuss two country examples of Mexico and Pakistan to gauge the success of U4HK so far. Both the countries vary in the burden of malnutrition as Mexico has one of the highest prevalence of childhood overweight and obesity, while Pakistan has one of the highest prevalence of childhood undernutrition and stunting.

Mexico was the first country to launch U4HK and chose four behaviors including ‘Manage Portions’, ‘Choose Nutritious Foods and Varied Options’, ‘Choose to Drink Water’ and ‘Feed your Baby Like a Baby’ and ‘Move More, Sit Less. Multiple partnerships were developed with the Ministry of Health, Ministry of Education, Kimberly Clark and Televisa and multiple communication channels were used to create awareness and reach large segments of the population, including digital media, mass media by broadcasting a reality show. Pakistan focused on three behaviors including

'Choose to drink water', 'Move more sit less' and 'Choose nutritious & varied options'. It utilized various channels to communicate the selected messages including digital media, mass media and school platforms and engaged celebrities to endorse the messages.

It was intended to measure the success of the program at three levels - Reach, Engage, and Impact. Initial evaluation from these two countries suggest that U4HK has been successful in reaching and engaging with its target population as in Mexico, digital media generated more than 13.5 million exposures with sufficient engagement rates and Pakistan showed greater awareness amongst mothers regarding the behaviors. A study on purchase and consumption of food patterns in Mexican families with children under 12 years suggested increase purchase and use in the healthy basket and a decrease of the unhealthy basket, with greater increase in consumption of fruits and vegetables.

U4HK is a comprehensive program designed to help parents establish healthier eating and lifestyle habits for their kids. Its strength of forming partnerships and using multiple communication channels has been effective to broaden its exposure and reach a large target audience. U4HK will also aid global understanding to design, implement and evaluate multipronged approaches to changing behaviors.

**Keywords:** U4HK, undernutrition, obesity, dietary behaviors

**Conflict of Interest disclosure:** JD is a member of the Scientific Advisory Board for United for Healthier Kids.

## BEHAVIOUR CHANGE PROGRAMS DRIVING HEALTHIER DIETS AND LIFESTYLES: WHAT DO WE KNOW?

French, Jeff.

PhD. Visiting Professor. Brighton University. Brighton. United Kingdom.

In this presentation a summary of what we currently know about how to design programmes aimed at influencing healthy diets and related lifestyle issues such as exercise will be presented. The presentation will cover what we know about the design characteristics of successful programmes including how they should be established, developed managed and evaluated. The presentation will be illustrated using examples of both success and failure from around the world. The presentation will also explore the role of different intervention ‘Types’ and ‘Forms’ and how these different approaches can be integrated into an effective and efficient programme mix.

**Keywords:** Social Marketing, diet, lifestyle, behavior change

**Conflict of Interest disclosure:** JF is a member of the Scientific Advisory Board for U4HK
# UNITED FOR HEALTHIER KIDS: A PROGRAM TO HELP PARENTS ESTABLISH HEALTHIER EATING AND LIFESTYLE HABITS

Prentice, Andrew M.

PhD. FMedSci. MRC Unit The Gambia and London School of Hygiene & Tropical Medicine.

Malnutrition in all its forms threatens the health and development of hundreds of millions of children worldwide. The prevalence of stunting and underweight is gradually declining as many countries pass through the economic transition. But the decline in undernutrition is being more than offset by a global rise in childhood overweight and obesity that heralds a future explosion in nutrition-related non-communicable diseases.

There are numerous societal and environmental drivers of the growing obesity pandemic that will require cross-sectoral approaches if they are to be reversed. Many parents lack awareness of the importance of their children maintaining a healthy body weight through appropriate diets and exercise and, even if concerned by their child's weight status may lack the life skills to implement effective change within the family.

United for Healthy Kids (U4HK) is an international programme that sets out to empower families to live a healthier lifestyle. The programme offers advice, training and participatory strategies to help parents effect healthy change in six core skills: Manage Portions; Choose Nutritious and Varied Options; Choose to Drink Water; Enjoy Meals Together; Feed Your Baby Like a Baby; and Move More, Sit Less.

U4HK represents a new model of private-public engagement that seeks to mobilise multiple governmental, non-governmental and private agencies to maximise its reach and impact. Country-specific implementation of the programme utilises the core suite of evidence-based skills but tailored to local needs. Innovative use of social media platforms provides a powerful tool for dissemination and reinforcement of key messages, interactive engagement with families and evaluation of impact.

U4HK has so far been implemented in 13 countries and has reached over 150m participants.

**Keywords:** Malnutrition, stunting, overweight, obesity, behavior change

**Conflict of Interest disclosure:** AMP is a member of the Scientific Advisory Board for U4HK

# FROM PPP TO PPE: A NEW OPPORTUNITY FOR ENGAGEMENT

Drewnowski, Adam.

Center for Public Health Nutrition, University of Washington, USA.

Multi-sectoral initiatives involving private industry are increasingly viewed as a necessary step to improve both diet quality and population health. Public private partnerships (PPPs) have

addressed a number of global nutrition challenges, ranging from biofortification and fortification to the promotion of more nutrient-rich diets and healthier lifestyles. The Food and Agriculture Organization (FAO) and the World Food Program (WFP) look to industry partners to improve the quality of the global food supply.

The traditional role of the private sector has been to provide technical assistance, knowledge transfer, and financial support for activities ranging from preventing hunger to promoting optimum health. Companies have used PPPs to alleviate hunger, promote food security, or help develop microenterprises or small businesses. Often, those activities were led by policymakers, local health jurisdictions, or international agencies, with industry assuming a secondary role.

The multi-sectoral U4HK program was created in direct response to calls by international agencies for more engagement by private companies to address the double burden of malnutrition in low and middle income countries (LMIC). Its development was consistent with the published principles on creating PPPs to address complex public health nutrition issues. The challenges, risks and benefits of PPPs have been set out in influential past work, notably by Kraak et al. (2011). While preserving those principles, the U4HK program represents a novel type of private-public engagement (PPE), distinct from the traditional PPP structure. A central feature of PPE is that the private sector takes the leading role in bringing together multiple actors, including families, schools, communities, policymakers, the media, and NGOs. Here, the rapid growth of social media has made it possible to reach families directly with messages about optimum diets and child health.

The U4HK protocols followed standard principles, such as having a clearly defined and achievable goals, clear statements of work, rules, and responsibilities, as well as an evaluation component. Details of U4HK design and implementation will be presented in this symposium.

**Keywords:** Public-private partnership (PPP); Private-public engagement (PPE); Social marketing

**Conflict of Interest disclosure:** AD is a member of the Scientific Advisory Board for U4HK and a member of the Nestlé Nutrition Council. He has received grants, contracts, and honoraria from public agencies, private industry, private foundations, and commodity groups for projects involving nutrient profiling, diet quality assessments, and health outcomes.

# THE SIX HEALTHIER HABITS TARGETED IN UNITED FOR HEALTHIER KIDS

Rolls, Barbara.

PhD. Professor in Nutritional Sciences. Department of Nutritional Sciences. The Pennsylvania State University. Pennsylvania. USA.

United for Healthier Kids (U4HK) aims to create a social movement through social media platforms that target parents and carers of children up to 12 years of age. A panel of global, independent experts with different expertise in public health, behavioural psychology and nutrition, and with different geographical backgrounds advised U4HK on a framework of six healthier habits.
its to target. These are ‘Manage Portions’, ‘Choose Nutritious and Varied Options’, ‘Choose to Drink Water’, ‘Enjoy Meals Together’, ‘Feed Your Baby Like a Baby’, and ‘Move More, Sit Less’. The habits were chosen based on in-depth evaluation of scientific evidence and were framed to affect a change in behaviours that could help minimize the risk of childhood obesity and under-nutrition. Each country in which U4HK is introduced chooses which of the six behaviours will receive the most attention. The choices depend on and are tailored to the local context and the specific nutritional needs, health priorities, and available resources at each country location. Thus far, countries have chosen to activate up to 3 to 5 of the healthier habits. All countries have included ‘Choose Nutritious and Varied Options’ and ‘Choose to Drink Water’. In this presentation, the science behind several habits and the varied ways they have been adapted and implemented by different countries will be discussed.

**Keywords:** Habits, dietary behaviors, under-nutrition, obesity

**Conflict of Interest disclosure:** BR is a member of the advisory board for United for Healthier Kids

SSS_144/1027

# NUTRIENTS AND BEYOND NUTRIENTS: SOCIAL, CULTURAL, AND ENVIRONMENTAL DRIVERS OF FOOD CHOICES GLOBALLY

## WHEN IS CHOICE AN OPTION?

Fischler, Claude.

PhD. Interdisciplinary Institute for Contemporary Anthropology (IIAC). EHESS/CNRS,.

Choice has become an omnipresent notion in nutrition and public health literature as well as in lay parlance. Consumers are told, or read in the media, that their choices of foods are detrimental to their health. They are repeatedly reminded that they have to make the right choices, i.e. the healthy choices.

Choice goes hand in hand with decision. An influential 2008 paper stated that 2.4 million deaths in 2000 can be attributed to personal decisions and could have been avoided if readily available alternative choices were made. In the paper, diet was one of the prominent sets of personal decisions involved.

The Oxford Dictionary defines decision as a conclusion or resolution reached after consideration. Using choice and decision to denote behavior implies assuming some degree of deliberation and/or intention. Assumed intentionality and free will make individual subjects the essential link in the causal chain. This in turn easily leads to holding them as solely responsible for their prediction.

Meanwhile, in recent decades, various disciplines, particularly in the social sciences (e.g. history, anthropology, sociology, social psychology), have shown that one of the most striking features of human eating is that it is an essentially social activity. In most societies, not just those labeled traditional, eating is performed

collectively. It is regulated by a body of rules (etiquette) adjusting individual behavior to fundamental principles of solidarity, hierarchy, morality, propriety. Children are socialized into these rules on the occasion of meals. In more traditional societies, lone eating is stigmatized and the very notion of likes, dislikes and aversions, particularly about staple foods, is irrelevant or non-existent: to that extent, choice is simply not an option.

For several decades, in contemporary, affluent societies, individual autonomy has enjoyed ever increasing recognition in most areas of life, including eating. But even in those individualistic cultures most daily eating unfolds according to an implicit, cultural script, and social interactions can, according to context, both inhibit or stimulate food intake. Moreover, degree of individualization as well as appreciation of choice are shown to vary considerably, including across Western cultures.

The unfounded assumption that food is just another form of consumption and that what people eat essentially depends on free will, choices and decisions is not just a cause for repeated failure in nutrition education and public health campaigns. There is some indication that it helps make the problem worse by promoting anxiety, confusion and aberrant dieting.

It is urgent to integrate into nutrition the wide, cross-disciplinary spectrum of knowledge relevant to the understanding of the human omnivore's eating behavior and complex relationship to food.

**Keywords:** Food selection, food habits, social and cultural determinants, individualization

**Conflict of Interest disclosure:** CF has received funding from public agencies and private or semi-private sector to investigate structure and evolution of food and eating patterns.

## TASTE RULES FOR KIDS

Orlet Fisher, Jennifer.

PhD. Professor of Social and Behavioral Sciences. Associate Director. Center for Obesity Research and Education. Temple University. USA.

Early childhood is considered to be a critical period for establishing healthful eating habits. At the same time, many of the poor dietary patterns seen among adults begin to emerge early in life. It has long been appreciated that taste plays a central role in shaping children's food preference and is rooted in biology. Preferences for sweet and savory tastes as well as rejection of bitter and sour tastes are seen well before children experience the first tastes of solid or complementary foods. From this perspective, children's love of sweets and dislike of vegetables seem a foregone conclusion. To what extent does taste actually rule when it comes to food choices among young children? While taste (and more recently temperature) predisposes children to readily prefer certain types of foods over others, the trajectory of food acceptance is fundamentally driven by experience that starts in early development. Children show the capacity to learn to accept a wide variety of foods in their diets, including vegetables which are neither particularly sweet nor energy-dense. Thus, the rules of taste are less deterministic
and more pliable than often perceived by parents and other adults who routinely feed young children. What are the essential rules for promoting acceptance of healthful food choices? Context is everything. Familiarity is one of the most fundamental dimensions of food preferences: children eat what they like and like what they know. A large body of evidence demonstrates that repeated exposure promotes liking via the accumulation of positive experiences around eating—both social and biological. Practices of caregivers, along with the broader socioeconomic environment, set the stage for these experiences. Caregivers determine which foods will become familiar to children, exhibit like and dislike of foods that children learn to model, and use practices that shape children's food preferences and choice. Children's preferences for sweets, for instance, are not only rooted in taste biology but are also socially reinforced by the use of such foods as treats, rewards, and celebration. Social context not only shapes children's understanding what and how much to eat, but also the time of day when eating should occur (e.g. snacks), the way foods are prepared and paired at a given eating occasion (e.g. a meat and a vegetable at meals), and salient qualities of those foods (e.g. healthy, treats). Practices around feeding children, in turn, reflect conditions of the local environment (e.g. availability and cost) as well as norms, values, and behaviors of family, community, and culture. For instance, snacking and eating sweets between meals is normative among US children, but uncommon in other countries. Collectively, these observations suggest that taste rules are universal but are not destiny for food choice among children. Rather, children's choices are rooted in the accumulation of day-to-day experiences—at the family table, in the school cafeteria, eating with their grandparents—and the multi-faceted social contexts in which those experiences occur. Repeated exposure to healthful foods in positive social contexts is the key rule for promoting healthful dietary patterns in early childhood.

**Keywords:** Children, taste, preference, acceptance, repeated exposure

**Conflict of Interest disclosure:** Sponsored by General Mills

## COST AND CONVENIENCE IN FOOD CHOICE

Drewnowski, Adam.

Center for Public Health Nutrition. University of Washington.
USA.

There is more to eating than nutrient consumption. There is more to non-communicable diseases than nutrient excess. Studies in nutritional epidemiology have tried to convince us that a single food, nutrient, or dietary ingredient could be linked to a specific health outcome, after adjusting for multiple covariates. Typically, socioeconomic variables were adjusted for, and thus removed from consideration, in order to show us the “true” relation between dietary components and health. As nutrition has come to embrace the social sciences, it has become clear that it is impossible to separate the food from the person and the person from society. The current trend is to analyze total food patterns, rather than nutrients, and their likely impact on health and well-being.

Indeed, recent dietary advice in the US has focused on total diets, with a focus on the USDA-style, Mediterranean style, DASH, and vegetarian food patterns. More attention is being paid to social inequities and to the socioeconomic determinants of both diets and health. The “new nutrition” science draws on insights from allied disciplined to illustrate the dynamics of food decision making across the world. Any attempts to improve dietary behaviors in target populations must be respectful of both cultural and social boundaries and economic constraints.

People with one type of dietary pattern may differ in several unobserved ways from people with another dietary pattern. In marketing studies, taste, cost, convenience, health, and variety are recognized as the key drivers of food choice, along with the food environment and socioeconomic status. Yet the monetary cost of diets and the geography of food retail and food consumption patterns have not yet entered mainstream nutritional epidemiology. First, linking dietary intakes from 24h recalls, food records, or food frequency questionnaires with retail prices (per 100g, edible portion) allows for the estimation of diet costs at the individual level. The monetary costs of foods is effectively treated as another nutrient vector; cost calculations follow the same principles as calculations of diets' energy or vitamin content. This procedure has permitted new studies on the relation between diet quality, diet cost and health outcome. Not surprisingly, higher diet cost was associated with better long term health outcomes.

Second, geo-location of dietary intakes data opens the door to new studies in spatial nutritional epidemiology. We have developed microsimulation modeling tools to map food related attitudes, diet quality and even obesity rates at the unprecedented census block level. Geo-positioning trackers have been used to map shopping patterns. Again, socioeconomic variables predicted the relative consumption of sugary drinks versus salad in Seattle King County. Dietary choices appeared to be driven by economics.

Within cities and countries, and across the world, there are dramatic social disparities in diet quality. This talk will consider how geography and economics influence food choice, and ultimately health. There are also opportunities to extend these procedures across regions and globally.

**Keywords:** Spatial epidemiology, food prices, diet costs, economics, geo-location

**Conflict of Interest disclosure:** Conflict of Interest disclosure: AD has received grants, contracts, and honoraria from public agencies, private industry, private foundations, and commodity groups for projects involving nutrient profiling, diet quality assessments, and health outcomes.
# Track 4: Nutrition and Management of Diseases

SSS_144/129

## STEVIA: AN ALLY TO SUPPORT NUTRITION AND HEALTH

### HEALTH AND WELLNESS OF STEVIA

Ayoob, Keith.

EdD, RD. Nutritionist. Associate Professor of Pediatrics. Albert Einstein College of Medicine. New York City. United States of America.

According to the latest WHO report, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. Now, one in twelve adults around the world has diabetes. In addition, the prevalence of overweight and obesity is one of the most serious health challenges of the century. Worldwide obesity has doubled since 1980 with almost two billion adults 18 years and older being overweight, of that, more than 600 million being obese.

Global policy guidelines have called for healthier lifestyles in general, for adults and children, and more specifically for reductions in calories and sugar consumption. Global and national health organizations recommend reducing added sugar to less than 10% of calories, with the WHO recommending aiming for less than 5% of total calories from added sugar. Achieving this is nearly unrealistic without the use of low- and zero-calorie sweeteners.

Stevia, being calorie-free, is part of the solution towards sugar reduction and weight management while providing sweet taste and it is a relevant option for a healthy lifestyle and for the diabetic population. Stevia leaf extracts have key health and wellness benefits due to their zero contribution to caloric intake. Emerging evidence suggests stevia may have a unique role in helping diabetics manage blood glucose levels. Additionally, stevia is plant-derived, providing an option for diabetics and others who prefer a naturally sourced zero-calorie sweetener.

**Keywords:** Diabetes, sugar reduction, obesity, overweight, stevia

**Conflict of Interest disclosure:** This symposium was sponsored by International Stevia Council (ISC) & Calorie Control Council (CCC) (Belgium)

### GLOBAL DEMAND FOR STEVIA AND STEVIA LABELLING WORLDWIDE

Scardigli, Maria Teresa.

Executive Director. International Stevia Council.

Increased consumer interest in calorie-reduced products combined with a stronger than ever call for natural products has boost-

ed the demand for high purity stevia extracts. In the last 3 years stevia has become a mass volume natural sweetening ingredient and has been heavily endorsed by core brands at the worldwide level: this trend is expected to continue in the future. Such development positively impacts all the players in the stevia value chain, including stevia leaf growers and will benefit many regional economies, such as in the Latin American region. Depending on the region, product labeling requirements vary slightly but the ability to use the word "natural" or "naturally occurring" in advertising materials varies more widely. The presentation aims at giving an overview of the global demand for stevia as well as an overview of the differences in labeling across several regions of the world.

**Keywords:** Stevia. Sweetening ingredient. Calorie-reduced products. Latin American region. Labeling.

**Conflict of Interest disclosure:** This symposium was sponsored by International Stevia Council (ISC) & Calorie Control Council (CCC) (Belgium)

### OVERVIEW OF STEVIA APPROVALS BY THE GLOBAL SAFETY AUTHORITIES

Roberts, Ashley.

Intertek Scientific and regulatory Consultancy.

