# Dietary patterns identified by latent profile analysis (lpa) among brazilian schoolchildren: using data from the web-caafe surveys

Adriana Lobo, Maria Alice Altenburg de Assis, Danielle Leal, Patricia

Hinning, Emil Kupek, France Bellisle

► To cite this version:

Adriana Lobo, Maria Alice Altenburg de Assis, Danielle Leal, Patricia Hinning, Emil Kupek, et al. Dietary patterns identified by latent profile analysis (lpa) among brazilian schoolchildren: using data from the web-caafe surveys. 21st International Congress of Nutrition, Oct 2017, Buenos Aires, Argentina. KARGER, Annals of Nutrition and Metabolism, 71, pp.1, 2017. hal-02736260

HAL Id: hal-02736260

https://hal.inrae.fr/hal-02736260

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IUNS
21st International Congress of Nutrition

Buenos Aires, Argentina, October 15-20, 2017

**Abstracts**

Guest Editors

Mabel Carrera, University of Buenos Aires, Buenos Aires

Angel Gil, University of Granada, Granada

J. Alfredo Martinez, University of Navarra, Pamplona
S. Karger
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# Committees

## Executive Committee

**Director**

Prof. Ángel Gil

**Chairperson**

Dr. Mabel Alicia B. Carrera

**Co-Chairperson**

Prof. J. Alfredo Martínez

**Secretary**

B.S. Gabriela Saad

**Members**

Prof. Benjamín Caballero

Prof. Carlos A. González Infantino

Prof. Ascensión Marcos

Prof. Reynaldo Martorell

Prof. Lynnette M. Neufeld

Dr. Olga Ramos

Dr. Nora Slobodianik

## Organizing Committee

**Chairperson**

Dr. Mabel Alicia B. Carrera

**Co-Chairpersons**

Dr. Carlos A. González Infantino

Dr. Mónica Katz

**Secretary**

B.S. Gabriela Saad

**Deputy Secretary**

B.S. Valeria Biamonti

**Treasurers**

Dr. Graciela Godoy

Dr. Zulema Stolarza

**Members**

Dr. Jorge Alvariñas

Dr. Guillermo Burlando

Dr. César A. Casávola

Dr. Graciela V. Fuente

Dr. Alicia Beatriz García

Dr. María del Carmen Morasso

Dr. Pedro Tesone

## Ethics Committee

**Members**

Prof. Lynette Neufeld

Dr. Graciela M. Soifer

B.S. Griselda Moreira

Dr. Adriana Ruffa

## Scientific Committee

**Chairpersons**

Dr. Olga Ramos

Dr. Nora Slobodianik

**Members**

Dr. Pablo Arias

Dr. Susana Barbeito

Dr. Ricardo Basile

Dr. Claudio Bernal

Mgter. Sandra Nora Blasi

Dr. Fernando D. Brites

B.S. Sergio Britos

B.S. Silvia Cadelago

B.S. Marisa Canicoba

Dr. Esteban Carmuega

Dr. José Esteban Costa Gil

Dr. Francisco D'Onofrio

Dr. Daniel H. de Girolami

Dr. Pablo Durán

Dr. Mabel Ferraro

B.S. María Florencia Flax Marcó

Dr. Gustavo Frechtel

Dr. Claudio D. González

Dr. Horacio González

Dr. Silvia Gorban de Lapertosa

Dr. Berta Gorelik

B.S. Paula Guastavino

Dr. Susana Gutt

Dr. Mónica Katz

Dr. Gustavo Rubén Kliger

Dr. Irina Kovalskys

B.S. Marcela Leal

Dr. Gabriela Levitus

B.S. Pilar Inés Llanos

B.S. Maria Leticia Mazzei

Dr. Carlos Markmann

Dr. Carmen Mazza

Dr. Ana María Menéndez

Dr. Hugo Montemerlo

Dr. Luis Oscar Olaya

Dr. Anabel N. Pallaro

Dr. Cecilia Pedernera

Dr. Gabriela Perdigón

Dr. Mario Perman

Dr. Patricia Ronayne

Dr. Clara Rubinstein

Dr. Roque Sant Yácumo
Dr. Silvio D. Schraier

Dr. Gabriel J. Sequeira

Dr. Susana Socolovsky

B.S. María Inés Somoza

Marcela Stambullian

Dr. Zulema Stolarza

Dr. Pilar Teresa García

Dr. Julio Szuster

Dr. Claudio Szymula

Dr. Liliana Trifone

Eng. Ricardo Weill

Eng. Mariano Winograd

## International Scientific Committee

### Chairperson

Dr. J. Alfredo Martínez

### Co-Chairperson

Dr. Ascensión Marcos

### Members

Dr. Linda Adair

Dr. Lindsay Allen

Dr. Eduardo Atalah-Samur

Dr. Manuel E. Baldeón

Dr. Rekia Belahsen

Dr. Heiner Boeing

Dr. Josefina Bressan

Dr. Benjamín Caballero

Dr. Philip C. Calder

Dr. Cristina Campoy-Folgoso

Dr. Ruth Charrondiere

Dr. Myung-Sook Choi

Dr. Verónica Cornejo E.