The presentation will review and evaluate the extensive research conducted to demonstrate the safety of high purity stevia extracts and how in particular the metabolic profile for the various glycosides including those conjugated with glucose, rhamnose and xylose permit the bridging of toxicological studies conducted with stevioside and rebaudioside A to all glycosides present within the leaf. The presentation will focus on the derivation of the ADI particularly by JECFA, which has been adopted on an International basis and the current global regulatory status taking in to account various estimated exposure paradigms, within different demographic populations. In addition to the evaluation of the steviol glycosides present within the leaf, new technologies are continuously being developed including those associated with a) enzyme modified glycosides, b) bioconversion and, c) steviol glycosides from genetically modified yeast. The presentation will therefore look briefly at the differences in production processes and provide a summary of the current international regulatory status of these materials.

**Keywords:** Stevia, Glycosides, regulatory

**Conflict of Interest disclosure:** This symposium was sponsored by International Stevia Council (ISC) & Calorie Control Council (CCC) (Belgium)
APPLICATION AND INNOVATION IN STEVIA AND
TASTE DEVELOPMENT

Fry, John.

Director. Connect Consulting. UK.

This presentation focusses on technological advances in un-
derstanding sensory properties of leaf-derived steviol glycosides.
The objectives were to investigate the taste relationships of simple
combinations of pure glycosides and to develop a predictive meth-
odology to assist the formulation of leaf-based ingredients of im-
proved performance. Such advances aim to satisfy expectations of
global consumers for sugar reduction through zero-calorie sweet-
eners with sugar-like taste.

Intensive sensory investigations of purified individual glycosides allowed the creation of concentration-response curves for sweetness, bitterness and the licorice side-taste. Glycosides were then examined in pairs, looking for synergy in sweetness or suppression of undesirable tastes. Where beneficial responses were found, these pairs were supplemented further with single glycosides to create ternary and quaternary mixtures.

The data from these interactions allowed mathematical mod-
elling of their taste relationships. The models, in turn, indicated
unsuspected combinations of glycosides with potentially superior
taste performance. The model combinations were then created on
a laboratory scale and checked by taste panel for quality.

This approach resulted in a number of novel glycoside mix-
tures, including minor glycosides, that maximised sweetness while
minimizing unwanted side-tastes. Key to this success were critical
concentrations of rebaudiosides A, B, D and, surprisingly, stevio-
side.

With this knowledge, natural leaf extracts of different compo-
sition could be selected and blended to produce ingredient-grade
materials of outstanding taste. The performance of these leaf ex-
tracts, verified in consumer products, allows greater degrees of
sugar reduction (70%+) than earlier types, such as those based
on about 80% rebaudioside A content. The latter were limited to
about 30-50% sugar reduction in a 10% sucrose equivalent sweet-
ness intensity beverage.

Keywords: Stevia, innovation, synergism, taste, sensory

**Conflict of Interest disclosure:** The author is an external consultant to Cargill Inc.

**Further collaborators:** Anne Brockhoff. Technische Universität München § German Institute of Human Nutrition Potsdam-Rehbrücke

Ting Carlson, Nicole Cuellar-Kingston, Hanna Drake, Nicole Falk, Brian Guthrie, Betsy Jones, Nathan Knutson, Paula Krogmann, Allison Leibovich, Tim Lindgren, Tommy Mao, Melinda Montgomery, Kris Mortenson, Michael Mortenson, Ravi Nana, Andrew Ohmes, Wade Schmelzer, Sean Smith, Paige Ties, Christopher Tyler, Nese Yurttas. (Cargill Inc.Consultant, Calorie Control Council)

Caroline Hellfritsch, Thomas Hofmann. (German Institute of Human Nutrition Potsdam-Rehbrücke)

Wolfgang Meyerhof, Frauke Stähler. (Technische Universität München)

NON-NUTRIENT PHYTOCHEMICALS &
NON-COMMUNICABLE DISEASES

Li, Duo.

Qingdao University. China.

Malnutrition is sharply decreased, and over or imbalanced nu-
trition and lifestyle related disorders are dramatically increased
during past two decades globally. Food and medicine arise from the
similar origins. In the early era, people experienced sickness, diar-
rhea, unconsciousness, even death due to ingestion of poisonous
plants, while some ailments were alleviated or relieved after eating
certain plants. Over time, we have learnt to identify and classify
plants based on their characteristic features, as well as developed
knowledge about herbal medicines. During the past century, sci-
entists have isolated and identified thousands of compounds from
natural sources, and exploited their usage and the relationships
between these compounds and their molecular mechanisms. Nu-
merous preparations of natural products are commercially avail-
able on the market worldwide. Substantial functional foods and
nutraceuticals have been developed such as omega-3 fatty acid,
flavonoids and isoflavones, isothiocyanates, carotenoids, dietary
fiber, probiotics, prebiotics, phytosterols, polyphenols, alkaloids,
terpenoids, saponinoids, polysaccharides, peptides, curcumin,
parthenolide, cucurbitacins, 1,8-cineole, pseudopterosins, cate-
chins, capsaicin, conjugated linoleic acid, fucoxanthin, soy isofla-
vone, glabridin, astaxanthin and cyaniding-3-glucoside, lyprinol,
bromelain, marine sponge natural products and Boswellia serrata
gum resin etc. They are widely used to adjunctive prevent and treat
lifestyle-related continually increasing non-communicable diseas-
es such as diabetes, cardiovascular diseases, cancers, mental disor-
ders, senile dementias, body weight control etc.. However, some
functions are need to be confirmed by randomised controlled clin-
ical trial, and detailed mechanism need to be explored.

**Conflict of Interest disclosure:** This symposium was sponsored by Sunwins Commodity Sales Co., Ltd & Qingdao University (China)

XANTHINE OXIDASE INHIBITORY CONSTITUENTS
OF CELERY SEEDS

Apium graveolens is a well known herb of family apiaceae. The
seeds, i.e. celery seeds are used as flavoring agents and as an an-

<footnote>(1)Chen, Jijun; (2)Yang, Tong-Hua; (3)Lu, Chen-Jie; (3)Lu, Cheng-Qian.</footnote>

<footnote>(1)Prof. State Key Laboratory of Phytochemistry and Plant
Resources in West China. Kunming Institute of Botany. Chinese
Academy of Sciences. China.; (2)State Key Laboratory of
Phytochemistry and Plant Resources in West China. Kunming
Institute of Botany. Chinese Academy of Sciences. China.;</footnote>

<footnote>(3)Beijing Sunwins Commodity Sales Co. Ltd.. China.</footnote>
ti-rheumatic formulation and showed significant effects on arthrit-
ic pain relief, for treating rheumatic conditions and gout. Accord-
ing to our bioassay, the 50% ethanol extract of celery seeds showed
moderate inhibitory activity on XOD. To clarify its active constit-
uents, the extract was further separated to provide two flavone
glycosides named graveobioside A (1) and luteolin-7-O-β-D-glu-
coside (2) elucidated by MS/MS and NMR techniques. Graveo-
bioside A and luteolin-7-O-β-D-glucoside possessed potent ac-
tivities against XOD with IC50 values of 287.17±2.3 and 77.36 ±
4.70 µg/mL, respectively. To further investigate inhibitory activity
of graveobioside A on XOD, three types of animal models were
established to evaluate its effects in mice. The effect of graveobio-
side A on potassium oxonate-induced hyperuricemia in mice was
determined. The results indicated that the serum uric acid level in
each dose group of graveobioside A (20 mg/kg10 mg/kg and 5 mg/
kg) significantly was reduced than that of hyperuricemic group
(P<0.01);In addition, the middle and high dose groups of graveo-
bioside A could obviously inhibit XOD activity in serum(P<0.05).
Then carrageen-induced mice paw edema model was employed
for the anti-inflammatory activity of graveobioside A. The result
showed each dose group of graveobioside A possessed most activ-
ities against inflammation. The rat acute feet swelling induced by
sodium urate was often used to test compounds effects on gouty
arthritis. The middle and high dose group of graveobioside A had
significant activity compared to the model group (P<0.01). There-
fore, graveobioside A had potential activity to treat gout and gouty
arthritis

**Conflict of Interest disclosure:** This symposium was spon-
sored by Sunwins Commodity Sales Co., Ltd & Qingdao Univer-
sity (China)

NON-COMMUNICABLE DISEASES AND ITS PRE-
VENTION IN CHINA

(1)Ma, Guan-Sheng; (2)Zhang, Na.

(1)PhD.Department of Nutrition and Food Hygiene. School of Public Health. Peking University. China.; (2)National Institute for Nutrition and Health. Chinese Center for Disease Control and Prevention. China.

Along with the rapid development of social and economic,
transitions in diseases pattern has been changed from infectious
diseases to the non-communicable diseases (NCDs). In 2012, the
mortality rate of NCDs among Chinese residents was 533/100 000,
accounting for 86.6% of the total deaths. Cardio-cerebrovascular
disease, cancer and chronic respiratory disease were the main cause
of death, accounting for 79.4% of total deaths. The prevalence of
overweight and obesity in adults aged 18 and over were 30.1% and
11.9%, respectively, while that for children aged 6~17 year olds
were 9.6% and 6.4%, respectively. The prevalence of hypertension
in adults aged 18 and over was 25.2% and the prevalence of diabe-
tes was 9.7%. According to the results of the national cancer regis-
tration in 2013 in China, the incidence of cancer was 235/100 000.
It is indicated that unhealthy lifestyle including unhealthy dietary

pattern, smoking, excessive drinking, inadequate physical activ-
ity and the extension of sedentary time, and psychosocial stress
was the main risk factors for the epidemic of NCDs. The epidemic
of NCDs brings serious burden to economy. In 2003, the direct
economic burden of five major chronic diseases (coronary heart
disease, stroke, hypertension, cancer and diabetes) was 151.422
billion RMB; in 2010, the direct economic burden of five major
chronic diseases was 211.436 billion RMB, accounting for 10.6% of
the total health expenditure. It is estimated that the cost of cardio-
vascular disease, cancer, chronic respiratory disease, diabetes, and
mental health will total 191 trillion RMB for the period 2012-2030.
The preventive interventions of NCDs are highly cost-beneficial.
Economic analysis showed that the comprehensive intervention,
dietary intervention and physical activity intervention for obesity
could avoid the loss of productivity equivalent to 314144.8 RMB,
31738.6 RMB, and 16391.6 RMB, respectively; and medical ex-
penses equivalent to 37448.1 RMB, 3357.0 RMB, and 2486.0 RMB,
respectively. In order to control the epidemic of NCDs, the Action
Plan of control and prevention of NCDs has been issued in 2012.
The Action Plan of Health China 2030 has been launched in 2016.
The cost-effective and cost-beneficial measures have been identi-
fied and implemented.

**Keywords:** Non-communicable diseases; Risk behavioral factors; Economic burden; Prevention and control

**Conflict of Interest disclosure:** This symposium was spon-
sored by Sunwins Commodity Sales Co., Ltd & Qingdao Univer-
sity (China)

OMICS BASED STUDY ON N-3 PUFA IN THE PRE-
VENTION AND TREATMENT OF TYPE 2 DIABETES
IN ASIAN

(1)Zheng, Jusheng; (2)Li, Duo.

(1)Career Development Fellow. University of Cambridge.; (2)PhD.
Professor. Department of Food Science and Nutrition. Zhejiang
University. China.

**Background and Objectives:** The interaction of genomics and metabolomics with omega-3 fatty acids among the Asian type 2 diabetic patients is not clear. We aimed to investigate the interaction between genes and omega-3 fatty acids for type 2 diabetes risk and for glycemic traits among type 2 diabetic patients. In addition, we aimed to examine the response of metabolomics profiles to omega-3 fatty acid intervention.

**Methods:** We conducted a case-control study involving 622 type 2 diabetic patients and 293 healthy controls, and a double-blinded randomized controlled trial among 185 type 2 diabetic patients for omega-3 supplements over 6 months. Among these participants, we genotypes several type 2 diabetes-related genetic variants to examine the interaction between omega-3 fatty acids and these genetic variants for type 2 diabetes in the case-control study and for glycemic traits in the trial. In addition, we examine the effect of omega-3 fatty acid intervention on the metabolomics profiles in a subset of the patients.
**Results:** In the case-control study, we found significant inter-action between a genetic risk score generated from 9 type 2 diabetes-related genetic variants, with the inverse association between erythrocyte alpha-linolenic acid and type 2 diabetes only observed in those with low genetic risk. In addition, PEPD variant interacts with total erythrocyte omega-3 fatty acids for type 2 diabetes risk, with the genetic risk of PEPD variant being abolished in high omega-3 fatty acid group. In the randomised trial, we did not detect similar gene-fatty acid interaction pattern as in the case-control study. In the metabolomics analyses of the trial, we identified a most significant biomarker of omega-3 fatty acid supplements: 3-carboxy-4-methyl-5-propyl-2-furanpropanoate, a furan fatty acid metabolite. Change of this metabolite is positively correlated with change of serum eicosapentaenoic acid and docosahexaenoic acid, but negatively correlated with change of serum triglycerides.

**Conclusions:** Both genomics and metabolomics approaches could help advance our understanding about the role of omega-3 fatty acids in type 2 diabetes prevention and treatment.

**Conflict of Interest disclosure:** This symposium was sponsored by Sunwins Commodity Sales Co., Ltd & Qingdao University (China)

# Track 5: Nutrients and Nutritional Assessment

SSS_144/1033

## EARLY DETECTION OF MALNUTRITION IN THE FACILITY AND COMMUNITY SETTING FOR IMPROVED HEALTH AND ECONOMIC OUTCOMES

### IMPROVING HEALTH OUTCOMES: EARLY DETECTION OF MALNUTRITION UTILIZING VALIDATED TOOLS

Correia, Isabel.

MD, PhD. Universidade Federal de Minas Gerais. Brazil.

**Background and Objectives:** Effective implementation of nutrition care plays a key role in achieving improved patient outcomes. Malnutrition negatively affects the patient evolution in terms of higher morbidity, mortality, re-admissions, prolonged hospitalizations and costs. Increased medical awareness regarding the impact of nutritional status on patient outcomes is essential. Malnourished patients cost more than patients with similar diseases who are well-nourished, demonstrating an independent and additive effect of malnutrition on negative outcomes. When malnutrition is identified and interventions are implemented, use of medical care and resulting costs decrease. Therefore, early use of screening and assessment tools (at hospital admission) to identify risk factors, establish a diagnosis of malnutrition and enable effective treatment is fundamental to provide the highest quality of care and improve patient outcomes. Methods: An estimated 30-50% of hospitalized adult patients are malnourished in the U.S. and internationally based on a combination of malnutrition screening and assessment studies. Yet, research indicates that the diagnosis/identification rate remains low with only 3.2% of adult patients are discharged with an International Classification of Diseases, Ninth Revision (ICD-9) malnutrition diagnostic code. Screening and assessment are different processes, the former should identify risk factors and the latter provides diagnosis. Both serve essential roles in creating a inter-disciplinary patient care plan. Results: A triangulation of indices is necessary to determine nutrition status. Weight loss in the last six months and decreased food intake are included in many of the various tools. Both are simple, easily available, do not require use of additional devices, can be provided by the patient or any member of the family and are related to morbidity and mortality in different populations. There are more sophisticated measurements including computed tomography and functional tools, particularly in cancer units, that when available can be added to increase accuracy. Conclusions: Dissemination and implementation of simple, validated tools that can be utilized in a variety of global healthcare settings, to early and accurately assess risk for and identify the presence of malnutrition is fundamental to improving patient and system level health outcomes.
**Keywords:** Health outcomes, malnutrition, screening, assessment. K

**Conflict of Interest disclosure:** Abbott Nutrition, Baxter Nutrition, Fresenius Kabi, Danone Nutrition, Nestlé Nutrition

**Conflict of Interest disclosure:** This work was funded by Abbott Nutrition.

**Further collaborators:** Organization for Health Excellence (OES) - Colombia.

## CREATING A REPLICABLE MODEL OF NUTRITION CARE EXCELLENCE IN THE CLINICAL SETTING

Pinzon Espitia, Olga Lucia.

Nutritionist. PhD Candidate. National University of Colombia. Méderi. Colombia.

**Background and Objectives:** Optimal quality of care is a must for all healthcare institutions across the world. Nutritional care processes must be a priority for hospitals, thus supporting their implementation in clinical outcomes. This is why the conception of nutritional care processes allows hospitalized patients experiencing superior results.

Considering the current approach of healthcare models, it is of utmost important to generate strategies that allow healthcare systems improve their process performance by integrating nutritional management into their patients' clinical care. A comprehensive model responds to the nutritional needs of hospitalized patients under the superior concept of generating value.

**Objective:** To develop a model of hospital nutritional care that allows minimizing malnutrition related risks, optimizing care processes and improving clinical outcomes of hospitalized patients.

**Methods:** A systematic review of literature on hospital nutritional care models informed the construction of a new nutritional model in 2016, which was consulted and validated with feedback from 10 participating hospitals.

**Results:** Publications related to nutritional quality standards have focused on methods of measuring the activities of nutrition processes, thus making it necessary to propose a model of easy duplication and validation in different scenarios of clinical practice. The model aims to promote good practices for clinics delivering nutritional interventions based on set criteria of excellence. Using existing literature on nutritional care models for inpatients and subsequent fieldwork, four lines of patient care plans were proposed: 1. Identification of nutritional risk; 2. Intervention and follow-up; 3. Exchange doors: path of patient care to ensure continuity of treatment; and 4. Education and generation of culture of nutritional care to the patient, caregiver, family and organization.

Quality standards were established to demonstrate the applicability of the model considering the need for organizations to evaluate the impact on their clinical results, inform the construction of models aimed at being differentiators through creation of value for the patients, and lead organizations to be centers focused on excellence.

**Conclusions:** The construction of the new model of care allows the achievement of processes of healthcare of superior value in order to bring hospital nutrition to sites of relevance previously not considered.

**Keywords:** Nutrition Therapy, Quality of Health Care.

## REDUCING THE ECONOMIC BURDEN OF DISEASE-ASSOCIATED MALNUTRITION THROUGH TARGETED INTERVENTIONS ACROSS THE CONTINUUM OF CARE

Sriram, Krishnan

Abbott Nutrition. Chicago. IL. USA.

**Background and objectives:** Disease-associated malnutrition costs health care systems across the globe billions of US dollars annually. This is a result of the direct and indirect costs associated primarily with higher rates of health care resource utilization by malnourished patients compared to their well-nourished counterparts. Nutrition interventions can be effective in terms of alleviating the burden of malnutrition and improving patient outcomes. Increasingly more real-world, pragmatic study designs such as quality improvement programs (QIPs) are used to study nutrition care improvements for malnourished patients across the continuum of care.

Objectives of the presentation include 1) brief overview of economic burden of disease-associated malnutrition; 2) review studies implementing effective research methods used to study nutrition interventions and their impact on patient health and economic outcomes; and 3) discuss key pragmatic studies targeting inpatients and community-dwelling malnourished adults.

**Methods:** Review of real-world, pragmatic research studies implemented in both US and ex-US countries aiming to assess the impact of nutrition-focused interventions on health and economic outcomes of malnourished hospitalized patients and community-dwelling adults.

**Results:** Report the results of different pragmatic research studies assessing the effectiveness of nutrition interventions on patient outcomes including significant reductions in 30-day unplanned readmissions, hospital length of stay, and health care costs.

**Conclusions:** Unplanned 30-day readmissions, length of stay, and healthcare costs among malnourished inpatients and community-dwelling adults can be significantly decreased through nutrition-focused pragmatic programs that include comprehensive screening of patients for malnutrition, prompt administration of oral nutrition supplements, and education of malnourished patients in both hospital and community settings. Real-world, pragmatic study designs are effective methods of generating data that can inform effective decision making in the optimization of nutrition care for malnourished adults across the continuum of care.

**Keywords:** Economic burden, malnutrition, oral nutritional supplements, pragmatic designs, outcomes research/QIP

**Conflict of Interest disclosure:** Abbott Nutrition Employee
# ADVANCING CLINICAL QUALITY IMPROVEMENT PROGRAMS: A DATA DRIVEN APPROACH TO CAPTURE THE COST OF MALNUTRITION

Ruiz, Alvaro.

MD. MSc. FACP. Department of Internal Medicine and
Department of Clinical Epidemiology. School of Medicine.
Pontificia Universidad Javeriana. Bogota. Colombia.

**Background and Objectives:** Nutrition deterioration or malnutrition risk among hospitalized patients is associated with increased complications, hospital stays and readmissions, which can lead to increased healthcare costs and resource utilization. Malnutrition risk, however, is not easy to detect unless actively searched and hospitals are concerned about the costs associated with the screening process. While different screening tools are available for hospitals to use, the Malnutrition Screening Tool (MST), which is a validated and easy to use tool has been shown to be the most valid and reliable tool for the identification of malnutrition in hospitalized patients.

Presentation objectives include 1) Brief review of studies evaluating hospital-associated malnutrition prevalence of up to 69%; 2) Presentation of a real-world cohort study aiming to evaluate malnutrition screening rates in four Colombian hospitals and report readmission rates and direct costs differences between patients with positive and negative MST results; 3) Presentation of descriptive results of a pilot study including MST screening rates, positive frequencies, and readmission rates; and 4) Discussion of study implications to highlight the importance of formal malnutrition screening programs and nutrition-focused interventions for malnourished hospitalized patients.

**Methods:** Review of previously published malnutrition studies and detailed overview of a cohort study in four Colombian tertiary care centers aiming to assess malnutrition screening rates, incidence of positive MST results, readmission rates and direct cost differences between malnourished and non-malnourished patients with acute myocardial infarction, community acquired pneumonia, chronic obstructive pulmonary disease and heart failure.

**Results:** Descriptive results (i.e., demographics and frequency of screening and of positive MST results) and comparative results in terms of length of stay, readmission and cost differences for malnourished versus non-malnourished patients participating in the real-world cohort study and the pilot ongoing study will be reported.

**Conclusions:** Healthcare costs of malnourished hospitalized patients are significantly higher than their well-nourished counterparts resulting primarily from prolonged hospitalizations and readmissions. The MST can be effectively used for identification of malnourished Colombian patients in need of nutrition-focused interventions. We will report findings of two studies suggesting that identification of malnourished patients can lead to improved health and economic outcomes for patients and hospitals.

**Keywords:** Malnutrition - Screening - Real-world - Healthcare costs - Nutrition-focused interventions

**Conflict of Interest disclosure:** Study funded by Abbott

# Track 6: Functional Foods and Bioactive Compounds

SSS_144/20

## ADDRESSING TODAY'S NUTRITION AND PUBLIC HEALTH CHALLENGES WITH FOOD TECHNOLOGY INNOVATIONS

### INNOVATION IN INGREDIENT TECHNOLOGY TO ADDRESS NUTRITION, HEALTH, AND CONSUMER NEEDS

Ingredient and food technology can produce practical, functional solutions to help people meet dietary recommendations and address some of the world's most significant public health-related challenges. To combat the rise of obesity and diet-related chronic diseases, global health and nutrition authorities have called for an "all sector approach" to encourage diets reduced in total calories, sodium, added sugars and with increased dietary fibre content to deliver adequate amounts of essential nutrients. Research shows that taste remains the most important attribute in food choice, reinforcing the need for new strategic solutions to improve the quality of the diet. Food technology is essential in the global effort to improve public health while delivering the great tasting foods and beverages that consumers expect. New technologies and innovative ingredient solutions are helping to address fibre and protein enrichments as well as sodium, added sugars and calorie reduction in foods and beverages. In addition, a number of added fibres also provide additional health benefits such as laxation, favorable glycemic response, and improved calcium absorption and bone calcium retention.

Investment in nutrition research and innovation has allowed ingredient manufacturers to work closely with food and beverage manufacturers, to deliver healthy options without compromising taste and texture.

**Keywords:** Food technology, Dietary fibre, Public health, Nutrition

**Conflict of Interest disclosure:** Employed by Tate & Lyle

<footnote>(1)Canene-Adams, Kirstie; (2)Spence, Lisa; (3)Karnik, Kavita.</footnote>

<footnote>(1)PhD. Senior Scientist. Global Nutrition. Tate & Lyle. USA;</footnote>

<footnote>(2)PhD. RD. Principal Scientist Global Nutrition. Tate & Lyle. USA;</footnote>

<footnote>(3)M.Med.Sci. PhD. Director Global Nutrition. Tate & Lyle PLC.
United Kingdom.</footnote>
# FOOD TECHNOLOGY AND INGREDIENT INNOVATIONS: POTENTIAL IMPACT FROM A PUBLIC HEALTH PERSPECTIVE

Ferruzzi, Mario.

Professor. Plants for Human Health Institute. North Carolina State University. Kannapolis NC. USA.

Addressing public health challenges requires a healthful food supply that provides diverse options for consumers to meet dietary guidance and nutritional needs. This notion must include consideration of the consumer's preferences for taste, quality and price within the modern food environment. With delivery of positive nutritional attributes increasingly becoming an important component in consumer choice of food, the potential to mix messages on consumer perception of factors impacting nutrition and health has grown. It is therefore critical to continue to foster collaborations between food science and nutrition disciplines that lead to development of consumer foods that are aligned to key principles of existing dietary guidance policies. To achieve this goal, advances in food and ingredient technology have been a critical tool for product researchers allowing for development and promotion of a diverse array of quality products that can fit within the lifestyles of a broad consumer base and align with existing dietary guidance. This lecture will focus on describing the manner in which food science and technology is a translational tool for nutrition science and policy. We will describe the existence of collaborations between these disciplines leading to innovations that can help consumers reach the aspirations of dietary guidance. Examples of food science and technology creating new and innovative nutrient dense food options for consumers and the continued progress on reducing nutritional limiters will be provided, including reduction strategies for added sugars, saturated fats and sodium in processed foods which have provided options for consumers to align to a healthy eating pattern. These examples of existing alignment will be balanced with the continued efforts that are required within the context of promoting constructive dialogue which can promote better consumer food options.

**Keywords:** Food Technology. Food Ingredients. Dietary Guidance. Public Health

**Conflict of Interest disclosure:** Corporate Advising/Board Service: Coca Cola Company. Sensient Technologies. Welch's Foods

Research Funding: Alliance for Potato Research and Education. Welch's Foods. General Mills. McCain Foods. Pepsico Global. USDA. USAID. NIH.

Travel Support: Tate & Lyle

# THE ROLE OF BIOACTIVE COMPOUNDS IN WHOLE GRAINS: POTENTIAL BENEFITS FOR HUMAN HEALTH

Korczak, Renne.

PhD. RD. LD. Department of Food Science and Nutrition. University of Minnesota. US.

Epidemiologic research has consistently identified beneficial associations between consumption of whole grains and whole grain foods and lower prevalence of a number of chronic diseases. New research is also pointing towards the prebiotic effect of whole grains on the human gut microbiota, indicating a potential benefit for digestive health.

While whole grains and whole grain foods provide major sources of carbohydrates, protein, B- vitamins, minerals and phytochemicals, they also contain extra nutritional elements known as bioactives. According to the National Institute of Health (NIH), dietary bioactive components are defined as compounds that are constituents in foods, other than those needed to meet basic nutritional needs which are responsible for changes in health status.

The major bioactives found in whole-grains are phenolic compounds including phytosterols, dietary fibers (beta-glucan), lignans, alkylresorcinols, phytic acid, γ-oryzansols, avenanthramides, cinamic acid, ferulic acid, inositols and betaine. Currently, no recommended intake levels for dietary bioactive components have been established, but it is well understood that the majority of bioactive compounds of whole-grains are present in the bran and germ fraction of cereal-grains.

To date, scientific researchers understand that bioactives may elicit health benefits through multifactorial physiological mechanisms. Potential mechanisms include antioxidant activity, mediation of hormones and inflammation, enhancement of the immune system, and facilitation of substance transit through the digestive tract. The additive and synergistic effects of the biologically active compounds within whole grains and whole grain foods may be responsible for their health benefits.

The objectives of this session are to provide an overview of bioactive components found within all whole grains and describe the potential impact of dietary bioactives on human chronic disease states or conditions such as type 2 diabetes, obesity, cardiovascular disease, cancer and digestive health. An open discussion of the need for recommended intake levels for bioactives will also be included during this session.

**Keywords:** Whole grains, bioactives, oats, health benefits, recommended intake levels

**Conflict of Interest disclosure:** Renee is a consultant for her own company, Premier Nutrition, LLC, Minneapolis, MN, 55401. She has received honoraria from PepsiCo to support preparation and presentation of this abstract. The views expressed in this abstract are those of the author and do not represent position or policy of PepsiCo, Inc.
# OATS. MORE THAN JUST A FIBRE: THE ROLE OF UNIQUE BIOACTIVE AVENANTHRAMIDES

Sang, Shengmin.

PhD.Doctor.Laboratory for Functional Foods and Human Health Center for Excellence in Post-Harvest Technologies. North Carolina Agricultural and Technical State University North Carolina Research Campus 500 Laureate Way. Kannapolis. NC 28081. USA.

Oats (Avena sativa L.) have been cultivated for more than two thousand years in various regions throughout the world, and considered as a multifunctional crop nutritionally superior to many other unfortified cereals. They are commonly consumed as a whole grain and are known to provide healthy nutrients, such as proteins, unsaturated fatty acids, vitamins, and minerals, to humans. Numerous laboratory and clinical studies have demonstrated that consumption of oat-based products can lower serum cholesterol levels, reduce glucose uptake, decrease plasma insulin response, and prolong satiety. The beneficial nutritional properties of oats have attracted attention from scientific researchers and the general public, and have resulted in the food industry using oats as a food ingredient more extensively. Oats can be found in various food products, including breakfast cereals, beverages, bread and infant foods.

Oat is a good source of dietary soluble fibre especially β-glucan, which has outstanding functional and nutritional properties. β-Glucan has been considered as the major active component in oat for its positive impact on cholesterol and glucose disposition. However, the nutritional benefits of oats appear to go beyond fiber to bioactive phytochemicals with strong antioxidant and anti-inflammatory effects. Oats contain many bioactive phytochemicals, which are structurally diverse secondary metabolites synthesized by plants. The major phytochemicals in oats include carotenoids, vitamin E, phytosterols, saponins, phenolic acids, flavonoids, lignans, and avenanthramides (AVAs).

Among these phytochemicals, AVAs are phenolic compounds that are unique because they are found exclusively in oats and not in any other cereals. More than 25 AVA compounds have been identified since they were first isolated in the 1980s, with the most abundant being 2c, 2f and 2p. The total concentrations of AVAs in oat grains can reach up to 300 mg kg-1 based on literature reports. However, some processing can result in a decrease in total AVAs. Recently, AVAs have been reported to possess different bioactivities that may have a health benefit, such as antioxidant, anti-inflammatory, and cholesterol lowering activities.

The nutrition of oats appears to go beyond the benefits of fibre, to also include possible benefits of bioactives for their strong antioxidant and anti-inflammatory effects, suggesting intake of oats have the potential to contribute to prevention of some chronic diseases. However, the studies on the beneficial health effects of AVAs are still in their infancy. Additional health benefits of AVAs may yet be identified. Therefore, more research is needed in this area.

**Keywords:** Oats. fiber. phytochemicals. avenanthramides. health effect

**Conflict of Interest disclosure:** The author has received honoraria from PepsiCo to support preparation and presentation of this abstract. The views expressed in this abstract are those of the author and do not represent position or policy of PepsiCo, Inc.

# FROM RESEARCH TO DIETARY RECOMMENDATIONS

Stolarza, Zulema.

Professor. MD. Nutrition and Diabetes Service of the Hospital Dr. Cesar Milstein. Argentina.

Whole grain oats are well-known for its many health benefits due to their nutrient-rich content, but mainly caused by the effect of β-glucan, its viscous soluble fiber which has been subject of research for a long time.

Since 1963, scientific research has shown evidence regarding soluble fiber and its lowering cholesterol properties to achieve a risk reduction on heart diseases when consumed with a healthy diet and a regular practice of physical activity.

The U.S. Food and Drug Administration (FDA) states that 3 g or more of β-glucan (oat soluble fiber) in conjunction with a diet low in saturated fat and cholesterol can reduce the risk of coronary heart disease; the American Heart Association also supports this statement. To achieve the heart health benefit, 56-150 g of whole grain oats can be consumed per day in form of oat bran, oat flakes, or in foods containing oats; e.g. ½ cup (40g) of oat flakes contain 2 g of β-glucan.

In regards to a glycemic response effect, the European Food Safety Authority (EFSA 2011) published an opinion allowing health claims for postprandial blood glucose response reduction when 4 g of β-glucans from oats for each 30 g of available carbohydrate should be consumed per meal.

Controlling appetite in order to adhere to dietary recommendations for weight loss /maintenance is necessary. Studies on the effect of oats on satiety have shown benefits at amounts of β-glucan ranging from 2.2g to 5.5g. Viscosity plays an important role in this effect, and then any processing could affect physicochemical process. This should be considered when we are looking for a satiety effect.

Besides soluble fiber, oats are also a source of insoluble fiber. A portion of 30g of oats contributes with approximately 10% of the daily value for fiber, which can be beneficial to achieve fiber recommendation. Both types of fiber are highly beneficial for digestive health.

Additionally, the nutrient content beyond fiber: unsaturated fatty acids, vitamin B complex and nutrients with antioxidant function make oats and oat containing products a great choice to improve breakfast quality.

**Keywords:** Oats, soluble fiber, health benefits, beta-glucan.

**Conflict of Interest disclosure:** The author has received honoraria from PepsiCo to support preparation and presentation of this abstract. The views expressed in this abstract are those of the author and do not represent position or policy of PepsiCo, Inc.
# IS THERE A ROLE FOR DIETARY/FOOD SUPPLE-
MENTS IN NUTRITION AND HEALTH?

## FROM CHALLENGES OF THE PAST TO OPPOR-
TUNITIES OF THE FUTURE: EVOLUTION OF THE
FIELD OF NUTRITION

Shao, Andrew.

Chair of the Scientific Council. International Alliance of Dietary/Food Supplement Associations. VP Global Nutrition Policy. Herbalife Nutrition.

The field of nutrition has evolved drastically over the past century. This has paralleled a shift in public health challenges from those related to communicable disease to lifestyle-related non-communicable disease. Nutrition scientists and policy makers are now faced with the dichotomous situation of malnutrition and obesity, with its associated comorbidities. In an attempt to control spiraling healthcare costs, societies' focus has shifted as well, to one aimed at prevention, and health maintenance and promotion. Nutrition research has in turn gone through a necessary evolution. Rapid advances in research and technology have led to important discoveries in the "omics" and microbiome. While these have greatly informed the understanding of the diet/life-style-chronic disease relationship, rates of chronic disease show no signs of abating in both developed and developing countries. This shortcoming may be due in part to the application of a reductionist approach, driven by a desire to understand what is responsible for nutritional effects down to the specific nutrient or molecule. This approach has necessarily expanded in recent years to become more holistic and multidisciplinary to better understand the role of nutrition in a broader context. Ultimately this approach will culminate in a full understanding of the dietary landscape – a web of interactions between nutritional, dietary, social, behavioral and environmental factors – and how it impacts health maintenance and promotion.

**Keywords:** Nutrition, non-communicable disease, dietary landscape, health promotion

**Conflict of Interest disclosure:** Dr. Shao is a full time employee of Herbalife Nutrition, a global nutrition company which manufactures and markets dietary/food supplements, functional foods and skin care products.

**Further collaborators:** Dr. Shao serves as the Chair of the Scientific Council for the International Alliance of Dietary/Food Supplement Associations, a non-profit alliance of sector associations from around the world.

## DIETARY/FOOD SUPPLEMENTS IN HEALTH PRO-
MOTION: ILLUSTRATIONS OF THE BENEFITS AND
RISKS OF RESEARCH

Blumberg, Jeffrey.

PhD. Professor of Nutrition Science and Policy. Tufts University.
USA.

A fundamental challenge in substantiating the benefits and risks of dietary/food supplements through research is the absence of a consensus regarding a framework for the scientific evidence. Can any degree of competent and reliable scientific evidence, including in vitro or animal models, be relied upon to provide supplement recommendations at a personal level or for public health? Is evidence derived from observational studies – such as cross-sectional, case-control, and/or cohort designs – sufficient to define these outcomes? Should one or more randomized clinical trials (RCTs) of any nutritional intervention be required before taking action to translate research results into the practice of nutrition care or public policy? As each of these research strategies has inherent strengths and limitations, must evidence be derived from two or more of these approaches to achieve sufficient scientific and regulatory agreement on the benefits and risks of dietary/food supplements and allow statements about health promotion and/or the reduction in risk of chronic disease? Should the breadth and depth of the evidence be dependent on the health claim allowed in communications via labeling and marketing? Despite the perception of RCTs in nutrition as the “gold standard” for determining causality, limitations common in their implementation often result a high risk of type II errors (i.e., false negatives – failures to detect an effect that is present); for example: absence of baseline and endpoint assessments of nutritional status; selection of a dose inappropriate to the response; too small a sample size or brief a duration for the intervention; designs ignorant of background dietary patterns; lack of relevant biomarkers of compliance and/or mechanisms of action; and confounding by issues such as health status, medication use, and non-intervention dietary components. These problems with RCTs often lead to results that contrast with evidence from experimental and observational studies. Thus, it is helpful to consider the options available in drawing conclusions when outcomes from RCTs and observational studies disagree: (i) the RCT is correct and the observational study is wrong; (ii) the observational study is correct and the RCT is wrong; (iii) both the RCT and observational study are wrong; and (iv) the RCT and observational study are both correct but, as designed and implemented, are asking different questions. It should be considered that the innate complexities of nutrient actions and interactions cannot always be adequately addressed through a single research design. In contrast to the use of RCTs within the context of a medical model, action to define the benefits and risks of essential nutrients and other dietary bioactive components provided as dietary foods/supplements should be taken at a level of confidence that is different from that needed in the evaluation of drug efficacy and safety in the treatment of disease.

**Keywords:** Dietary supplements, nutrition, research, benefits, risks

**Conflict of Interest disclosure:** Consultant to dietary supplement companies
## REGULATION OF DIETARY/FOOD SUPPLEMENTS: A GLOBAL OVERVIEW

Pettman, Simon.

International Alliance of Dietary/Food Supplement Associations
IADSA.

There are three questions which are most commonly asked about regulation and food supplements: Are they regulated? Are they sufficiently regulated? And what is the future of regulation in this area?

Over the past 25 years the global supplement market as developed substantially and with that growth has come new regulation across the world. This regulation has in some cases responded to the market, in other cases defined the market. But despite it often being developed along national or regional lines the commonalities of this regulation across the world significantly outweigh the elements that are today not common.

When looking at the question of whether supplement products are sufficiently regulated, it is important to first look at the origins of legislation in this area and where it is today. It is then important to look at this in a national or regional context of the efficacy of the systems in place for control and enforcement of products and manufacturing. It is the total management system for supplements that defines whether the regulation is sufficient.