Dr. Camila Corvalan-Aguilar

Dr. Stefaan de Henauw

Dr. Mercedes De Onis

Dr. Nathalie M. Delzenne

Dr. José Eduardo Dutra de Oliveira

Dr. Michael Fenech

Dr. Lynnette R. Ferguson

Dr. Any Ferreira-Heyn de Saguier

Dr. Rafael Figueredo-Grijalba

Dr. María Nieves García-Casal

Dr. Catherine Geissler

Dr. Ángel Gil

Dr. Paulo Giorelli

Dr. Mirjana Gurinovic

Dr. Pedro Hallal

Dr. Teodora Handjieva-Darlenska

Dr. Manuel Hernández-Triana

Dr. Helmut Heseker

Dr. Frank Hu

Dr. Esther Infanger

Dr. Hisanori Kato

Dr. Cecily Kelleher

Dr. Zohar Kerem

Dr. Berthold Koletzko

Dr. Martin Kohlmeier

Dr. Duo Li

Dr. Xu Lin

Dr. Julie Lovegrove

Dr. Ian MacDonald

Dr. Mark L. Wahlqvist

Dr. Francisco José Mardones-Santander

Dr. Reynaldo Martorell

Dr. Purmina Menon

Dr. Teuro Miyazawa

Dr. Marja Mutanen

Dr. Godwin D. Ndossi

Dr. Lynnette M. Neufeld

Dr. Shane Norris

Dr. Veronique Pallet

Dr. Fátima Pérez De Heredia Benedicte

Dr. Vishwesihwaraiah Prakash

Dr. Michael Pratt

Dr. Andrew M. Prentice

Dr. Rita P. Ramán

Dr. Pingfan Rao

Dr. Durval Ribas-Filho

Dr. Juan Ángel Rivera-Dommarco

Dr. Swapan Kumar Roy

Dr. Harshpal Singh Sachdev

Dr. José Luis Santos-Martín

Dr. Malgorzata Schlegel-Zawadzka

Dr. D. Mauro Serafini

Dr. Lluís Serra-Majem

Dr. Olga María Silverio Amancio

Dr. Liseti Solano

Dr. Noel W. Solomons

Dr. Shawn Somerset

Dr. Ricardo Uauy

Dr. Emorn Udomkesmalee

Dr. Roxana Valdes-Ramos

Dr. Helio Vannucchi

Dr. Salimata Wade

Dr. Julia Wärnberg

Dr. Christine Williams

Dr. Xiaoguang Yang

Dr. Nelly Mercedes Zavaleta-Pimentel
Dear Scientific and Academic Colleagues,

The 21st International Congress of Nutrition (ICN) is organized under the auspices of the International Union of Nutritional Sciences (IUNS) to be celebrated in Buenos Aires, October 15th-20th 2017. The IUNS-ICN is a four-yearly meeting that has been held since 1946. The 2017 IUNS-ICN edition has been conjointly organized by the Argentinian Society of Nutrition (Sociedad Argentina de Nutrición, SAN) and the IUNS Council with the integrative collaboration of the Organizing, Scientific and Executive Committees under the motto "From Sciences to Nutrition Security". The aim of this IUNS 21st ICN is to promote the global exchange of knowledge in Nutritional Sciences. The scientific program comprises 6 Plenary Lectures, 40 keynote Lectures, 108 parallel symposia, 22 sponsored symposia, and 18 satellite symposia.