Looking forward, two of the major areas of future regulation are becoming the global priorities for regulatory bodies. How to fairly and consistently provide consumers with information about products; and how to regulate the use of botanicals in products? Ensuring the confidence of the regulatory, scientific and consumer communities in regulation in these and related areas will help define the next stage in the evolution of the supplement category.

**Keywords:** Food Supplement, Dietary Supplement, Regulation, Trends

**Conflict of Interest disclosure:** Simon Pettman is the Executive Director of IADSA which is funded by supplements associations across the world and companies engaged in marketing food supplements.

## Track 7: Food Culture Practices and Nutritional Education

SSS_144/19

### GLOBAL FOOD VALUES IMPACT SURVEY: MEASURING HOW FOOD VALUES IMPACT THE POLICY AND REGULATORY LANDSCAPE

#### GLOBAL FOOD VALUES: PREDICTIONS AND THE IMPACT ON EMERGING FOOD VALUES FROM AROUND THE GLOBE

Pitman, Susan.

MA. RD. Founder. Executive Vice President. FoodMinds. USA.

Globally, the traditional primary value equation of food decisions and purchases: taste, price, and convenience, is evolving. Today, new food values beyond the product itself, including experience, social impact, environment, and transparency, are shaping how consumers view, and ultimately, make food purchase and health decisions. Food values are closely tied to human emotions and reflect gender, life stage and experiences, education, income, geographic location and culture. The impact of these new food values extends beyond the individual consumer—food and nutrition policies around the world reflect this evolving values. While science remains integral to policy development, policy decisions are no longer based solely on evidence-based data. Food and health policies are rapidly evolving to adapt to these new food values. Policies are emerging to encompass societal, environmental, experiential, safety, and health and wellbeing values that may, or may not be driven by science.

To understand the possible future impact of food values on the food and nutrition affairs landscape, FoodMinds embarked on an effort to construct and anticipate emerging values that are shaping consumer food decisions and behaviors as well as policy formulation flowing from shifts in these values. A first-of-its-kind prototype tool, the FoodMinds Food Values Factor Analysis TM, informed by a survey conducted in over 15 countries in six continents using an interactive forecasting model to curate predictions from the global nutrition and food experts overlaid with market and modeling data, will be presented. The Analysis reveals a broad set of food values, which is comprised of several interrelated social, political, regulatory, agricultural and technological factors that are changing the way food is produced, distributed, marketed, regulated, sold and consumed. Importantly, these food values are emerging in different places around the globe and are being woven together in the flow of human migration and digital connectivity, including social media. Understanding the differences between these food values, level of impact and the relationships between them provides a deeper understanding of today's food and nutrition landscape, and can help to predict the future environment and policies that shape it.
**Keywords:** Consumer Decision; Food Policy; Nutrition Policy; Public Health; Nutrition Trends.

**Conflict of Interest disclosure:** I am aware that my presentation must be evidence based, and free from bias towards any commercial entity or manufacturer. If there are any changes in my relationships between now and the time of the activity, I will inform the Scientific Department prior to the conference.

## REVIEW OF THE IMPACT OF EMERGING FOOD VALUE EQUATION ON POLICIES AROUND THE GLOBE - AND PREDICTIONS FOR THE FUTURE

Rowe, Sylvia.

President. SR Strategy. Adjunct Professor at the University of Massachusetts Amherst and Tufts Friedman School of Nutrition Science and Policy. USA.

Evidence-based policy has been the standard for major authoritative bodies, but in recent years, emerging food values are playing an impactful role in the global policy landscape. A decade ago, the impact of food as medicine, renewable energy and energy sources, risk, and ethics began to appear on the horizon as key factors of food development. These issues converge when using a food systems approach. The United Nations Food and Agriculture Organization (FAO) and the World Health Organization (FAO) assert the importance of food systems, which encompass all aspects of food from farm to fork, to promote healthy and sustainable diets in its Sustainable Development Goals, which broaden how policy makers consider food, nutrition and its impact on society.

Additionally, there is a call for a “One Health” conceptual approach from authoritative bodies such as the WHO and FAO, which ties together the health of humans, animals and the environment. This concept is practical in its application to non-communicable diseases, but more holistic in its application to food values, from local and sustainable food to animal welfare to worker safety and social justice. While food values can be analyzed as factors to delve into specific drivers of change, the totality of these factors can also predict how the food and nutrition landscape may change. These values inform the “One Health” concept as an approach to how we think about food, while concurrently reflecting how society is thinking about food.

Policies have begun to encompass societal, environmental, experiential, safety and health and wellbeing values that may or may not be driven by science. Policy levers to curb consumption of sugar, sugar sweetened beverages, and “junk food” are being encouraged, despite what some note as limited evidence. At a national level, the most recent United States Dietary Guidelines for Americans Committee proposed the inclusion of sustainable eating patterns as part of the 2015-2020 Dietary Guidelines for Americans, which were later excluded in the final policy due to lack of conclusive evidence on the association between sustainable eating patterns and health outcomes plus political pressure.

Science is the foundation of policy, but the complex, multifactorial issues of obesity and climate change in today's environment

present challenges to our standard approach to addressing scientific evidence. “Public health rules” suggest that exploring a practice-based evidence approach grounded on natural or “real world experiments” versus an evidence-based approach, may be the new strategy going forward.

Another important part of the equation is how to effectively communicate science, as this impacts not only how the science is heard, but how decisions are made at the policy level. In an environment where multiple factors, beyond science affect global public health, science needs to be approached in a transdisciplinary manner.

**Keywords:** Public Health Policy; Nutrition Policy; Food Industry; Evidence-based Policy; Sustainability.

**Conflict of Interest disclosure:** I am aware that my presentation must be evidence based, and free from bias towards any commercial entity or manufacturer. If there are any changes in my relationships between now and the time of the activity, I will inform the Scientific Department prior to the conference

## FOOD CULTURE PRACTICES AND NUTRITIONAL EDUCATION

Guarita, Heloisa.

MS. Co-Founder. RGNutri. Brazil.

Latin America (LA) countries face, at the moment, a double burden of malnutrition. On one hand, even with the rates of stunting and wasting falling - although in different proportions among the LA countries -, the numbers of undernutrition parameters are still substantial. Among specific population groups, regions or even in low-income countries, there are low intakes of critical nutrients and food insecurity, which predisposes to micronutrient deficiency or, at least, to hidden hunger. On the other hand, overweight/obesity is increasing to alarming rates, as can be observed in Mexico, Venezuela, Chile and Uruguay, countries in which overweight already affects more than 60% of the population. In absolute numbers, the overweight/obesity has overcome undernutrition in almost all of the LA countries.

One of the most striking changes in food systems of LA countries is the displacement of dietary patterns based on meals and dishes prepared from unprocessed or minimally processed foods by those that are increasingly based on ultra-processed food and drink. The result is diets with excessive energy density, high in free sugars and unhealthy fats and salt, and low in dietary fiber that increase the risk of obesity and other diet-related non-communicable diseases (NCDs). This movement has a close relationship with the industrialization, urbanization and modernization processes, which have changed the dynamics of the families, the rhythm of life and lifestyle of the individuals.

As an answer to this epidemiological scenario, public health authorities are promoting positive changes in the dietary patterns of LA populations. For example, Ecuador, Chile, and Mexico have recently passed laws to promote Front-of-Package (FOP) in packaged foods. According to studies, the system with the most
favorable results in terms of healthy food choices and perception of healthfulness was the Multi-Traffic Light labeling system, and the summary system demonstrated the greatest impact on food reformulation. However, the LA region has specific characteristics that need to be considered when implementing any strategy regarding food labeling, such as mathematical and reading skills and education levels.

Brazil (2014) and Uruguay (2016) have launched new dietary Guidelines for its populations, both of which based its principles on a classification of food in the four categories: in natura, minimally processed, processed and ultra-processed; and a healthy diet must be based on the first two categories. PAHO has already adopted this classification, and affirms that “the proportion of ultra-processed products in food supplies can be seen as a measure of overall population diet quality”.

Aware of its responsibility and role in public health, the food industry has moved to improve the nutritional quality of its products, either by reducing the sugar and sodium levels progressively or by prioritizing the elaboration of clean label products, among other actions.

As a result of health authority actions and increased access to information, there seems to be a population movement, albeit timid, to make more conscious food choices, prioritizing food with a better nutritional profile, and gradually regaining the habit of cooking at home.

**Keywords:** Double burden; Dietary pattern changes; Public health policy; Food industry actions; Consumer perception

**Conflict of Interest disclosure:** I am aware that my presentation must be evidence based, and free from bias towards any commercial entity or manufacturer. If there are any changes in my relationships between now and the time of the activity, I will inform the Scientific Department prior to the conference.

## HOW EVOLVING FOOD VALUES ARE DRIVING MAJOR POLICIES IN EUROPE

Azaïs-Braesco, Véronique.

PhD. Founder. VAB-nutrition. France.

Since the late 1990's, the value system around foods has significantly changed for European consumers. Price, taste and convenience remain major attributes, but a wide range of other concerns have emerged which result in an increasingly complex environment for all stakeholders to perform tasks such as providing, preparing, eating and regulating food. The survey carried out by FoodMinds helps us to better understand the link between changes in food values and changes in food policies and regulation.

A key learning of the survey is that economic considerations do not appear as major drivers of food choices as they used to be 50 years ago. In highly developed countries, cost concerns roughly rank as 8th rank out of 14 drivers. However, price is still believed to be important and the “tax” lever has been recently used in several European countries as a tool to orientate food consumption (e.g., tax on saturated fat in Denmark, on sweetened beverages

in France, etc.), especially in people with lower incomes, who are thought to be at highest risk of unbalanced diets and obesity. Results have often been mitigated, but not null, and the nutritional efficiency of taxes remains under discussion.

European consumers are paying increased attention to the nutritional content of their foods. Sugar is becoming the number one enemy, illustrated by new guidelines, such as in UK, where it is recommended that added sugar accounts for no more than 5% of daily energy; there are also by strong pressures from the European Union for manufacturers to significantly decrease the sugar content of processed foods and more generally to improve the nutritional quality of products. Consumer concerns about foods have also translated into food-labeling requirements, which have been answered, at least partially, by a 2011 European regulation which, harmonized nutrition information, and made detailed ingredient listing mandatory in all countries, including, country of origin for some.

The geographic and socio-demographic structures of the European population largely contribute to explain food behaviors, with a high proportion of working educated urban people with little time to buy food or cook, yet have concerns about food quality (see above) and often environmental worries, which are increasingly important in Europe. Although it does not (yet?) appear to be a major driver, the environmental dimension impacts many areas, including food. Organic or “reasoned farming” practices are encouraged by the European Union and in several countries, and measures are taken that promote local and/or organic supplies for school meals to limit pesticides intakes and green-house gas emissions. Emblematic of the fight against “industrial agriculture” has been the ban of genetically-modified organisms in 19 European countries in 2015.

This very short overview suggests that in Europe, food-related policies and the food consumer values are often connected, but not always strictly. This is probably a reassuring conclusion, as public policies should consider consumer interest, concerns and opinion, but should not been dictated by the latter two, nor should attempts at regulating which remains each one's area of freedom and free choice.

**Keywords:** Europe; Nutrition Policy; Public Health Policy; Consumer Choice; Consumer Behavior

**Conflict of Interest disclosure:** I am aware that my presentation must be evidence based, and free from bias towards any commercial entity or manufacturer. If there are any changes in my relationships between now and the time of the activity, I will inform the Scientific Department prior to the conference.
# BREAD AND THE MEDITERRANEAN DIET: A DUET FOR THE PREVENTION OF CHRONIC DISEASES

Gil, Ángel.

PhD. Prof. Department of Biochemistry and Molecular Biology. Institute of Nutrition and Food Technology. Centre of Biomedical Research. University of Granada. CIBERobn. Spain.

Wholegrain cereals are rich in nutrients and many phytochemical compounds, with recognised benefits for health, including dietary fibre, a number of phenolic compounds, lignans, vitamins and minerals and other bioactive components. Foods based on wholegrain cereals, including bread, play an important part in health and well-being. Thus, research consistently indicates that the regular consumption of wholegrain cereals reduces the risk of CVD, type 2 diabetes mellitus (DM2) and certain types of cancer, as well as several gastrointestinal pathologies.

The inclusion of different ingredients or the use of different baking technologies may modify the satiety response to bread, and aid in the control of food intake. We have performed a systematic search of randomized clinical trials on the effect of bread consumption on appetite ratings in humans. The inclusion of appropriate ingredients such as fiber, proteins, legumes, seaweeds and acids into breads and the use of specific technologies may result in the development of healthier breads that increase satiety and satiation, which may aid in the control of weight gain and benefit postprandial glycaemia. Indeed, we have investigated the appetite ratings and postprandial glucose, insulin, and gastrointestinal hormone responses related to hunger and satiety after the intake of a cereal-based bread contained a variety of cereal flours (wheat, oat, and spelt) and consisted of 22% dried fruits (figs, apricots, raisins, and prunes). It was also enriched with both fiber (7% from wheat cross-linked maltodextrins and pea) and protein (10–11% from wheat gluten and hydrolyzed wheat proteins). Consumption of that cereal-based bread contributed to appetite control by reducing hunger and enhancing satiety. In addition, consumption of this bread improved glycemic, insulinemic, and gastrointestinal hormone responses in healthy adults.

Additionally, we have carried out a study evaluating the glycemic response, insulin response, appetite and gastrointestinal hormone responses, following the intake of the five most common breads consumed in Spain differing in their composition and manufacturing process. We did not find relevant differences in glycemic index or insulinemic index within the breads. However, we found differences in glycemic load among the tested breads, mainly in the wholemeal bread. We did not obtain relevant differences in either appetite ratings or gastrointestinal hormone responses between breads. Despite this, more emphasis on encouraging the consumption of different breads, specially whole wheat breads, should be made by national authorities in order to promote healthier and varied diets, and therefore, to establish healthy lifestyles.

## References

Gil A, Ortega RM, Maldonado J. Public Health Nutr. 2011 Dec;14(12A):2316-22.

Gonzalez-Anton C, Lopez-Millan B, Rico MC, Sanchez-Rodriguez E, Ruiz-Lopez MD, Gil A, Mesa MD. J Nutr. 2015 Feb;145(2):231-8.

Gonzalez-Anton C, Rico MC, Sanchez-Rodriguez E, Ruiz-Lopez MD, Gil A, Mesa MD. Nutrients. 2015 May 27;7(6):4033-53.

Gonzalez-Anton C, Artacho R, Ruiz-Lopez MD, Gil A, Mesa MD. Crit Rev Food Sci Nutr. 2017 Sep 22;57(14):3035-3050.

**Keywords:** Bread. Glycaemic index. Glycaemic load. Satiety. Whole grains.

**Conflict of Interest disclosure:** This symposium has been sponsored by the International Uniof of Bakers (UIB)

# GLUTEN INTRODUCTION AND THE RISK OF CELIAC DISEASE

Da Costa Ribeiro, Hugo.

Associate Professor of Pediatrics. Chief. Division of Pediatric Nutrology. General Coordinator of Fima Lifshitz Research Unit. Pediatric Nutrition Research Unit. Federal University of Bahia. Brazil.

Celiac disease (CD) is a unique disorder in which consumption of a specific food nutrient, namely gluten, in conjunction with genetic susceptibility, is essential for the development of naively evolving autoimmune reaction affecting the gut and other organs.

CD is a permanent condition that affects approximately 1 to 3% of the general population in most parts of the world except for population in which the HLA risk alleles (HLA-DQ2 and/or DQ8) are rare such as in South East Asia.

The only treatment currently available for CD is strict adherence of a GFD for life. There is evidence that diagnosed but untreated CD is associated with significant increase in morbidity and mortality. Prolonged adherence to a GFD may reduce this risk for both morbidity and mortality to the levels found in the general population.

Adherence to a GFD in children results in remission of the intestinal lesions and promotes better growth and bone mineral density. It is the task of health care professionals to monitor and advise patients about adhering to a GFD because compliance with a GFD is variable and may be as low as 40%.

**Summary of Recommendation:** The recommendations are based on findings in children genetically predisposed to developing CD, because the risk of inducing CD through a gluten-containing diet exclusively applies to persons carrying at least 1 of the coeliac risk alleles. The following recommendations are conditional due to the low quality of evidency, however, applicable to all infants, although it is recognized that they may not be relevant to approximately two thirds of the population.

Breast-feeding and CD
(1) Recommendations on BF should not be modified because of considerations regarding prevention of CD (low quality of evidence).

(2) Introducing gluten while the infant is being breast-fed can-
not be recommended as a means of reducing the risk of developing
CD (low quality of evidence). BF should, however, be promoted
for its other well-established health benefits.

Timing of Gluten Introduction

(1) Gluten can be introduced into the infant's diet between the ages of 4 and 12 completed months. The age of gluten introduction in infants in this age range does not seem to influence the absolute risk of developing CDA or CD during childhood (depending on the age, quality of evidence varies from very low to high quality of evidence).

Type of Gluten

(1) No recommendation can be made regarding the type of gluten to be used at introduction (very low quality of evidence).

Amount of Gluten

(1) Despite the optimal amounts of gluten to be introduced at weaning or the effects of different wheat preparations on the risks of developing CD and CDA have not been established, ESPGHAN suggests that consumption of large amounts of gluten should be discouraged during the first months after gluten introduction (very low quality of evidence).

**References:** • Szajewska H, Shamir R, Chmielewska A, et al. Systematic review with meta-analysis: early infant feeding and coeliac disease—update 2015. Aliment Pharmacol Ther 2015;41:1038 – 54.

• Husby S, Koletzko S, Korponay-Szabo IR, et al. Guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54: 136 – 60.

• Ivarsson A, Hernell O, Stenlund H, et al. Breast-feeding protects against celiac disease. Am J Clin Nutr 2002;75:914–21.

• Aronsson CA, Lee H-S, Liu E, et al. Age at gluten introduc-
tion and risk of celiac disease. Pediatrics 2015;135:239–45.

• Størdal K, White RA, Eggesbø M, et al. Early feeding and risk of celiac disease in a prospective birth cohort. Pediatrics 2013;132:1202 – 9.

• Hania Szajewska, Raanan Shamir, Luisa Mearin, et al. Gluten Introduction and the Risk of Coeliac Disease: A Position Paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN 2016;62: 507 – 51.

Keywords: Gluten, Complementary feeding, Coeliac disease,

**Conflict of Interest disclosure:** This symposium has been
sponsored by the International Uniof of Bakers (UIB)

POTENTIALLY HEALTH PROMOTING PHYTO-
CHEMICALS OF THE BENZOXAZINOID GROUP
ARE ABUNDANT IN CEREAL GRAINS AND FOOD
PRODUCTS

(1)Fomsgaard, Inge; (2)Krogh Steffensen, Stine; (2)Bahadur Adhikari, Khem; (2)Pedersen, Hans Albert; (2)Tanwir, Fariha;

(2) Gregersen, Per L.

(1)Associate Professor of Natural Product Chemistry and Environmental Chemistry. Dept. of Agroecology. Faculty of Science and Technology. Aarhus University, Denmark; (2)Dept. of Agroecology Faculty of Science and Technology Aarhus University, Denmark.

Proteins, carbohydrates and fat are large molecules that are necessary nutrients for growth and development; both for the human consumer and for the cereal crop itself. Small molecules, such as benzoxazinoids (BXs), lignans, phenolic compounds and alkylresorcinols are not needed for growth and development, but they often have interesting exploitable biological activities; - and they are present in cereal food products.

For a long time BXs were believed only to be present as de-
fence compounds in the young cereal plants.

In 2008 we discovered that mature grains of rye and wheat contain BXs. Bread baked in our lab from rye or hydrothermally processed wheat showed to contain substantial amounts of BXs. The composition and quantity of BXs in food products depended much more on the food preparation process than on the cultivar. BXs were taken up by pigs, rats and humans after consuming rye-based food. BXs have a range of potential pharmacological properties, as reviewed by Adhikari et al (2015). When bacteria induce the production of inflammatory cytokines in innate immune cells, a previous diet high in BXs enhances this production, indicating an immune-modulating effect of the BXs. With a highly sensitive analytical method uptake of 6 BX compounds in human prostate tissue was documented after one week's high-BX diet.

Intake of BXs by humans, pigs and rats is not restricted to
take place in experimental trials with specially produced food
items. Our recent analyses of 25 commercial cereal food prod-
ucts, purchased in Danish supermarkets, showed concentrations
of BXs from not detected to >500 µg/g dry weight. Most products
high in rye content had high concentrations of BXs.

Based on the above, the possible health protecting effects of
BXs should be in focus in future development of functional food
products for humans and of feed for animals. Future research
should cover: full characterization of BX structures; methods for
easy isolation of pure compounds; fate of BXs in the body - oc-
currence in plasma and urine, and distribution to tissues; effect
studies - not only registration of effects but understanding of
mechanisms behind effects.

**Keywords:** Benzoxazinoids. Bread. Cereal grains. Phytochemicals.

**Conflict of Interest disclosure:** The present Symposium is
sponsored by the International Union of Bakers and Confection-
eers (UIBC)
# WHY JAPANESE CUISINE IS HEALTHY?

## SYNERGISM IN UMAMI TASTE WHICH IS CENTRAL TO JAPANESE CUISINE 'WASHOKU'

Ninomiya, Kumiko.

PhD. Director. Non-Profit Organization Umami Information Center. Japan.

When we eat, we use all of our senses - sight, hearing, smell and touch - to form general judgments about our food. Taste however, is the most influential in determining how delicious a food is. Conventionally, it has been thought that our sense of taste is comprised of four basic or primary tastes, which cannot be replicated by mixing together any of the other primaries tastes, sweet, sour, salty and bitter. However, a further primary taste is now recognized: Umami. It is the lingering, pleasant taste one experiences when eating savory foods. Japanese cooking uses many umami rich foods, although it is a universal taste common in many foods.

Taking its name from Japanese, umami is a pleasant savory taste imparted by glutamate, a type of amino acid, and ribonucleotides, including inosinate and guanylate, which occur naturally in many foods including meat, fish, vegetables and dairy products. As the taste of umami itself is subtle and blends well with other tastes to expand and round out flavors, most people do not recognize umami when they encounter it, but it plays an important role in making food taste delicious.

Many chefs around the world gained much more awareness of umami by storing up tastes in preparation for creating new flavors. With the umami spectrum, they always find clear notes of umami in a good ripe tomato, aged Parmezan cheese or other fermented foods like miso and soy sauce, dried shiitake mushrooms, kombu, etc. Kombu is the indispensable material to cook Japanese soup stock 'dashi.' Taste of dashi is very subtle and delicate, but it brings out original taste of various vegetables and makes excellent harmony with other tastes. Further more, combination of glutamate and inosinate or guanylate enhances umami, more than 7 or 8 times higher than umami by single compounds. Once chefs understand synergistic mechanism by combination of different umami compounds, they successfully develop new dishes. It is possible to create a new dish which is built on the top of umami through a balanced mixture of the other four primary tastes. Having experiences of umami taste sensation in our mouth is crucial to understand exact meaning of this unique taste. Its taste quality is quite different from other four basic tastes. Everyone can easily imagine tastes of sweet, sour, salty and bitter. However, umami may not be noticed by some people without the experience being pointed out, because it is very subtle and overshadowed by other tastes.

In this presentation, I would like to let you understand what is umami and synergism between glutamate and inosinate or guanylate. Chef Takehiro Ohno's presentation and demonstration will deepen your knowledge on umami with experiences.

**Keywords:** Umami, Glutamate, Inosinate, Guanylate, Synergism

**Conflict of Interest disclosure:** The author is Senior Fellow at the Ajinomoto Co., Inc.

## HEALTH MERITS IN THE JAPANESE CUISINE

Nishimura, Toshihide.

Ph. D. Professor. Kagawa Nutrition University. Professor emeritus. Hiroshima University. Japan.

In 2013, Japanese Cuisine "WASHOKU" was registered on the Representative List of the Intangible Cultural Heritage of UNESCO. "WASHOKU" is defined as the "Traditional Dietary Cultures of the Japanese". Therefore, "WASHOKU" is a social practice based on an essential spirit of the Japanese, "respect for nature". It has four characteristics as follows; at first, ingredients used in WASHOKU are diverse, fresh and available in four distinct seasons such as spring, summer, autumn and winter. Next, since WASHOKU requires well-balanced and low-fat diets, it contributes to health. For example, fishes, soy beans, vegetables and so on, are widely used as materials for WASHOKU. The third point is that WASHOKU is associated with the beauty of nature in the presentation such as plates of dishes, decorating tables and rooms. Finally, WASHOKU has developed using traditional knowledge and customs closely associated with nature and in connection to annual events. Therefore, when Japanese people share a mealtime together, they enhance the bonds among family and community members.

The traditional Japanese Cuisine "WASHOKU" constitutes one soup and three dishes. In general, miso soup is the typical soup in WASHOKU and it is consumed at least once every day. Miso is made from soy beans via fermentation. Umami substances are added to miso soup as seasonings to enhance its flavor. One of the dishes constitutes cooked rice. The other two dishes are foods cooked using fresh materials such as fishes, seaweeds and vegetables. Since there are four seasons in Japan, fishes and vegetables are diverse and fresh. From science, we know that fishes contain some functional substances such as EPA and DHA, vegetables contain dietary fibers, many kinds of vitamins and minerals, and green tea contains polyphenols with antioxidant activities. Thus, the ingredients in WASHOKU contain functional compounds while being a low-fat diet.

The longevity of the Japanese was about fifty years old immediately after the Second World War. Then, it gradually increased and reached to 70 years old in 1980s, until the longevity of Japanese male and female became 80.8 and 87.1 years old, respectively, in 2016. The increase of the Japanese longevity is thought to be caused by the increase of animal foods and the decrease of carbohydrate as well as the development of medical techniques. Animal foods contain lots of protein with well-balanced essential free amino acids and fat. Recently, Japanese cancer center reported that the intake of animal foods decreased the risk of mortality by about 10% related to the traditional Japanese Cuisine. Modern Japanese Cuisine "WASHOKU" consists on animal foods such as meats and milk products as well as fishes, soy beans and vegetables, leading
“WASHOKU” to become a more well-balanced diet and increas-
ing the longevity of Japanese people.

In this presentation, I would like to introduce Japanese Cuisine
“WASHOKU” and explain its merits in health.

**Keywords:** Washoku, healthy, well-balanced diets, umami substances

**Conflict of Interest disclosure:** This symposium was spon-
sored by Ajinomoto Co., Inc. (Japan)

SSS_144/1028

BUILDING A HEALTHIER SOCIETY BY HELPING PEOPLE TO EAT WELL

THE 21ST CENTURY NUTRITIONAL CHALLENGES THAT FACES THE FOOD INDUSTRY

Tontisirin, Kraisid.

Professor and Senior Adviser. Institute of Nutrition. Mahidol
University.

Since nutrition is a link between food and health regarding the fulfilment of dietary needs of energy, protein, vitamin, mineral and phytonutrients from food in human life course for good health and well-being, the 21 century nutritional challenges will have to aim for achieving food and nutrition security for all. Global nutrition situation compiled by FAO/WHO at the 2nd International Conference on Nutrition (ICN2) held at FAO in Rome in November 2014 indicated that 805 million people suffer from hunger; 161 million children under-five are stunted, 99 m. are underweight, and 51 m. are wasting; 2 billion people affected by micronutrient deficiencies; 43 m. children under five are overweight and obese; 500 m. people are obese with a rapidly increasing rates of diet related non-communicable diseases (NCDs); 3.4 m. people die each year due to overweight and obesity; and the cost of malnutrition is about 3.5 trillion USD per year. The commitments from ICN2 by member countries, UN agencies, civil societies and private sectors include eradicating hunger and prevent all forms of malnutrition, enhancing sustainable food systems, raising the profile of nutrition, ensuring healthy diets throughout the life course, and creating enabling environment for making informed choice. The ICN2 also endorsed the “Global Nutrition Targets 2025” from WHA Resolution by reduction of low birth weight, childhood stunting and wasting, anemia in women of reproductive age, no increase in childhood over weight, and increase in the rate of exclusive breast feeding rate. Framework for actions from ICN2 include sustainable, resilient food system for healthy diets; aligned health system providing universal coverage of essential nutrition actions; social protection and nutrition education; trade and investment for improved nutrition; safe and supportive environments for nutrition at all ages; and strengthen nutrition governance and accountability.

The UN General Assembly in 2015 adopted the 17 Sustainable Development Goals (SDGs) to be achieved by the year 2030. All

SDGs are interrelated and complemented to other goals. For ex-
ample SDG 2 “End hunger, achieve food security and improved
nutrition and promote sustainable agriculture” will be related to
SDG 1. Ending poverty, SDG 3. Good health and well-being, SDG
4. Quality education for all, SDG 5. Gender equality, SDG 6. Clean
water and sanitation, SDG 9. Industry, innovation and infrastruc-
ture. SDG 12. Responsible consumption and production, SDG 13
Climate actions, and SDG 17. Revitalize the global partnership for
sustainable development. It has been emphasized that a successful
sustainable development agenda requires partnerships between
governments, the private sector and civil society. These inclusive
partnerships built upon principles and values, a shared vision,
and shared goals that place people and the planet at the centre, are
needed at the global, regional, national and local level.

Since food industries are key players in food systems which are fundamental and essential for human well-being and sustainable development, they should welcome and engage actively with other stakeholders for achieving global nutrition targets including controlling of the NCDs, and achieving the SDGs particularly goal 2 ending hunger and all form of malnutrition.

**Keywords:** Nutrition security, SDGs, malnutrition, obesity, NCDs

**Conflict of Interest disclosure:** This symposium was spon-
sored by Ajinomoto Co., Inc. (Japan)

THE IMPORTANCE OF TASTE TO SUPPORT HEALTHY DIETS

Beauchamp, Gary.

PhD. Distinguish Member. Monell Chemical Senses Center.

The sense of taste plays a crucial role in food selection and utilization. Traditionally, this sense has encompassed a small set of primary or basic qualities, namely sweet, salty, sour and bitter. These primary qualities have been thought to exist to insure that an organism can identify and consume critical nutrients (e.g. simple sugars and sodium) and avoid potential toxins. In 1909, Ki-kunae Ikeda identified a potential additional primary taste which he proposed was involved in identifying amino acids and protein. This taste quality, now called umami, had as its primary stimulus the sodium salt of the amino acid glutamate, best known as MSG. Over the subsequent 100+ years, considerable evidence has supported Ikeda's original hypothesis that umami constitutes a fifth basic taste quality although one with significant differences from the other four. In the second part of this presentation, I will describe some of the history of umami taste development from the point of view of a researcher in the United States. Among the topics I will address are early studies of the importance of MSG in many food systems, the identification of specific receptors for umami compounds, human developmental studies, and studies on the functional significance of umami. I will also raise important questions about umami that remain to be investigated. Throughout I will emphasize the central role that the Ajinomoto company has had in fostering basic and clinical research on this topic.
**Keywords:** Flavor, taste, umami, human, food

**Conflict of Interest disclosure:** The author is an Advisor to Ajinomoto Inc. He receives no personal funding directly from the company. His expenses for travel and lodging for this meeting are provided by Ajinomoto.

## SPORTS NUTRITION FOR ACTIVE LIFE-STYLE

Shimomura, Yoshiharu; Kitaura, Yasuyuki.

PhD. Nagoya University. Japan.

Branched-chain amino acids (BCAAs), leucine, isoleucine, and valine, are non-indispensable amino acids for humans. Recent studies have found that BCAAs, especially leucine, work as not only building blocks of proteins, but also regulators of protein metabolism. It is also known that BCAAs are used as energy source during exercise. Human skeletal muscle contains free BCAAs at the concentration of ~650 µM, which is similar to the plasma concentration. The plasma BCAA concentrations are rapidly elevated by BCAA supplementation and peak at ~30 min after ingestion. We examined effects of BCAA supplementation (0.1 g of BCAAs/ kg BW) right before squat exercise (20 squat/set x 7 sets with 3 min interval between sets) on the delayed-onset muscle soreness using untrained young female subjects. Dextrin was used as a control in place of BCAAs. The subjects participated two trials (BCAAs and control) with ~3 months interval. The trials were conducted with a crossover and double-blind design. The results showed that BCAA supplementation significantly decreased the muscle soreness 2-3 days after exercise, suggesting that the amino acid supplementation improves the muscle conditions after exercise.

The BCAA catabolism is regulated by branched-chain alpha-ketoacid dehydrogenase (BCKDH), which is located at the second step in the catabolism. The BCKDH is regulated by covalent modification. BCKDH kinase (BDK) is responsible for inactivation by phosphorylation of the BCKDH. Skeletal muscle has the high BDK activity to inactivate the BCKDH, resulting in providing BCAAs for protein synthesis. However, exercise promotes BCAA oxidation by activation of BCKDH in skeletal muscle. We prepared mice with chronically low levels of BCAAs by muscle-specific deletion of BDK (muscle-specific BDK knockout (BDK-mKO) mice). We examined the role of BCAAs in the adaptability to exercise training using the mice. The endurance capacity was increased by the 2-week training program in both mice, but was significantly less in BDK-mKO mice than in control mice, suggesting that sufficient BCAAs are required for the animals to maximally adapt the exercise training. These findings suggest that BCAAs are useful as sports nutrition for acute and chronic exercise.

**Keywords:** BCAAs, delayed-onset muscle soreness, exercise training, skeletal muscle, BCAA catabolism

**Conflict of Interest disclosure:** This symposium was sponsored by Ajinomoto Co., Inc. (Japan)

## HOW THE AJINOMOTO FOUNDATION APPROACHES THE CHALLENGES OF NUTRITION SECURITY

Kuriwaki, Kei.

The Ajinomoto Foundation.

The Ajinomoto Foundation (TAF) was established by Ajinomoto Co., Inc. and certified as the Public Interest Incorporated Foundation by the Cabinet Office of Japan in 2017.

TAF took over 4 nutrition related social projects, formerly managed by Ajinomoto, and is making them more public-oriented, socially impactful and sustainable.

We believe nutrition is the base of Sustainability and even economic growth. Its goals are closely tied with 2030 Agenda/ SDGs, particularly Goal 2, 3, 5, 1, under partnership to "end all forms of malnutrition".

1. Ghana Nutrition Improvement Project "KOKO Plus"

-Target: 6-24m infants (1st 1000 days) in Ghana

-Means: Product/ Education

TAF acquired the right of "KOKO Plus" from Ajinomoto and is building the Social Business model. This supplement food satisfies nutritional needs for infants, fortifying traditional complementary food koko with energy, protein, an amino acid and micronutrients. It was developed through Ajinomoto's expertise of processed food and nutrition to be Acceptable, Accessible and Affordable. This attracted partners including Ghana Health Service, University of Ghana and INF as well as donors like JICA, USAID, WFP and GAIN.

"KOKO Plus" has been proved to improve the health status of infants (stunting and anemia) and is under the scaling up phase now.

2. AIN program

Target: 2-5 y children, adolescent girls and adults in developing countries

Means: Education/ Agriculture/ School Meal/Food Processing

TAF has taken over the AIN (Ajinomoto International Nutrition network) program which started in 1999 as a grants for NGOs dedicated to the improvement of eating habits and nutrition. Since then, AIN has supported 74 projects in 14 countries. We collaborate with NGOs to change the lifestyle of individuals through power of knowledge, empowerment and self-efficacy as nutrition issues has been shifting from undernourishment to NCDs and DBM.

3. VINEP (Vietnam Nutrition system Establishment Project)

Target: Ministries/ Universities

Means: Education system/ Lobbying

Ajinomoto launched VINEP in 2011 with the National Institute of Nutrition (NIN), Vietnam to expand their education programs for nutritional infrastructure. As a milestone, a regulation specifying the status of "dietitian" was put into effect in 2015 (job code). Then "dietitian" became a nationally recognized profession. The 2nd milestone is the graduation of 1st class bachelors of nutrition from Hanoi Medical University in June 2017. TAF is further working with the Japan Dietetic Association and the Ministry of Health, Labor and Welfare to support NIN to create Nutrition
Standard so that dietitians can take an active part and become nutrition leaders in the country.

4. Support for reconstruction after disaster

Target: Elderly residents in disaster-struck areas

Means: Cooking Together & Eating Together with nutritionally balanced menu

In temporary housings in Tohoku since 6 years ago, nutrition-related problems have been detected; increased risk of diabetes and heart troubles, vitamin and mineral deficiency caused by lack of vegetables, reluctance to prepare food, and fewer opportunities for conversation due to the destruction of communities. Our solution to those is “Cooking together, Eating Together” events using tailor-made mobile cooking table and our original menus. Seniors enjoy the valuable opportunity to gather and enjoy conversation, which helps to prevent isolation, with “reduced salt, more vegetable” menus.

**Keywords:** SDGs, KOKO Plus, AIN, amino acid, dietitian

**Conflict of Interest disclosure:** The speaker is the employee of Ajinomoto Co., Inc. and the initial funding of The Ajinomoto Foundation was solely made by Ajinomoto Co. Inc.

# Track 8: Agriculture, Food Science and Safety

SSS_144/165

## NUTRITIONAL REFORMULATION OF FOOD PRODUCTS – A KEY STRATEGY FOR IMPROVING FOOD SUPPLY IN LATIN AMERICA

### FOOD POLICIES AND REFORMULATION OF FOODS IN CANADA

(1)Labbe, Mary; (2)Ahmed, Mavra; (3)Arcand, JoAnne; (2)Schermel, Alyssa.

(1)PhD. Earle W McHenry Professor and Chair. Dept of Nutritional Sciences. University of Toronto. Canada; (2)MSc. Department of Nutritional Sciences, University of Toronto. Canada; (3)RD. PhD. Assistant Professor. Faculty of Health Sciences. University of Ontario Institute of Technology. Canada.

The prevalence of overweight and obesity in Canada has increased 2.5 fold over the past 25 years [1]. Unhealthy diets are a major contributor to overweight and obesity, key risk factors for non-communicable diseases (NCDs) [2]. WHO has indicated the widespread production and marketing of energy-dense, nutrient poor foods and beverages high in fat, sugar and sodium as important contributors to obesity and NCDs [2]. As a result, public health initiatives at the nutrient level (e.g. labelling, advertising restrictions and reformulation) have been proposed as complementary strategies to improve diets. Nutrient profiling is the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health [3]. Thus programs such as front of pack labelling and setting reformulation targets require nutrient profiling systems that can be used in a transparent manner to define ‘healthier’ or ‘less healthy’ products for such programs.