The congress focuses on every aspect of nutrition issues, going through a wide variety of topics, which will be dealt with from different perspectives in order to enrich our attendees' points of view. Let us mention the tracks of the devised program:

1. Advances in Nutrition Research

2. Nutrition Through Life Course

3. Public Health Nutrition and Environment

4. Nutrition and Management of Diseases

5. Nutrients and Nutritional Assessment

6. Functional Foods and Bioactive Compounds

7. Food culture practices and Nutritional Education

8. Agriculture, Food Science, and Safety

The main goal is to offer a high-level scientific meeting focused on addressing the key aspects of nutrition in a multicultural environment, from state-of-the-art reviews to cutting edge nutritional science information. Sessions are planned to deliver latest investigations and outcomes concerning the impact of nutrition on homeostasis and body metabolism, on dietary intake and nutritional status of the population and the individual for precision nutrition as well on the role of dietary prescriptions in disease management and prevention. Translational research orientated to design and implement strategies and approaches to change dietary behaviors and to develop policies, as well as aspects related to public health issues, Nutrition Education and Climate Change, or Food and Agriculture for Health Maintenance, are included in the program. Six plenary sessions framed the program with eminent speakers covering all health aspects in the life cycle with integrative views on food security. The present supplement accounts for 2029 abstracts from 97 countries, and additional 297 abstracts selected for oral communications. Including the summaries of more than 500 selected guest speakers participating in the scientific symposia.

<table><caption>The distribution of abstracts for the different selected tracks appears below:</caption><thead><tr><th>TRACK</th><th>ORAL</th><th>POSTER</th><th>TOTAL</th></tr></thead><tbody><tr><td>Track 1: Advances in Nutrition Research</td><td>33</td><td>110</td><td>143</td></tr><tr><td>Track 2: Nutrition Through Life Course</td><td>39</td><td>276</td><td>315</td></tr><tr><td>Track 3: Public Health Nutrition and Environment</td><td>62</td><td>499</td><td>561</td></tr><tr><td>Track 4: Nutrition and Management of Diseases</td><td>33</td><td>280</td><td>313</td></tr><tr><td>Track 5: Nutrients and Nutritional Assessment</td><td>32</td><td>239</td><td>271</td></tr><tr><td>Track 6: Functional Foods and Bioactive Compounds</td><td>36</td><td>129</td><td>165</td></tr><tr><td>Track 7: Food Culture Practices and Nutritional Education</td><td>33</td><td>111</td><td>144</td></tr><tr><td>Track 8: Agriculture, Food Science and Safety</td><td>29</td><td>88</td><td>117</td></tr><tr><td>TOTAL</td><td>297</td><td>1732</td><td>2029</td></tr></tbody></table>
In these times of worldwide economic burdens and financial crisis, it has been a chal-
lenge to build a solid Nutrition Congress; for that reason, we counted on the advice of
the Ethics Committee in order to avoid potential conflicts of interest. Notwithstanding,
in parallel, it opens the exceptional occasion to link the multidisciplinary spaces of nutri-
tional sciences, chiefly basic and applied research activities relating Nutrition and Food
with Health. Also, food safety, food production, and environmental sustainability are
approached in the program.

The 21st ICN organizers wish to recognize and thank the important involvement of young investigators and nutrition professionals from transition countries. A special fee rate for students and participants from low- and middle-income countries was offered to encourage their participation. Travel grants, registration fee discounts, and accommodation reductions for selected young investigators and other awardees were made possible by the contribution from international agencies and the private sector. In this context, IUNS granted 70 scholarships to its Adhering Bodies' affiliates and early career scientists from universities and research institutes from all over the world. We wish to express our genuine appreciation to all attendants, also to invited speakers and international experts and delegates whose participation and interest will undoubtedly produce a successful IUNS 21st ICN for sharing and exchanging knowledge in nutritional sciences for the benefit of the human being.

Prof. Mabel Carrera

President of the Organizing Committee

Prof. Ángel Gil

Director of the Executive Committee

Prof. J. Alfredo Martínez

President of the International Scientific Committee

DISCLAIMER

All abstracts have been printed as received and formatted for uniformity and the Or-
ganizing and Scientific committees cannot be claimed responsible of the contents and
future applications. All views expressed during the scientific sessions at this Congress
are those of the individual authors and do not necessarily reflect the views of any of the
Committees or any other individual member of these Committees or the views of any of
the official organizing bodies.
**Opening Lecture:**

# FIT FOR THE FUTURE: ALIGNING NUTRITIONAL SCIENCES FOR THE SERVICE OF HUMANITY

Prentice, Andrew M.

PhD, FMedSci, MRC Unit The Gambia & MRC International Nutrition Group. London School of Hygiene & Tropical Medicine. London. United Kingdom.