In Canada, reformulation approaches included publishing sodium reduction benchmark targets for packaged foods in 2012 (as part of the national sodium reduction strategy) and earlier voluntary trans fatty acids (TFAs) limits which also encouraged substitution with unsaturated fats. Recently, Health Canada released their Healthy Eating Strategy which included a number of efforts including front-of-pack labelling, restrictions on marketing to children, and regulations eliminating partially hydrogenated oils. However, the potential for these approaches to be successful relies in part, on reformulation efforts by industry and public monitoring of the food supply.

The University of Toronto Food Label Information Program (FLIP) is a branded nutrition composition database of ~26,000 unique food and beverage products that began in 2010. Data includes national and private-label brand foods from the 4 largest Canadian grocery chains, accounting for approximately 75% of food retail sales. FLIP allows for an effective monitoring of the impact of reformulation efforts on the Canadian food supply over
time. We have utilized FLIP to comprehensively assess changes in sodium and trans fat levels in packaged foods sold in Canada from 2010 to 2013.

Analyses using the FLIP database to assess changes in sodi-
um levels indicated that 16.2% of the food categories had signifi-
cant reductions in sodium levels, with significant improvements
seen in imitation seafood, condiments, breakfast cereals, canned
vegetables/legumes, plain chips, hot cereals, meat analogues,
canned condensed soup, and sausages and wieners. However,
these analyses were done at year 3, mid-way through the 6-year
target goals, and over 80% of the food supply had not yet made
significant progress [4]. In contrast, impressive improvements
were seen in elimination of trans fat, where 97% of products
were meeting the TFAs limits within 7 years [5]. With the re-
cent announcement of a front-of-pack labelling system in Cana-
da (i.e. Warning Signs) and other programs, examination of the
Canadian food supply in relation to these policy changes will be
important to monitor industry reformulation progress in meet-
ing healthy eating goals.

**Keywords:** Public health initiatives, policy, reformulation, sodium, front-of-pack labelling

**Conflict of Interest disclosure:** Funding: Canadian Institutes of Health Research; Burroughs Wellcome Fund, Innovation in Regulatory Science Awards; University of Toronto, McHenry Research Chair (MRL)

NUTRIENT PROFILING FOR PRODUCT REFOR-
MULATION: THE BENEFIT FOR THE CONSUMER

(1)Masset, Gabriel; (2)Lehmann, Undine; (3)Mathias, Kevin;

(⁴)Vlassopoulos, Antonis; (⁵)Gressier, Mathilde.

(1)PhD. Consumer Science & Applied Nutrition. Nestlé Research Center. Lausanne. Switzerland.; (2)PhD. Nutrient Profiling group leader. Consumer Science & Applied Nutrition. Nestlé Research Center. Lausanne. Switzerland.; (3)PhD. Dietary Recommendations. Nestlé Research Center. Lausanne. Switzerland.; (4)PhD. Consumer Science & Applied Nutrition. Nestlé Research Center. Lausanne. Switzerland.; (5)Consumer Science & Applied Nutrition. Nestlé Research Center. Lausanne. Switzerland.

Public health initiatives aimed at improving the nutritional
content of food and beverages are regarded by WHO and other
health authorities as an effective means to improve the health of the
global population. Examples of countrywide initiatives include the
UK responsibility deal (2011) with sodium as the primary target,
the Health Canada guidance for the food industry (2012), and the
recent United States FDA proposal (2016). In Latin America, sev-
eral governments have proposed or implemented such approach-
es, such as the “Menos Sal Más Vida” initiative in Argentina, and
the Brazilian Sodium initiative (2011). All of these approaches put
the reformulation of food and beverages at the center of the public
health nutrition agenda in addition to nutritional education and
behavioral change initiatives.

To implement reformulation, manufacturers need guidance. Nutrient profiling (NP), the science of categorizing foods based on their nutrient composition, has emerged as an essential tool to guide reformulation and other nutrition policies. NP systems should be adapted to their specific purposes as it is challenging to design one system that can equally address all policies and purposes, e.g. reformulation and labelling.

In the symposium, we will present the principles and the validation process of the Nestlé Nutritional Profiling System (NNPS) that has been specifically designed for reformulation. The NNPS is a category-specific NP system which provides nutritional targets per serving for 7 to 10 nutrients, depending on the category; all nutrient targets need to be met to obtain an NNPS Pass status [1]. The system has been implemented since 2005 and is now used in all countries in which Nestlé operates (191 in 2016). The NNPS was recently shown to be able to identify more nutritious options within food and beverage categories [2], and a modeling study highlighted that potential reformulations following NNPS standards could improve nutritional intakes of the US and French populations [3]. These studies also identified some potential limitations of reformulation and the NNPS to address nutrition gaps, for example to act mainly on nutrients to limit but only with limited extend on nutrients to encourage [3]. New approaches for NNPS evolution that e.g. address this point and provide more holistic food and beverage product development guidance will be discussed.

In order to achieve its maximum potential and modify the
food environment in a beneficial manner, reformulation should
be implemented by the entire food sector. Multi-stakeholder part-
nerships including governments, food industry, retailers and con-
sumer associations that will state concrete time-bound objectives
accompanied by an independent monitoring system are the po-
tential solution. Further, reformulation per se will not address the
whole nutrition gap that exists in many countries, and there is a
need to combine reformulation with other public health initiatives
in more integrated frameworks.

References

1. Vlassopoulos A, Masset G, Charles VR, et al. A nutrient profiling system for the (re)formulation of a global food and beverage portfolio. Eur J Nutr. 2017;56(3):1105-1122. doi:10.1007/s00394-016-1161-9.

2. Combet E, Vlassopoulos A, Mölenberg F, et al. Testing the capacity of a Multi-Nutrient profiling system to guide food and beverage reformulation: Results from five national food composition databases. Nutrients. 2017;9(4):1-17. doi:10.3390/nu9040406.

3. Gressier M, Privet L, Mathias KC, Vlassopoulos A, Vieux F, Masset G. Modeled dietary impact of industry-wide food and beverage reformulations in the United States and France. Am J Clin Nutr. 2017;106(1):225-232. doi:10.3945/ajcn.117.153361.

**Keywords:** Food and beverage reformulation, nutrient profiling, diet modeling, food supply

**Conflict of Interest disclosure:** All authors were employed
by Nestec SA (Nestlé Research Center) at the time of submission
# FOOD REFORMULATION: A PUBLIC HEALTH AND ECONOMIC PERSPECTIVE

Soler, Louis-Georges.

PhD. Economist. INRA. Paris. France.

To address public health issues related to poor dietary habits, governments and public health agencies have been implementing policies intended to promote preventive behaviors thanks to information campaigns and food product labeling. Reviews of these policies show that they have some positive impact that, however, remains small, at least in the medium term. In addition, some of these policies are suspected to increase health inequalities, with less-educated individuals responding less to information policy. Given the modest impact of information-based policies, public health agencies are now considering other policies to modify the market environment to facilitate healthier food choices, even by non health-sensitive consumers. A broad range of instruments have been considered, from price policies to nutrition-related standards.

Policies focused on food quality are intended to facilitate healthy choices by consumers, even those who are not fully informed about the links between food consumption and health. Decreasing the salt and fat content in foods and increasing the whole grain content are good examples of food composition changes being made to address health-related issues. In this context, public health agencies urge the food industry to favor a better food environment through changes in the quality and variety of foods and through changes in advertising and marketing, and some governments are partnering with the food industry and the retail sector to generate changes on the supply side.

Are policies focused on the supply side more promising than policies focused on consumers? Which public health benefit can we expect from their implementation? Are market incentives sufficient to induce voluntary changes by firms or is public regulation of food quality needed to reach public health objectives?

To deal with these questions, we will first review the results of modeling-based articles to estimate the potential public health impact of changes in the nutritional quality of foods. We will suggest that the improvement of the nutritional quality of foods may induce significant health benefits even in the absence of changes in consumers' diet patterns. Although food reformulation alone would not be sufficient to dramatically reduce the prevalence of chronic diseases related to food consumption, it can play an important role in that direction.

Second, we will review the initiatives currently implemented by the food industry and assess their impact on consumers' initiatives by using data collected in France. We will show that voluntary commitments made by firms are sometimes significant, but the final impact on consumers is still modest because the number of committed firms and the market shares of reformulated food remain limited.

Third, we will discuss what we can expect from self-regulation vs. public regulation of food quality. Although voluntary commitments could offer potential cost savings for regulators and firms, their success depends on several conditions that we will identify. Among them, we will insist on the need to favor collective agree-

ments at the food industry level and the availability of monitoring tools to quantify and control their implementation.

**Keywords:** Food reformulation, self-regulation, quality standards, food consumption

**Conflict of Interest disclosure:** This symposium was sponsored by Nestlé Research Center (Switzerland)
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<table><tr><td>Aguilar Cordero, María José</td><td>292</td></tr><tr><td>Aguilar Mendoza, Luis</td><td>824, 1085</td></tr><tr><td>Aguilar Rabito, Ana Carolina</td><td>721, 991, 1111, 1135, 1307</td></tr><tr><td>Aguilar, Ana María</td><td>239, 1220</td></tr><tr><td>Aguilar, Gloria</td><td>782, 799</td></tr><tr><td>Aguilar, María José</td><td>1283, 1284</td></tr><tr><td>Aguilar-Rabito, Ana Carolina</td><td>518</td></tr><tr><td>Aguilera Cervantes, Virginia Gabriela</td><td>52</td></tr><tr><td>Aguilera, Concepción María</td><td>168, 346, 350, 354, 426</td></tr><tr><td>Aguirre Ackermann, Marianela</td><td>128, 1007</td></tr><tr><td>Aguirre, Carolina</td><td>307</td></tr><tr><td>Aguirre, Julio Andrés</td><td>1188</td></tr><tr><td>Aguirre, María Victoria</td><td>1076, 1188</td></tr><tr><td>Aguirre-Polanco, Carolina</td><td>536</td></tr><tr><td>Ahami, Ahmed Ot</td><td>712, 1061, 1122</td></tr><tr><td>Ahishakiye, Jeanine</td><td>343, 400</td></tr><tr><td>Ahmad, Nazir</td><td>1098</td></tr><tr><td>Ahmadi, Davod</td><td>1038</td></tr><tr><td>Ahmadu, Abraham Ajigasokoa</td><td>1233</td></tr><tr><td>Ahmed, Badahi</td><td>467</td></tr><tr><td>Ahmed, Faruk</td><td>698</td></tr><tr><td>Ahmed, Mavra</td><td>718, 1363</td></tr><tr><td>Ahmed, Parvez</td><td>69</td></tr><tr><td>Ahmed, Tahmeed</td><td>353, 686</td></tr><tr><td>Ahoya, Brenda</td><td>189, 527, 568</td></tr><tr><td>Ahumuza, Gracious</td><td>318, 494, 517, 518, 1064, 1249</td></tr><tr><td>Aiba, Naomi</td><td>905, 1010</td></tr><tr><td>Aidam, Bridget</td><td>265, 666, 1244</td></tr><tr><td>Aiko Hiane, Priscila</td><td>956, 1215</td></tr><tr><td>Ailton Oliveira Carneiro, José</td><td>882</td></tr><tr><td>Aing, Hoksrun</td><td>84, 684</td></tr><tr><td>Ainomugisha, Prudence</td><td>494, 517, 518, 929, 1064, 1249</td></tr><tr><td>Ainuson-Quampah, Joan</td><td>918</td></tr><tr><td>Ainuson-Quampah, Joana</td><td>919</td></tr><tr><td>Ait Aissa, Myriam</td><td>106</td></tr><tr><td>Ajami, Marjan</td><td>358, 616, 1026</td></tr><tr><td>Akao, Makoto</td><td>381</td></tr><tr><td>Akem, Chrysanthus</td><td>1314</td></tr><tr><td>Akeyo, Florence</td><td>189, 527</td></tr><tr><td>Akhter, Kazi Turjaun</td><td>276</td></tr><tr><td>Akik, Chaza</td><td>758</td></tr><tr><td>Akiko, Shikano</td><td>508</td></tr><tr><td>Akilimali, Pierre Z</td><td>278</td></tr><tr><td>Akinbule, Oluwafunke</td><td>1046, 1047</td></tr><tr><td>Akinyele, Isaac Olaoluwa</td><td>362</td></tr><tr><td>Akita, Morkor C</td><td>500, 617</td></tr><tr><td>Akpa, Onoja Matthew</td><td>362</td></tr><tr><td>Akparibo, Robert</td><td>358</td></tr><tr><td>Aktar, Bachera</td><td>298</td></tr><tr><td>Akter, Ferdausy</td><td>1240</td></tr><tr><td>Akter, Sonia</td><td>1254</td></tr><tr><td>Akter, Syeda Mahsina</td><td>296, 503, 911, 1240, 1254</td></tr><tr><td>Akunaye, Christine</td><td>340</td></tr><tr><td>Akwaa Harrison, Obed</td><td>1310</td></tr><tr><td>Akyol, Asli</td><td>1281</td></tr><tr><td>Al Dhaheri, Ayesha</td><td>913, 915</td></tr><tr><td>Al Khatib, Dana</td><td>913</td></tr></table>

<table><tr><td>Alam, Ashraful</td><td>72, 403, 404, 553</td></tr><tr><td>Alamu, Oladeji</td><td>1327</td></tr><tr><td>Alamu, Osas</td><td>423</td></tr><tr><td>Alaofe, Halimatou</td><td>1273, 1308, 1311</td></tr><tr><td>Alarcon, Amarilys</td><td>224</td></tr><tr><td>Alateq, Arwa</td><td>1235</td></tr><tr><td>Alatiah, Gabriel</td><td>1049</td></tr><tr><td>Alayon, Silvia</td><td>122</td></tr><tr><td>Albano, Renata Doratioto</td><td>667, 668</td></tr><tr><td>Albarracín, Sonia Luz</td><td>171, 1212</td></tr><tr><td>Albert Baracho Rüegg, Rodrigo</td><td>1298</td></tr><tr><td>Albert Pérez, Enrique</td><td>1101</td></tr><tr><td>Albuquerque de Souza, Mikaelle</td><td>1190, 1191</td></tr><tr><td>Alcântra, Solange Pires Leite de</td><td>839, 840</td></tr><tr><td>Alcázar, Mireia</td><td>441</td></tr><tr><td>Alcocer-Gamboa, Alberto</td><td>825, 1128</td></tr><tr><td>Aldaco García, Rubén</td><td>1300, 1301</td></tr><tr><td>Ale, Marcelo</td><td>578</td></tr><tr><td>Alebuena, Daiana</td><td>619</td></tr><tr><td>Aleman Mateo, Heliodoro</td><td>165</td></tr><tr><td>Alemayehu, Mihret</td><td>845</td></tr><tr><td>Alexander, Eugene</td><td>1141</td></tr><tr><td>Alexandra Moreira das Neves, Renata</td><td>1229</td></tr><tr><td>Alexandrino, Clóvis</td><td>1034</td></tr><tr><td>Alexescu, Alexandra</td><td>1057</td></tr><tr><td>Alexy, Ute</td><td>526</td></tr><tr><td>Alfaro Mora, Flory Virginia</td><td>785, 1247</td></tr><tr><td>Alfaro, Agustina</td><td>892</td></tr><tr><td>Alfaro, Norma</td><td>582, 776</td></tr><tr><td>Alfonzo Maciel, Lilian Fabiola</td><td>846</td></tr><tr><td>Alfredo Gomes Arêas, José</td><td>1210</td></tr><tr><td>Ali, Hasmot</td><td>1130</td></tr><tr><td>Ali, Masum</td><td>597, 1312</td></tr><tr><td>Ali, Md. Shahjahan</td><td>982</td></tr><tr><td>Ali, Mohamed</td><td>1007</td></tr><tr><td>Alias, Nur Atiqah</td><td>707</td></tr><tr><td>Alicia Beatriz García</td><td>1025</td></tr><tr><td>Aliete dos Santos Vieira, Diva</td><td>663</td></tr><tr><td>Alimoradi, Mohammad</td><td>616</td></tr><tr><td>Aljaadi, Abeer</td><td>369</td></tr><tr><td>Alla, Amal</td><td>839</td></tr><tr><td>Allemand, Pauline</td><td>468</td></tr><tr><td>Allemandi, Lorena Andrea</td><td>788, 797, 799</td></tr><tr><td>Allen, Cami</td><td>621</td></tr><tr><td>Allen, Elizabeth</td><td>300, 621</td></tr><tr><td>Allen, Isabel</td><td>794</td></tr><tr><td>Allen, Kate</td><td>25</td></tr><tr><td>Allen, Lindsay H</td><td>541, 713</td></tr><tr><td>Allen, London</td><td>1169</td></tr><tr><td>Allès, Benjamin</td><td>359, 858, 1144</td></tr><tr><td>Allman-Farinelli, Margaret</td><td>734</td></tr><tr><td>Almagià Flores, Atilio</td><td>817</td></tr><tr><td>Almeida Costa, Luciana</td><td>1323</td></tr><tr><td>Almeida Oliveira, Maria Goreti</td><td>1075</td></tr><tr><td>Almeida Palles Ramos, Caroline</td><td>1015</td></tr><tr><td>Almeida Roediger, Manuela de</td><td>608, 840</td></tr><tr><td>Almeida, Alinne</td><td>920</td></tr></table>
<table><tbody><tr><td>Almeida, Carlos Alberto Nogueira</td><td>134</td></tr><tr><td>Almeida, Claudia Choma Bettega</td><td>365</td></tr><tr><td>Almeida, Monique</td><td>1057</td></tr><tr><td>Almeida, Paulo César</td><td>784</td></tr><tr><td>Almeyda, Rocio</td><td>1200</td></tr><tr><td>Alonso Balthazar, Emilia</td><td>820, 1279</td></tr><tr><td>Alonso Torres, Jairo</td><td>780</td></tr><tr><td>Alonso, Elizabeth</td><td>929, 941</td></tr><tr><td>Alonso, Maria del Rosario Zariategui</td><td>134</td></tr><tr><td>Alonso, Natalia</td><td>716</td></tr><tr><td>Alonso-Alonso, Miguel</td><td>174</td></tr><tr><td>Aloraini, Munirah</td><td>1235</td></tr><tr><td>Alorda, María Beatriz</td><td>630</td></tr><tr><td>Aloud, Basma</td><td>385</td></tr><tr><td>Alqahtani, Amera</td><td>1235</td></tr><tr><td>Alsagabi, Beshair</td><td>1235</td></tr><tr><td>Alsubaie, Areej</td><td>1235</td></tr><tr><td>Altamirano Martínez, Martha Betzaida</td><td>786</td></tr><tr><td>Altare, Chiara</td><td>106</td></tr><tr><td>Altenburg de Assis, Maria Alice</td><td>679, 1065</td></tr><tr><td>Altmann, Mathias</td><td>106</td></tr><tr><td>Alvarado, Brenda M</td><td>1135</td></tr><tr><td>Alvarado, Rocio</td><td>303, 555</td></tr><tr><td>Alvarenga, Marle</td><td>436, 520, 1266, 1271</td></tr><tr><td>Alvares Duarte Bonini Campos, Juliana</td><td>893</td></tr><tr><td>Alvarez Castaño, Luz Stella</td><td>488, 1291</td></tr><tr><td>Alvarez Cordova, Ludwig Roberto</td><td>603, 1076</td></tr><tr><td>Alvarez Di Fino, Eliana Marina</td><td>32</td></tr><tr><td>Álvarez, Cristina</td><td>781</td></tr><tr><td>Álvarez, María Fernanda</td><td>809</td></tr><tr><td>Alvarez-Dongo, Doris</td><td>651, 792</td></tr><tr><td>Alverson, CJ</td><td>255, 320</td></tr><tr><td>Alves do Nascimento, Fabiana</td><td>707</td></tr><tr><td>Alves dos Santos, Ivete</td><td>912</td></tr><tr><td>Alves Guimarães, Rafael</td><td>1123</td></tr><tr><td>Alves Pereira, Rosangela A</td><td>1274</td></tr><tr><td>Alves, Raquel Duarte Moreira</td><td>922</td></tr><tr><td>Alves, luna</td><td>721, 1274</td></tr><tr><td>Alves, Maria José Queiroz de Freitas</td><td>1036</td></tr><tr><td>Alvey, Jeniece</td><td>595</td></tr><tr><td>Alzamendi, Ana</td><td>1332</td></tr><tr><td>Alzate, Teresita</td><td>1283</td></tr><tr><td>Alzineth Campos, Chiara</td><td>611</td></tr><tr><td>Amaka, Marian Odenigbo</td><td>1289</td></tr><tr><td>Amaral Mais, Laís</td><td>582, 786</td></tr><tr><td>Amaral, Yasmin</td><td>599, 827</td></tr><tr><td>Amarilla, Maria Rosa</td><td>1066</td></tr><tr><td>Amarra, Sofia</td><td>56</td></tr><tr><td>Ambato, Lorena</td><td>199</td></tr><tr><td>Ambrosino, Cintia</td><td>1069</td></tr><tr><td>Amer, Sherif</td><td>1055</td></tr><tr><td>Amezcuá Jagger, Teresita</td><td>1317</td></tr><tr><td>Amigo, Hugo</td><td>230, 728, 831, 849, 870</td></tr><tr><td>Amigo, Ludwig</td><td>1224</td></tr><tr><td>Aminee, Ahmadwali</td><td>1081, 1131</td></tr><tr><td>Amini, Maryam</td><td>405, 406, 848</td></tr><tr><td>Aminu, Francis</td><td>710</td></tr></tbody></table>

<table><tbody><tr><td>Amiot-Carlin, Marie Josephine</td><td>349, 672, 741, 768, 855</td></tr><tr><td>Amir, Mehreen</td><td>492</td></tr><tr><td>Amirhamidi, Zeinab</td><td>406, 848</td></tr><tr><td>Amiri, Parisa</td><td>613</td></tr><tr><td>Amissah, Niilante</td><td>1278</td></tr><tr><td>Amorim Angotti, Alanis</td><td>394</td></tr><tr><td>Amoussa-Hounkpatin, Waliou</td><td>719</td></tr><tr><td>Amran Gazi, Mohammod</td><td>686</td></tr><tr><td>Amundson, Kimberly</td><td>197, 578, 1286</td></tr><tr><td>An, Hae-Sun</td><td>1147</td></tr><tr><td>An, Jeehyun</td><td>432</td></tr><tr><td>An, Xiaoyi</td><td>233</td></tr><tr><td>An, Young Hwan</td><td>454</td></tr><tr><td>An, Yu</td><td>447</td></tr><tr><td>Anand, Krishnan</td><td>1237</td></tr><tr><td>Ananthan, Rajendran</td><td>1103</td></tr><tr><td>Anater, Andrea</td><td>520</td></tr><tr><td>Anaya-Loyola, Miriam Aracely</td><td>389, 1131</td></tr><tr><td>Anderson, Harvey</td><td>174</td></tr><tr><td>Andersson, Maria</td><td>371, 452, 1092</td></tr><tr><td>Andracchi, Rita</td><td>747</td></tr><tr><td>Andrada, Ana Cristina</td><td>1206</td></tr><tr><td>Andrada, Javier</td><td>619</td></tr><tr><td>Andrade Muñoz, Diana Jesús</td><td>403, 833, 1272</td></tr><tr><td>Andrade Tenesaca, Dolores Susana</td><td>403, 833, 835, 842, 1125, 1272</td></tr><tr><td>Andrade, Carlos</td><td>300, 517</td></tr><tr><td>Andrade, Giovanna</td><td>726, 775</td></tr><tr><td>Andrade, Samantha Caesar de</td><td>1282</td></tr><tr><td>Andreeva, Valentina</td><td>858, 919</td></tr><tr><td>Andreoli, Angela</td><td>488, 662</td></tr><tr><td>Andres-Lacueva, Maria Crisitina</td><td>263</td></tr><tr><td>Andrews-Trevino, Johanna Y</td><td>762, 1312</td></tr><tr><td>Andriamihaja, Mireille</td><td>974</td></tr><tr><td>Anduro-Corona, Ivan</td><td>697</td></tr><tr><td>Angarita Dávila, Lissé</td><td>1231</td></tr><tr><td>Angeles-Agdeppa, Imelda</td><td>382, 1056</td></tr><tr><td>Anger, Vanesa Erica</td><td>945</td></tr><tr><td>Ängquist, Lars</td><td>352, 735</td></tr><tr><td>Anguita-Ruiz, Augusto</td><td>350, 354</td></tr><tr><td>Anjos, Luiz Antonio</td><td>1118, 1126, 1139</td></tr><tr><td>Anjum, Faqir Muhammad</td><td>1098</td></tr><tr><td>Anjum, Rifat</td><td>1254</td></tr><tr><td>Annan, Reginald</td><td>360</td></tr><tr><td>Anne, Williams</td><td>105</td></tr><tr><td>Anny, Aklima</td><td>701</td></tr><tr><td>Anono, Esther</td><td>479</td></tr><tr><td>Anselmi, Maria Eugenia</td><td>1030</td></tr><tr><td>Antal, Emese Antal</td><td>832</td></tr><tr><td>Anton, Stephen</td><td>869</td></tr><tr><td>Antonacci, Liliana</td><td>185, 459</td></tr><tr><td>Antonio Marassi Guariento, Vitor</td><td>1000</td></tr><tr><td>Antonio Ponce de Leon F Carvalho, Rodrigo</td><td>1297</td></tr><tr><td>Antún, María Cecilia</td><td>716, 1256</td></tr><tr><td>Antunes dos Santos, Elizeu</td><td>1229, 1230</td></tr><tr><td>Antunes, Adriane</td><td>1307</td></tr><tr><td>Anwari, Ehsan</td><td>1081</td></tr><tr><td>Anzo, Anahi</td><td>331</td></tr></tbody></table>
<table>
  <tbody>
    <tr>
      <td>Anzolo, Jimmy</td>
      <td>1027</td>
    </tr>
    <tr>
      <td>Ao, Pui-Lam</td>
      <td>658</td>
    </tr>
    <tr>
      <td>Aoi, Wataru</td>
      <td>1219</td>
    </tr>
    <tr>
      <td>Aoki, Yuki</td>
      <td>1187</td>
    </tr>
    <tr>
      <td>Aoyama, Shinya</td>
      <td>478</td>
    </tr>
    <tr>
      <td>Aparecida Almeida Paula, Hudsara</td>
      <td>479, 862</td>
    </tr>
    <tr>
      <td>Aparecida Crispim, Cibele</td>
      <td>694, 1123</td>
    </tr>
    <tr>
      <td>Aparecida da Silva Alvarenga, Adriana</td>
      <td>1139</td>
    </tr>
    <tr>
      <td>Aparecida Manólio Soares Freitas, Rosana</td>
      <td>1210</td>
    </tr>
    <tr>
      <td>Aparecida Oliveira da Silva, Amanda</td>
      <td>862</td>
    </tr>
    <tr>
      <td>Aparecida Silva Alvarenga, Adriana</td>
      <td>1153</td>
    </tr>
    <tr>
      <td>Aparecida Vinci Carlos, Suellen</td>
      <td>956</td>
    </tr>
    <tr>
      <td>Aparecida Zanetti Passos, Maria</td>
      <td>1127</td>
    </tr>
    <tr>
      <td>Aparecido da Silva, Silvano</td>
      <td>1000, 1016</td>
    </tr>
    <tr>
      <td>Aparicio Bautista, Diana Ivette</td>
      <td>464</td>
    </tr>
    <tr>
      <td>Aparicio Camargo, Daniel</td>
      <td>1231</td>
    </tr>
    <tr>
      <td>Aparicio Ugarriza, Raquel</td>
      <td>306, 376, 1102</td>
    </tr>
    <tr>
      <td>Aparicio, Estefania</td>
      <td>617, 618</td>
    </tr>
    <tr>
      <td>Apaza Quispe, Mercedes Lucia</td>
      <td>829</td>
    </tr>
    <tr>
      <td>Apres, Norma</td>
      <td>229</td>
    </tr>
    <tr>
      <td>Aquino Ramírez, Anthony</td>
      <td>775, 879</td>
    </tr>
    <tr>
      <td>Ara, Ferdous</td>
      <td>337, 503, 660, 701, 829, 911</td>
    </tr>
    <tr>
      <td>ARA, GULSHAN</td>
      <td>397, 404</td>
    </tr>
    <tr>
      <td>Ara, Riffat</td>
      <td>114</td>
    </tr>
    <tr>
      <td>Araba Osei-Kwasi, Hibbah</td>
      <td>671</td>
    </tr>
    <tr>
      <td>Arafat, Yasir</td>
      <td>702</td>
    </tr>
    <tr>
      <td>Aragão do Nascimento, Valter</td>
      <td>1215</td>
    </tr>
    <tr>
      <td>Aragona, Hilda Susana</td>
      <td>1158</td>
    </tr>
    <tr>
      <td>Arakelian, Meghan</td>
      <td>113</td>
    </tr>
    <tr>
      <td>Aramayo, Hugo</td>
      <td>878</td>
    </tr>
    <tr>
      <td>Arambepola, Carukshi</td>
      <td>967</td>
    </tr>
    <tr>
      <td>Aranceta, Javier</td>
      <td>248, 367, 796, 868</td>
    </tr>
    <tr>
      <td>Aranda, Nuria</td>
      <td>617, 618, 748</td>
    </tr>
    <tr>
      <td>Arango Arias, Luz Stella</td>
      <td>827</td>
    </tr>
    <tr>
      <td>Arango Perez, José Alonso</td>
      <td>77</td>
    </tr>
    <tr>
      <td>Aranguren, Marcela</td>
      <td>1030</td>
    </tr>
    <tr>
      <td>Aranha, Flávia</td>
      <td>1052, 1177</td>
    </tr>
    <tr>
      <td>Arantes Ferreira Peres, Wilza</td>
      <td>932</td>
    </tr>
    <tr>
      <td>Arashova, Bahar</td>
      <td>1180</td>
    </tr>
    <tr>
      <td>Araújo da Silva, Ana Paula</td>
      <td>850</td>
    </tr>
    <tr>
      <td>Araújo da Silva, Sara</td>
      <td>707</td>
    </tr>
    <tr>
      <td>Araujo de Assis Rocha, Amanda</td>
      <td>850</td>
    </tr>
    <tr>
      <td>Araujo do Nascimento, Ivanice</td>
      <td>857</td>
    </tr>
    <tr>
      <td>Araújo Nobre, Aline</td>
      <td>319, 814</td>
    </tr>
    <tr>
      <td>Araujo Pino, Silvia Stella</td>
      <td>793, 991, 1016, 1111, 1307</td>
    </tr>
    <tr>
      <td>Araújo Teixeira, Juliana</td>
      <td>294, 497</td>
    </tr>
    <tr>
      <td>Araújo, Arthenize Riame Praia G. C</td>
      <td>1173, 1293, 1294</td>
    </tr>
    <tr>
      <td>Araujo, Cecilia</td>
      <td>1031</td>
    </tr>
    <tr>
      <td>Araújo, Maria Lúcia Gonsales da Costa</td>
      <td>1036</td>
    </tr>
    <tr>
      <td>Araujo, Mariangela</td>
      <td>723, 1120</td>
    </tr>
    <tr>
      <td>Araujo, Marina C</td>
      <td>845, 1065</td>
    </tr>
    <tr>
      <td>Araújo, Roberta</td>
      <td>573, 574</td>
    </tr>
    <tr>
      <td>Aravena, Javiera</td>
      <td>482</td>
    </tr>
    <tr>
      <td>Araya Arredondo, Victor</td>
      <td>1277</td>
    </tr>
    <tr>
      <td>Araya B, Marcela</td>
      <td>1151</td>
    </tr>
    <tr>
      <td>Arbañil Huamán, Hugo</td>
      <td>775, 879, 1091</td>
    </tr>
    <tr>
      <td>Arboleda, Juan</td>
      <td>689</td>
    </tr>
  </tbody>
</table>

<table>
  <tbody>
    <tr>
      <td>Arboleda, Luz Marina</td>
      <td>689, 780, 807, 1272</td>
    </tr>
    <tr>
      <td>Arcand, JoAnne</td>
      <td>108, 1363</td>
    </tr>
    <tr>
      <td>Arcot, Amrita</td>
      <td>88</td>
    </tr>
    <tr>
      <td>Arellano Gómez, Laura</td>
      <td>880</td>
    </tr>
    <tr>
      <td>Arens-Azevedo, Ulrike</td>
      <td>89</td>
    </tr>
    <tr>
      <td>Arévalos Morel, Sonia Carolina</td>
      <td>518</td>
    </tr>
    <tr>
      <td>Argólo, Dayane</td>
      <td>1054</td>
    </tr>
    <tr>
      <td>Arguello, Brunilde</td>
      <td>799</td>
    </tr>
    <tr>
      <td>Argüello, Rocío</td>
      <td>1011</td>
    </tr>
    <tr>
      <td>Arhire, Lidia luliana</td>
      <td>1151</td>
    </tr>
    <tr>
      <td>Arias Tichij, Valeria</td>
      <td>838</td>
    </tr>
    <tr>
      <td>Arias, Carolina</td>
      <td>1036</td>
    </tr>
    <tr>
      <td>Arias, Katherine</td>
      <td>499, 501, 519, 909</td>
    </tr>
    <tr>
      <td>Arias, María Nidia</td>
      <td>1164</td>
    </tr>
    <tr>
      <td>Arias, Miriam</td>
      <td>586, 847</td>
    </tr>
    <tr>
      <td>Arifeen, Shams El</td>
      <td>289, 563, 564, 605</td>
    </tr>
    <tr>
      <td>Arija, Victoria</td>
      <td>245, 268, 617, 618, 883</td>
    </tr>
    <tr>
      <td>Arimond, Mary</td>
      <td>309, 547, 554, 781</td>
    </tr>
    <tr>
      <td>Aristizabal, Juan</td>
      <td>35, 36, 432</td>
    </tr>
    <tr>
      <td>Ariyo, Oluwaseun</td>
      <td>364, 655, 1242</td>
    </tr>
    <tr>
      <td>Arizona Amador, María Betzabé</td>
      <td>1258</td>
    </tr>
    <tr>
      <td>Arjmandi, Bahram</td>
      <td>1329</td>
    </tr>
    <tr>
      <td>Arlappa, Nimmathota</td>
      <td>356, 366, 700, 761</td>
    </tr>
    <tr>
      <td>Armendariz, Gabriela</td>
      <td>555</td>
    </tr>
    <tr>
      <td>Armeno, Marisa</td>
      <td>1031</td>
    </tr>
    <tr>
      <td>Armstrong, David</td>
      <td>1018</td>
    </tr>
    <tr>
      <td>Arnaiz, Pilar</td>
      <td>454, 760</td>
    </tr>
    <tr>
      <td>Arnold, Benjamin F</td>
      <td>713</td>
    </tr>
    <tr>
      <td>Arnold, Charles D</td>
      <td>542, 547, 584, 713, 982</td>
    </tr>
    <tr>
      <td>Arocha Oriol, Caridad</td>
      <td>500, 542, 1108</td>
    </tr>
    <tr>
      <td>Arós, Fernando</td>
      <td>193, 475</td>
    </tr>
    <tr>
      <td>Arpón, Ana</td>
      <td>450</td>
    </tr>
    <tr>
      <td>Arqueros, Valeria</td>
      <td>1341</td>
    </tr>
    <tr>
      <td>Arrachea, Maria Jose</td>
      <td>1250</td>
    </tr>
    <tr>
      <td>Arredondo Mendoza, Gerardo Ismael</td>
      <td>388</td>
    </tr>
    <tr>
      <td>Arredondo, Francisco X</td>
      <td>1164</td>
    </tr>
    <tr>
      <td>Arriaga, Claudia Lorena</td>
      <td>424, 485, 1167, 1234</td>
    </tr>
    <tr>
      <td>Arriola, Nidia</td>
      <td>1016</td>
    </tr>
    <tr>
      <td>Arroyave Zuleta, Luisa Fernanda</td>
      <td>813</td>
    </tr>
    <tr>
      <td>Arroyo, Gustavo</td>
      <td>582</td>
    </tr>
    <tr>
      <td>Arroyo, Susana</td>
      <td>779</td>
    </tr>
    <tr>
      <td>Arruda Alves, luna</td>
      <td>1274</td>
    </tr>
    <tr>
      <td>Arruda, Soraia</td>
      <td>784, 995</td>
    </tr>
    <tr>
      <td>Arshad, Muhammad Umair</td>
      <td>1098</td>
    </tr>
    <tr>
      <td>Arthur, Eunice</td>
      <td>528</td>
    </tr>
    <tr>
      <td>Arulogun, Oyedunni S</td>
      <td>1252</td>
    </tr>
    <tr>
      <td>Arumapperuma, Prasantha</td>
      <td>557, 565</td>
    </tr>
    <tr>
      <td>Arundhana, Andi Imam</td>
      <td>654</td>
    </tr>
    <tr>
      <td>Aryeetey, Richmond</td>
      <td>119, 196, 265, 530, 666, 774, 866</td>
    </tr>
    <tr>
      <td>As'ad, Suryani</td>
      <td>502</td>
    </tr>
    <tr>
      <td>Asaduroglu, Ana Virginia</td>
      <td>245, 822</td>
    </tr>
    <tr>
      <td>Asamo, Feleke Milikias</td>
      <td>1041</td>
    </tr>
    <tr>
      <td>Asano, Ai</td>
      <td>900</td>
    </tr>
    <tr>
      <td>Asante, Matilda</td>
      <td>500, 655</td>
    </tr>
    <tr>
      <td>Asare, George</td>
      <td>500</td>
    </tr>
    <tr>
      <td>Asare-Marfo, Dorene</td>
      <td>160</td>
    </tr>
    <tr>
      <td>Asayama, Kei</td>
      <td>934</td>
    </tr>
  </tbody>
</table>
<table><tbody><tr><td>Ascurra, Marta</td><td>999</td></tr><tr><td>Asghari, Golaleh</td><td>279, 281, 470, 675, 680</td></tr><tr><td>Ashabaugh Enguidanos, Rosa Ana</td><td>269</td></tr><tr><td>Ashenafi, Nigat</td><td>845</td></tr><tr><td>Ashida, Hitoshi</td><td>1181, 1194</td></tr><tr><td>Ashong, Joseph</td><td>45</td></tr><tr><td>Ashorn, Per</td><td>67, 309, 511, 539</td></tr><tr><td>Ashorn, Ulla</td><td>67</td></tr><tr><td>Ashour, Fayrouz</td><td>88</td></tr><tr><td>Ashouri, Asieh</td><td>953</td></tr><tr><td>Ashraful Alam, Mohammed</td><td>686</td></tr><tr><td>Asif, Chowdhury Abdullah Al</td><td>1265, 1309</td></tr><tr><td>Askari, Sufia Askari</td><td>66</td></tr><tr><td>Asna, Alfi Fairuz</td><td>636</td></tr><tr><td>Asomboya, Mirabel</td><td>537</td></tr><tr><td>Aspres, Norma</td><td>570</td></tr><tr><td>Assabri, Ali Mohamed</td><td>576</td></tr><tr><td>Assefa, Tsehai</td><td>305</td></tr><tr><td>Assey, Vincent</td><td>452</td></tr><tr><td>Assimiti, Daniela</td><td>1077</td></tr><tr><td>Assis, Bruno dos Santos de</td><td>839, 840</td></tr><tr><td>Assis, Gustavo Marchese</td><td>1125</td></tr><tr><td>Assis, Maria Alice Altenburg de</td><td>769, 1264</td></tr><tr><td>Assmann, Karen E</td><td>858</td></tr><tr><td>Assuncao, Maria Cecilia</td><td>508</td></tr><tr><td>Astiazarán-García, Humberto</td><td>697, 949</td></tr><tr><td>Asus, Nazarena</td><td>183</td></tr><tr><td>Atala, Elias</td><td>1231</td></tr><tr><td>Ateia, Simona</td><td>1146</td></tr><tr><td>Atilano-Carsi, Ximena</td><td>145</td></tr><tr><td>Atinmo, Tola</td><td>655, 904, 1233</td></tr><tr><td>Atiya, Naushin</td><td>296, 503</td></tr><tr><td>Atkinson, Fiona</td><td>124</td></tr><tr><td>Atoyebi, John Olayinka</td><td>648</td></tr><tr><td>Attah, Alfred</td><td>904</td></tr><tr><td>Attah, Eno Angela</td><td>710</td></tr><tr><td>Atukorala, Sunethra</td><td>763</td></tr><tr><td>Atuobi-Yeboah, Afua</td><td>774</td></tr><tr><td>Aubel, Judi</td><td>1244</td></tr><tr><td>Augustin, Hanna</td><td>541</td></tr><tr><td>Augustinho Giorgette, Mylena</td><td>1323</td></tr><tr><td>Augusto Cardoso, Marly</td><td>611, 621</td></tr><tr><td>Auler, Flavia</td><td>824, 1021, 1143, 1275</td></tr><tr><td>Auón, Aneth</td><td>809</td></tr><tr><td>Aurino, Elizabetha</td><td>630, 631</td></tr><tr><td>Ausman, Lynne</td><td>767</td></tr><tr><td>Avelar, Carine</td><td>833</td></tr><tr><td>Avelino, Erikarla</td><td>1111, 1112</td></tr><tr><td>Avena, Virginia</td><td>384</td></tr><tr><td>Avenidaño, Ariel</td><td>693</td></tr><tr><td>Avenidaño, Ramon</td><td>1123</td></tr><tr><td>Averbuch, Natalia</td><td>1045</td></tr><tr><td>Avula, Laxmaiah</td><td>356, 700</td></tr><tr><td>Avula, Rasmi</td><td>114</td></tr><tr><td>Awang Mahmud, Bulgiba</td><td>831</td></tr><tr><td>Awojulugbe, Oluseyi</td><td>422</td></tr><tr><td>Awuah, Raphael</td><td>727</td></tr></tbody></table>