Nutrients, water and oxygen are the fundamental needs of hu-
man existence. This simple statement emphasises the salience of
nutritional sciences and the contribution that we can make to opti-
mising human health and combatting disease. But our discipline is
beset by challenges that we must address if we are to be fit to serve
the best interests of our fellow beings into the future. I will focus
on five of these challenges working upwards from basic science to
population health. Knowledge gaps: Nutrition text books catalogue
the properties and functions of the essential and non-essential nu-
trients but there are still vast gaps in our knowledge especially in
relation to the complexities of nutrient-nutrient and nutrient-ge-
nome-epigenome interactions. We cannot shy away from these
complexities; we must address them head on and this will require
an infusion of mathematical and modelling sciences. In this regard
the much vaunted 'omics' sciences have failed to make a substantial
impact so far, but their day will come. Nutrition needs an infusion
of bright young computational scientists. Funding gaps: Scientists
complain that there is never enough money to do vital research;
funders complain that there is a paucity of novel ideas and that
we do not deliver effective solutions to their target diseases. The
truth lies somewhere in between. Two challenges stand out. First,
such is the desire of funders to find the magic bullet, that they pre-
maturely invest tens of millions in very large 'definitive' trials that
usually end in failure. Second, that every scientist believes they can
'do' nutrition and hence our funding options are encroached upon
by other disciplines. We must reassert our ownership of nutrition;
but this can only be achieved by delivering excellence. Solution
gaps: We have had our successes. Observations of low folate sta-
tus in the mothers of babies born with Neglected tropical diseases
(NTDs) was confirmed by randomised controlled trials and has
translated into very effective public health interventions. But we
have far more failures in which, seemingly strong diet-disease as-
sociations fail the test of a randomized controlled trial (RCT). We
must develop stronger epidemiological methods that can robust-
ly establish causality before we waste funds on ill-advised trials.
Gaps in trust: Many in our field treat the food industry with a level
of antagonism that blocks constructive dialogue. If global multi-
nationals are part of the problem they must surely be part of the
solution. Gaps in credibility and authority: A substantial segment
of the population ignores nutritional advice because they read

constantly conflicting messages in the print and electronic media; many others follow highly dubious nutritional fads. Re-establishing public trust in evidence-based advice represents one of the key challenges in our field.

**Plenary Lectures:**

ZINC TRANSPORTER FUNCTIONS IN HEALTH
AND DISEASE

Cousins, Robert J.

Boston Family Professor of Nutrition. Director. Center for Nutri-
tional Sciences. University of Florida. USA.

The supply of zinc needed for cellular functions is influenced
by multiple variables. These include dietary composition and ge-
netics. For zinc to carry out its biochemical roles in protein and
nucleic acid structure, catalysis and cell regulation, a high degree
of coordination is essential. That coordination is provided through
the activity of about 24 transporter proteins derived from two
gene families: ZIP and ZnT. Some of these genes are regulated via
signals from the dietary zinc supply. Other transporter genes are
regulated physiologically via hormones and immune mediators.
Convincing evidence is accumulating from genetics that muta-
tions in some human transporter genes lead to disease. In addi-
tion, molecular studies with gene knockout models with rodents
are leading to identification of specific transporter-requiring, zinc
signaling pathways that also can contribute to metabolic disorders
in humans. These conditions include neurodegenerative diseases,
arthritis, cancer, endotoxemia, diabetes and metabolic syndrome.
One hallmark of zinc transporter activity is the cell-specificity of
expression of the Zip and ZnT genes. ZnT2, highly expressed in
secretory cells of the exocrine pancreas and mammary gland and
ZnT8, in pancreatic β cells, are but two examples. Cellular locali-
zation and transporter trafficking to specific sites is a second hall-
mark of zinc transporter activity. This provides the opportunity
for the targeting of zinc ions sites necessary for activation or inhi-
bition of specific pathways. In this presentation, I will give exam-
ples of targeted zinc transporter activity by summarizing research
on ZIP14, a zinc transporter that is regulated by proinflammatory
conditions including IL6. I will describe roles for ZIP14 in diverse
processes including hepatic ER stress, impaired intestinal barrier
function and defense, adipocyte NF-κB activity control, endoso-
mal insulin receptor activity in hepatocytes, bone homeostasis
with aging and prevention of neurodegeneration. Research dis-
cussed was supported by the National Institutes of Health.
## HUMANS VS OBESITY: WHO WILL WIN?

Caballero, Benjamin.

Bloomberg School of Public Health. Johns Hopkins University.
Maryland. USA.

Efforts to stop the global obesity epidemic have been ongoing for at least 3 decades. While there is no single global coordinated program, many programs are based on similar premises, e.g., reducing dietary energy intake with low nutritional value, promoting physical activity, etc. The WHO and other organizations have defined frameworks to assist in the development of obesity prevention programs in different geographic and cultural contexts.

And yet, the rise in obesity prevalence continues almost in all countries. The situation calls for a pause and reflection on a few conceptual issues related to our understanding of the epidemic. First, there are well recognized questions about our key indicators, particularly BMI. This parameter evolved from a screeening tool to a diagnostic/predictive indicator for NCD, diabetes, early mortality, etc. Second, we have never really defined our endpoint. What would constitute a “victory” over the obesity epidemic? To have no more than 5% of the population with a BMI above 25? If so, the gap with the current situation in many countries would be enormous, and that goal is unlikely to be reached in many generations, if ever. Another question is whether the continuing increase in BMI in the world is a combination of an epidemic and a historic secular trend in body size, since human body size has been increasing continuously for at least 300 years. If there is a fraction of the continuing rise in obesity prevalence that is due to a “natural” secular trend, that fraction might be less responsive to prevention programs having BMI as an outcome indicator.

## IUNS LIFETIME AWARD LECTURE: FROM TREATING CHILDHOOD MALNUTRITION TO PUBLIC HEALTH NUTRITION

T. James, W. Philip.

CBE, FRSE, MD, DSc Hon. Prof. Nutrition. London School of Hygiene and Tropical Medicine. London. United Kingdom.

My first understanding of nutritional issues started on landing in the Tropical Metabolism Research Unit in Jamaica as a young doctor with some paediatric experience. The task was to understand and effectively treat children with marasmus and kwashiorkor. Albumin levels were a key marker but we soon found its limited utility because of albumin's unrecognised extra-cellular adaptations. Mortality rates, however, were high with diarrhoea a major problem. So a new biopsy and 5 lumen perfusion techniques for assessing gut morphology, motility, digestive and absorptive capacity were developed. There was a marked inability to digest and therefore absorb disaccharides, especially lactose, and compensatory dietary fluid composition was critical. Whereas the gut digestive capacity recovered we found that insulin secretory capacity seemed permanently impaired. Only recently have we linked this to our more recent findings of excess diabetes on adult weight gain in Asians, Mexicans, Africans e.g.in the Caribbean

and now Middle East nationals. Jamaican children with gastroenteritis also had marked jejunal secretion only overcome by careful repeated small glucose/saline feeding. The NIH Bangladesh cholera group then linked these data with their own research findings and then introduced glucose/saline treatment solutions for childhood diarrhoea and cholera thereby saving annually millions of lives. Shortly thereafter, when assessing schoolchildren's nutritional state in Montserrat, it was shown that stunting rather than crude "weight for age" was the key, dominant issue when assessing global childhood malnutrition.

Returning to the UK I established the criteria for the normal mortality related BMI and for obesity and later for adult underweight or "chronic energy deficiency". Assessing energy balance with new whole body calorimeters, however, led to the re-evaluation for WHO/FAO/UNU of individual, national and global basic food needs with new criteria for FAO analyses based on our predicted basal metabolic rates and physical activity levels (PALs). The emphasis on low BMIs and height transformed policy analyses and showed that dietary surveys supposedly showing very low "adaptive" energy intakes in poor countries were misleading.

This led to new dietary validation analyses with biomarkers and the lithium tracking of dietary salt sources thereby revealing striking differences between dietary salt sources in pre and post industrialised societies, essential for understanding the approach to salt reduction to prevent strokes in lower income countries.

I was privileged to chair many WHO consultations and the SCN's Millennium report where we discovered that stunting also related to the prevalence of low birth weight so maternal nutritional health was crucial and we needed a new life - course approach to nutrition while recognising the potential importance of epigenetic programming of children's future well-being and the trans-generational amplification of nutritional risk. We then showed that lower income countries now have epidemic obesity and probably nutritionally programmed exaggerated diabetes rates. Our International Obesity Task Force focused on poorer societies and income groups for WHO with our new analyses highlighting the need for integrated multi-sector policies. Recently our revised analyses on sugar intakes and dental caries helped WHO to emphasise the importance of very low (max 5%) sugar intakes for overall public health nutritional prevention.

**Keywords:** Childhood Malnutrition Public Health

## BUILDING AND IMPLEMENTING EVIDENCE-BASED NUTRITION POLICY

Rivera Dommarco, Juan Ángel.

Managing Director. National Institute of Public Health. Mexico.

Malnutrition and poor diets are the largest risk factors responsible for the global burden of disease. Therefore, ending all forms of malnutrition by 2030 is an international priority.

Essential to achieving this goal is to design and implement nutrition policy based on the best available scientific evidence. The demand for evidence-based nutrition policy may originate directly from policy makers or through social actors. In both cases, the role of research institutions is to generate relevant evidence for public policy. The design of sound policy to tackle malnutrition
in all its forms requires that research institutions develop strategic research agendas.