<table><tbody><tr><td>Ayala-Sumuano, Jorge Tonatiuh</td><td>288</td></tr><tr><td>Ayana, Girmay</td><td>621, 633</td></tr><tr><td>Ayaz, Aylin</td><td>860, 861, 1281</td></tr><tr><td>Ayoma, Selina</td><td>427, 496</td></tr><tr><td>Ayoob, Keith</td><td>1346</td></tr><tr><td>Azaïs-Braesco, Véronique</td><td>1357</td></tr><tr><td>Azaoui, Fatima Zehra</td><td>712</td></tr><tr><td>Azeredo, Catarina</td><td>890</td></tr><tr><td>Azevedo de Aquino, Luana</td><td>839, 840</td></tr><tr><td>Azevedo dos Santos, Talita</td><td>843, 1214</td></tr><tr><td>Azevedo, Mirela</td><td>899, 949, 1045</td></tr><tr><td>Aziz Adish, Abdul</td><td>625</td></tr><tr><td>Azizi, Fereidoun</td><td>675, 680</td></tr><tr><td>Azuma, Yuki</td><td>431</td></tr><tr><td>Azzaretti, Leticia</td><td>35</td></tr><tr><td>Azzolina, Danila</td><td>696, 930</td></tr><tr><td>B. Naveen kumar</td><td>375, 864</td></tr><tr><td>B, Swetha</td><td>375</td></tr><tr><td>B.M. Mensink, Gert</td><td>930</td></tr><tr><td>Baah, Rose</td><td>1310</td></tr><tr><td>Babatope, Similoluwa</td><td>1242</td></tr><tr><td>Babicz-Zielinska, Ewa</td><td>664</td></tr><tr><td>Babio Sánchez, Nancy Elvira</td><td>441, 475, 476</td></tr><tr><td>Babirekere-Iriso, Esther</td><td>278</td></tr><tr><td>Baca Quiñonez, Jean</td><td>879</td></tr><tr><td>Bacallao, Jorge</td><td>710, 746, 860</td></tr><tr><td>Bachman, Patrice</td><td>352</td></tr><tr><td>Bachmann, Patrick</td><td>938</td></tr><tr><td>Bachunguye, Richard</td><td>1027</td></tr><tr><td>Baczkowicz, Malgorzata</td><td>1255</td></tr><tr><td>Badahi, Ahmed</td><td>468</td></tr><tr><td>Baddou, Issad</td><td>201, 795, 798, 800, 885, 887, 1121</td></tr><tr><td>Badham, Jane</td><td>251</td></tr><tr><td>Badiane, Abdou</td><td>511</td></tr><tr><td>Badillo Camacho, Nayeli</td><td>786</td></tr><tr><td>Baena García, Laura</td><td>292</td></tr><tr><td>Baeta, Danielli</td><td>1036</td></tr><tr><td>Báez, Alicia</td><td>1011, 1016</td></tr><tr><td>Bagatini Saud Ferro, Elen Lúcia</td><td>984, 1067, 1068, 1252, 1259, 1260</td></tr><tr><td>Bahadur Adhikari, Khem</td><td>1359</td></tr><tr><td>Bahena, Liliana</td><td>676, 725, 818, 820</td></tr><tr><td>Bahizire, Esto</td><td>278</td></tr><tr><td>Bai, Yan</td><td>274</td></tr><tr><td>Baião, Mirian</td><td>573, 574</td></tr><tr><td>Bailey, Karl</td><td>209</td></tr><tr><td>Bailey, Lynn</td><td>873, 877</td></tr><tr><td>Bailey, Regan</td><td>109, 110</td></tr><tr><td>Bairros, Fernanda Souza de</td><td>1082</td></tr><tr><td>Bajana Jurado, Gloria Salome</td><td>1076</td></tr><tr><td>Bajerska, Joanna</td><td>994</td></tr><tr><td>Bajit, Habiba</td><td>652, 832, 1053</td></tr><tr><td>Baker, Jean</td><td>234</td></tr><tr><td>Bakker, Stephan J.L</td><td>277, 351, 355, 746, 757, 939, 979, 981, 986, 991</td></tr><tr><td>Bala, Alba</td><td>1301</td></tr><tr><td>Bala, Malgorzata</td><td>1248</td></tr><tr><td>Balakrishna, Nagalla</td><td>356, 366, 683, 700, 761</td></tr><tr><td>Balbino, Karla</td><td>916</td></tr></tbody></table>
<table>
  <tbody>
    <tr>
      <td>Balcerzak, Agnieszka</td>
      <td>468</td>
    </tr>
    <tr>
      <td>Baldan Pineda, Paula Henrique</td>
      <td>884</td>
    </tr>
    <tr>
      <td>Baldeón, Manuel E.</td>
      <td>172</td>
    </tr>
    <tr>
      <td>Baldi, Giulia</td>
      <td>251, 254</td>
    </tr>
    <tr>
      <td>Baldi, Pablo César</td>
      <td>347</td>
    </tr>
    <tr>
      <td>Balieiro, Laura</td>
      <td>357, 596, 1123</td>
    </tr>
    <tr>
      <td>Balladares Saltos, Aida Mercedes</td>
      <td>602, 610</td>
    </tr>
    <tr>
      <td>Ballard, Terri</td>
      <td>779</td>
    </tr>
    <tr>
      <td>Ballinas Aquino, José Manuel Ballinas Aquino</td>
      <td>409</td>
    </tr>
    <tr>
      <td>Ballonga, Carla</td>
      <td>245</td>
    </tr>
    <tr>
      <td>Baltar, Valéria T</td>
      <td>425, 637</td>
    </tr>
    <tr>
      <td>Baltenweck, Isabelle</td>
      <td>413</td>
    </tr>
    <tr>
      <td>Bamia, Christina</td>
      <td>950</td>
    </tr>
    <tr>
      <td>Banda Cambron, Sergio Antonio</td>
      <td>410</td>
    </tr>
    <tr>
      <td>Banda, Mtisunge</td>
      <td>1012</td>
    </tr>
    <tr>
      <td>Bandinelli, Stefania</td>
      <td>126, 263</td>
    </tr>
    <tr>
      <td>Bandoni, Daniel</td>
      <td>315</td>
    </tr>
    <tr>
      <td>Bandurska-Stankiewicz, Elzbieta</td>
      <td>699, 1070</td>
    </tr>
    <tr>
      <td>Bandy, Lauren</td>
      <td>867</td>
    </tr>
    <tr>
      <td>Banerjee, Reshmi</td>
      <td>469</td>
    </tr>
    <tr>
      <td>Bangura, Allieu</td>
      <td>1244</td>
    </tr>
    <tr>
      <td>Bannerman, Boat</td>
      <td>666, 774</td>
    </tr>
    <tr>
      <td>Banski, Jerzy</td>
      <td>1292</td>
    </tr>
    <tr>
      <td>Baptista Menezes, Ana Maria</td>
      <td>276</td>
    </tr>
    <tr>
      <td>Baquerizo Sedano, Luis</td>
      <td>824, 1085</td>
    </tr>
    <tr>
      <td>Baquerizo Sedano, Marilia</td>
      <td>824, 1085</td>
    </tr>
    <tr>
      <td>Baqui, Abdullah H</td>
      <td>69</td>
    </tr>
    <tr>
      <td>Baral, Kedar Prasad</td>
      <td>762, 1312</td>
    </tr>
    <tr>
      <td>Baraldi, Larissa</td>
      <td>882, 1261</td>
    </tr>
    <tr>
      <td>Baraldi, Larissa Galastri</td>
      <td>1261</td>
    </tr>
    <tr>
      <td>Barale, Adrián</td>
      <td>999, 1008, 1084</td>
    </tr>
    <tr>
      <td>Baran, Jesica Dana</td>
      <td>1030</td>
    </tr>
    <tr>
      <td>Barata, Mayra</td>
      <td>733, 1261</td>
    </tr>
    <tr>
      <td>Barba, Armando</td>
      <td>1315</td>
    </tr>
    <tr>
      <td>Barba, Corazon</td>
      <td>602, 766</td>
    </tr>
    <tr>
      <td>Barbiche, Jean-Christophe</td>
      <td>106</td>
    </tr>
    <tr>
      <td>Barbosa Brito, Flávia</td>
      <td>1105</td>
    </tr>
    <tr>
      <td>Barbosa Carvalho, Heráclito</td>
      <td>33, 36</td>
    </tr>
    <tr>
      <td>Barbosa Cunha, Diana</td>
      <td>845, 1069</td>
    </tr>
    <tr>
      <td>Barbosa Merlim Abrantes, Taciane</td>
      <td>1015</td>
    </tr>
    <tr>
      <td>Barbosa, Giovanna</td>
      <td>1111, 1112</td>
    </tr>
    <tr>
      <td>Barbosa, Roseane Moreira Sampaio</td>
      <td>836</td>
    </tr>
    <tr>
      <td>Barchi, Natalia</td>
      <td>1177</td>
    </tr>
    <tr>
      <td>Barchuk, M</td>
      <td>1176</td>
    </tr>
    <tr>
      <td>Barchuk, Magali</td>
      <td>37</td>
    </tr>
    <tr>
      <td>Barclay, Alan</td>
      <td>15</td>
    </tr>
    <tr>
      <td>Bärebring, Linnea</td>
      <td>541</td>
    </tr>
    <tr>
      <td>Bareiro Arce, Alberto</td>
      <td>753, 1011</td>
    </tr>
    <tr>
      <td>Bar-El Dadon, Shimrit</td>
      <td>181</td>
    </tr>
    <tr>
      <td>Barffour, Maxwell A</td>
      <td>584</td>
    </tr>
    <tr>
      <td>Barich, Fatima</td>
      <td>467, 468</td>
    </tr>
    <tr>
      <td>Barja, Salesa</td>
      <td>454, 958, 959</td>
    </tr>
    <tr>
      <td>Barkat, Amina</td>
      <td>467, 468, 652, 743, 744, 800, 832, 839, 1053</td>
    </tr>
    <tr>
      <td>Barker, Margo</td>
      <td>713</td>
    </tr>
    <tr>
      <td>Barker, Mikaela</td>
      <td>278</td>
    </tr>
    <tr>
      <td>Barnard, Jandri</td>
      <td>693</td>
    </tr>
    <tr>
      <td>Barouaca, Hassan</td>
      <td>959, 1269</td>
    </tr>
  </tbody>
</table>

<table>
  <tbody>
    <tr>
      <td>Barquera, Simon ... 14, 212, 334, 657, 676, 801, 810, 818, 820, 1006, 1009</td>
    </tr>
    <tr>
      <td>Barr, Susan I</td>
      <td>369, 1051</td>
    </tr>
    <tr>
      <td>Barragán Wug, Zandy Mariela</td>
      <td>1262</td>
    </tr>
    <tr>
      <td>Barragán-González, Ana María</td>
      <td>665</td>
    </tr>
    <tr>
      <td>Barraj, Leila</td>
      <td>187, 391</td>
    </tr>
    <tr>
      <td>Barraj, Leila M</td>
      <td>187</td>
    </tr>
    <tr>
      <td>Barraza-Villarreal, Albino</td>
      <td>583, 585, 589, 1114</td>
    </tr>
    <tr>
      <td>Barrella, Ana Beatriz</td>
      <td>575, 722</td>
    </tr>
    <tr>
      <td>Barrera, Cythnia</td>
      <td>506</td>
    </tr>
    <tr>
      <td>Barrera-Reyes, Paloma</td>
      <td>388</td>
    </tr>
    <tr>
      <td>Barreto Malta, Maíra</td>
      <td>588, 611, 621, 753, 1261</td>
    </tr>
    <tr>
      <td>Barreto, Anna</td>
      <td>1063</td>
    </tr>
    <tr>
      <td>Barreto, Patricia</td>
      <td>243</td>
    </tr>
    <tr>
      <td>Barretto, Daniela</td>
      <td>1177</td>
    </tr>
    <tr>
      <td>Barría, Maika</td>
      <td>1270, 1315</td>
    </tr>
    <tr>
      <td>Barrionuevo, Omar T</td>
      <td>178, 181</td>
    </tr>
    <tr>
      <td>Barrios, Pamela L</td>
      <td>583, 585, 589, 1114</td>
    </tr>
    <tr>
      <td>Barros Gomes, Caroline</td>
      <td>753</td>
    </tr>
    <tr>
      <td>Barros Pereira Ferreira, Natália</td>
      <td>944, 947, 955, 1026, 1027</td>
    </tr>
    <tr>
      <td>Barros, Aluísio JD</td>
      <td>1261</td>
    </tr>
    <tr>
      <td>Barros, Denise</td>
      <td>573, 574</td>
    </tr>
    <tr>
      <td>Barros, Iracema</td>
      <td>1267</td>
    </tr>
    <tr>
      <td>Barroso, Bárbara Malén</td>
      <td>1290</td>
    </tr>
    <tr>
      <td>Barroso, Helainne Kristina Benedito</td>
      <td>1310</td>
    </tr>
    <tr>
      <td>Barrubés, Laura</td>
      <td>441, 475</td>
    </tr>
    <tr>
      <td>Barsimanto, Graciela Raquel</td>
      <td>878</td>
    </tr>
    <tr>
      <td>Bartolini, Rosario</td>
      <td>731, 842</td>
    </tr>
    <tr>
      <td>Bas, Fernando</td>
      <td>1067</td>
    </tr>
    <tr>
      <td>Basabe Tuero, Beatriz</td>
      <td>1108</td>
    </tr>
    <tr>
      <td>Bascuñan, Karla</td>
      <td>506</td>
    </tr>
    <tr>
      <td>Basendowski, Silke</td>
      <td>368</td>
    </tr>
    <tr>
      <td>Bashaasha, Bernard</td>
      <td>415, 442, 552, 948</td>
    </tr>
    <tr>
      <td>Basile, Lívia</td>
      <td>1223, 1225, 1285</td>
    </tr>
    <tr>
      <td>Bassey, Emma</td>
      <td>956</td>
    </tr>
    <tr>
      <td>Basso, Renata</td>
      <td>1100</td>
    </tr>
    <tr>
      <td>Bassoli, Lucas</td>
      <td>1034</td>
    </tr>
    <tr>
      <td>Bastani, Nasser</td>
      <td>1174</td>
    </tr>
    <tr>
      <td>Bastiani, Maria Inês Dantas</td>
      <td>1133</td>
    </tr>
    <tr>
      <td>Bastos Pimentel, Jessica</td>
      <td>850</td>
    </tr>
    <tr>
      <td>Batal, Malek</td>
      <td>662</td>
    </tr>
    <tr>
      <td>Batis, Carolina</td>
      <td>81, 242, 1006</td>
    </tr>
    <tr>
      <td>Batista da Rocha Romero, Amanda</td>
      <td>993, 1035</td>
    </tr>
    <tr>
      <td>Batista Lima, Luciana</td>
      <td>1296</td>
    </tr>
    <tr>
      <td>Batista, Ângela</td>
      <td>470</td>
    </tr>
    <tr>
      <td>Batista, Carolina de Araujo</td>
      <td>819, 875</td>
    </tr>
    <tr>
      <td>Batista, Mariana</td>
      <td>1303</td>
    </tr>
    <tr>
      <td>Baudry, Julia</td>
      <td>359, 760, 849, 858, 1144</td>
    </tr>
    <tr>
      <td>Bauer, Jean-Martin</td>
      <td>452</td>
    </tr>
    <tr>
      <td>Bauer, Patricia</td>
      <td>303</td>
    </tr>
    <tr>
      <td>Bauermann Gubert, Muriel</td>
      <td>507, 513</td>
    </tr>
    <tr>
      <td>Baxter, Jo-Anna</td>
      <td>386</td>
    </tr>
    <tr>
      <td>Bayo, Abou</td>
      <td>1020</td>
    </tr>
    <tr>
      <td>Bazer, Fuller W</td>
      <td>154</td>
    </tr>
    <tr>
      <td>Beato, Gariel c</td>
      <td>463, 1098</td>
    </tr>
    <tr>
      <td>Beatriz Behling, Estela</td>
      <td>1045</td>
    </tr>
    <tr>
      <td>Beauchamp, Gary</td>
      <td>1361</td>
    </tr>
    <tr>
      <td>Beaumont, Maurice</td>
      <td>526</td>
    </tr>
  </tbody>
</table>