The two key objects of analysis for the design of effective policy are the magnitude, distribution and trends of malnutrition in all its forms in the population (nutrition conditions) and the policies and programs available, including the identification of platforms and competences required by human resources, for the provision of products and services (social response).

In addition, systematic literature reviews about the risk factors of malnutrition as well as the efficacy and effectiveness of an array of promising policy actions lead to evidence based policy recommendations. For some topics, international evidence based recommendations developed by expert panels with clear criteria for identifying and classifying the evidence are already available (WHO/PAHO, WCRF, Lancet Series and commissions, etc.). Given the multifactorial nature of malnutrition, the drivers and risk factors operate in several systems (food, health, education, and social) and may be immediate, underlying or basic causes. This multilevel complexity should be considered when developing recommendations.

Evidence-based recommendations should be then adapted to the local conditions in the country, using the locally generated evidence about the nutrition conditions and the known risk factors in the population. This exercise will produce locally adapted evidence based recommendations, which ideally should be tested in small-scale interventions for feasibility and efficacy before implementing at scale. In some instances, when immediate action is required, locally adapted recommendations are implemented without small-scale testing. In those cases policies or large-scale programs should be evaluated, so that the body of evidence about effective policy actions is produced.

The last exercise required is the evaluation to provide feedback to policy makers. This exercise should include assessing the design, implementation, results and effectiveness. Design evaluation is inexpensive and not time demanding, making it a cost-effective tool to avoid implementation of flawed policy or programs. For a policy or program to be effective, correct implementation is critical; thus, implementation evaluation is essential for the success of a well-designed policy and provides timely feedback for improvement. Effectiveness evaluation assess the results of programs and policy on behaviors (i.e. food purchases, healthy eating, physical activity) and nutrition outcomes (i.e. nutritional status). The results of the evaluation often guide decisions about keeping or modifying policies or lead to recommendations for improving their design or implementation. They may also generate new research questions that feed the research-to-policy cycle. Finally, the whole process for the generation and evaluation of policies should include provisions for avoiding conflicts of interests.

**Keywords:** evidence-based nutrition policy

The current food system is not delivering on the healthy diets needed for optimal health and nutrition. The nutrition situation and the rising prevalence of diet-related non-communicable diseases have become a global concern. About 30 years ago, our major preoccupation was with hunger. We have been able to reduce undernourishment by about 45% from over 1 billion in 1990/1992. Despite progress on this front, we still have about 795 million people being hungry in 2014-2016 (FAO, 2016). About two billion people worldwide are micronutrient deficient, with more than half a million women of reproductive age suffering from iron deficiency anaemia. Among children under 5 years, 156 million are stunted, 50 million are wasted. Nearly two billion people are overweight or obese. Obesity is one of the drivers for the increase in non-communicable diseases. Children have not been spared; over 40 million children are overweight or obese. Altogether, malnutrition in all forms is estimated to affect 1 in 3 persons globally. Underlying the current nutrition situation are unhealthy diets. The Global Burden of Disease identified dietary risk factors as contributing the highest to early deaths among adults. Our diets are changing: although more varied, less healthy, comprising over processed foods, high is sugar, fat and salt, and less consumption of fruits, and vegetables. The food systems determine the quantity, quality, diversity and nutritional content of the foods available to consumers. Thus a faulty food system affects the food environment, from which the consumer selects food and ultimately access to healthy diets. The current global attention given to nutrition provides the opportunity to put in place the policies and programs to turn the food systems around for the better. At the 2nd International Conference on Nutrition organized by FAO and WHO in November 2014, countries committed to enhance food systems by developing coherent public policies from productions to consumption and across sectors to promote safe and diversified diets. The 2030 Agenda of the Sustainable Development Goals has Goal 2, with improved nutrition as a key outcome of food security and sustainable agriculture. In April 2016, the UN General Assembly declared the period 2016-2025 the Decade of Action on Nutrition. It is time for all stakeholders and sectors to step up efforts to eliminate malnutrition in all its forms. Improved nutrition starts with healthy diets. Nutrition scientists we have a role to play in the quest for healthy diets. There are gaps around healthy diets for which the world is looking for answers: What are the essential elements of foods that contribute to a healthy diet? Studies are needed that relate the long term impact of diets from different geographic regions of the world to health outcomes. What food systems policies will contribute to healthy diets? What is impact of globalization on healthy diets? The evidence-base for food systems for healthy diets is still murky. The space is large for nutrition scientists to step in.

**Keywords:** Healthy diets, food systems, improved nutrition
Track 1: Advances in Nutrition Research

KL_144/3565

IMMUNONUTRITION AND DETERMINANTS OF
LIFESTYLE

Marcos, Ascensión.

Research Professor at the Spanish National Research Council (CSIC). Spain.

Lifestyle habits have suffered enormous changes in the last 30
years, mainly as a consequence of a stressful life and the abuse
of new technologies and communications. Obviously, these new
behaviours attack all ages, from childhood to adulthood passing
through the risky period of adolescence. As an example, the sed-
entary jobs have been duplicated to the detriment of physically
jobs. A growing proportion of computer-user workers are in pro-
fessional positions, using their computers for more than half their
working day. Irregular working schedules and an elevated number
of long hours spent on computer devices induce stressful effects
on mental performance and also lead to a high risk to suffer from
different diseases, most of them, related to inflammatory process-
es, even musculoskeletal injuries. Overweight and obesity are clear
consequences of a stressful type of life that appear more and more
frequently early in life, developing a high impact on morbidity and
mortality in the mid adulthood, leading to chronic diseases such
as type 2 diabetes, cardiovascular and neurological disorders, a
high incidence of certain tumours, as well as an increased and un-
desirable symptomatology of allergies and more severe infections.
Nowadays, stress is being confirmed to be related to mental disor-
ders that are acquiring high dimensions in the general population,
leading to attention deficit hyperactivity disorder (ADHD), among
others. This disorder involves an inflammation process associated
with immune dysregulation together with a high oxidative stress,
increased toxic metal burden and intestinal dysbiosis. Moreover,
food consumption has also suffered the impact of the globaliza-
tion with a detriment of the intake of healthy diets, such as the
Mediterranean diet. Nowadays, the assessment of the adherence to
the Mediterranean has been used to evaluate the nutritional status
of different groups of population. The study of Immunonutrition
includes the knowledge of the interactions between the immune
system and nutrition status. Therefore, Immunonutrition has a
main role in the evaluation of nutritional situations, including not
only food intake, but also eating behaviours, physical activity and
sedentary habits, sleep profile and stress situations. Thus, the as-
sessment of immunological and metabolism biomarkers acquires

a great interest facing out the big concern about the changes of life-
style in the last three decades in order to detect risks of disease and
to prevent the high incidence of chronic metabolism and inflam-
mation-related illnesses that nowadays is an important burden for
public health policies.

**Keywords:** Lifestyle determinants, Immunonutrition, chronic diseases, management

KL_144/3374

MICROBIOTA AND OBESITY

(1)Martínez, J. Alfredo; (2)Reizu-Boj, José Ignacio; (3)Milagro, Fermin I.

(1)Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra. IdiSNA. Pamplona. Spain. CIBERobn. Madrid. Spain.; (2)Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra. Pamplona. Spain. IdiSNA. Pamplona. Spain.; (3) Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra. Pamplona. Spain. CIBERobn. Madrid. Spain.

Metagenomics concerns the study of a complete genome from
an environmental sample. The conception and application of cul-
ture-independent methods has extended the understanding about
the diversity and features concerning gastrointestinal tract mi-
crobial populations. Two main methods have been implemented
concerning characterization of the microbiome that are not based
on pure culture, such as sequencing technologies to define the
lineages existing in a sample and metagenomics studies based on
the whole metagenome shotgun sequencing. In some cases, the
first approach is also termed as a "metagenomic" study because
they analyse a heterogeneous sample of community DNA. The
involvement of the gut microbiota in the onset and development
of a wide variety of diseases, including obesity, is being nowadays
thoroughly examined. Actually, disruptions on gut microbiota
content and composition may be important causal factors in some
pathological conditions, although mechanisms are so far not well
characterized. Indeed, the ratio between firmicutes and bacterio-
detes, as well as the phyla biodiversity, have been found to be al-
tered in various animal models and in obese subjects as compared
to lean individuals. Therefore, promotion of specific gut bacterial
communities to improve/benefit the expansion of "healthy" bac-
terial groups and reduce detrimental bacteria might be a comple-
mentary therapeutic approach for the management of excessive
body weight and other chronic diseases. In this framework, fiber,
carbohydrates, proteins, polyphenols and other food components
occurring in plant sources, such as flavonoids (i.e. quercetin) and
non-flavonoids (i.e. trans-resveratrol), or from animal sources, may elicit health protective properties. A parallel interplay between some food compounds and the gastrointestinal microbiota arising at intestinal plane has been hypothesized to be responsible, to some extent, for some wellbeing beneficial outcomes. Moreover, polyphenols and other compounds such as betaine might drive to the formation of other metabolites or bacterial-derived co-metabolites with additional biological activities. Therefore, scientific evidences about the impact of pure natural compounds on gut microbiota and, in turn, host metabolism are important in order to further understand the health benefits derived from the intake of diverse food components taking advantage of new technologies, namely next-generation sequencing and untargeted metabolomics. Noteworthy, the consumption of a high-fat/high-sucrose diet impacts on gut microbiota distribution putatively altering the bacterial balance towards an obesity-associated gut microbial profile. The prescription of some dietary patterns, such as a Mediterranean-based food diet, or the administration of bioactive compounds could counteract the accompanying disturbances on the gastrointestinal microbiota by promoting the growth of some beneficial bacteria while reducing some pathogenic and obesity-associated microbes. Finally, metagenomic analyses also may enable to discriminate people in different groups based on the dietary intake or the dietary prescription they might need. In this context, gut microbiota composition might be used as a predictive biomarker of the metabolic response to different dietary interventions, being one of the main pillars in the development of precision nutrition in obesity and associated clinical complications.

Goni L, et al. Future perspectives of personalized weight loss interventions based on nutrigenetic, epigenetic and metagenomic data. J Nutr 2016;146:905-912S.

**Keywords:** Metagenomics, Metabolomics, Polyphenols, Fiber, Prebiotics

KL_144/3222

# HOW TO MAKE THE MOST OF HIGH - DENSITY GENETIC DATA FOR HUMAN NUTRITION RESEARCH

Kohlmeier, Martin.

MD PhD. Nutrigenetics Laboratory. UNC Nutrition Research Center. University of North Carolina Chapel Hill. USA.

The impact of most nutrition exposures depends to some extent on inherited disposition. In many instances the differences in response between genetically distinct individuals are so large that they cannot be ignored. Therefore, common genetic variation always needs due consideration for the design, implementation and evaluation of nutrition endeavors. High-density genetic analyses are rapidly gaining ever wider use, facilitated by the ease, speed and affordability of new generation technologies. This includes the use of common microarrays, analysis of targeted genes as well as whole-genome sequencing. The main challenge in respect to genetic analyses is now shifting from consideration of their inclusion

to bewilderment by the information overload. Practical examples will showcase for the non-specialist nutrition scientist some approaches and strategies to extract novel and useful knowledge from available high-density genetic data.

It is often illuminating to use publicly available genome browsers to investigate the architecture of target loci even before engaging with any study data. Repositories of genome data are continuously expanding and are starting to be more representative for non-Caucasian populations. This makes the use of genetic data more predictable for nutrition scientists around the world. Careful study of relevant regions helps them to plan for likely diversity and ensure adequate group sizes. Every beginner should make it a priority to learn how to handle their favorite genome browser and use it often.

Genome-wide genetic data include a wealth of information describing each sample donor. Verifying gender is best practice to detect erroneous sample assignments. Other generic uses may include the detection of duplicates, controlling for population stratification and taking into account major known genetic determinants. Strand-specific sequences (haplotypes) across gene segments, or even extended regions, and the resulting diplotypes (defined by the two haplotypes present in an individual) can greatly simplify resolving the genetic diversity resulting from dozens of polymorphisms in a typical gene. Individual diplotypes are often common enough to single-locus genotypes. Allele counting algorithms can bring together the impacts of multiple influencers in the many instances where several variants are likely to contribute to the same outcome. Modeling functional differences of multiple constituents in metabolic or regulatory networks can be another effective way to explore complex genetic data.

With some relatively simple tools, often available as open source versions, most nutrition scientists can try their hand on exploratory analyses of their study data. While the collaboration with genetics experts is invaluable, research progress and scientific understanding will be greatly facilitated with more active engagement by non-expert nutrition scientists. Unlike many other advanced science approaches, exploration of high-density genetic information is relatively inexpensive, does not pose the risk of breaking expensive instruments and is easy to get started with using available training data sets.

**Keywords:** Nutrigenetics, nutrient gene interaction, haplotypes, genome browsers, nutritionist training
# Track 2: Nutrition Through Life Course

KL_144/2919

## IMPACT OF EARLY LIFE NUTRITION ON THE GUT MICROBIOME AND HOST - MICROBE INTERACTIONS IN THE HUMAN INFANT

Donovan, Sharon.

Professor, Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61801 USA.

Nutrition in early life is critically important for short and long-term health outcomes. Epidemiological data show that breast-fed infants have lower incidences of infections in early life and gastrointestinal diseases, reduced risk of childhood obesity and improved cognitive development than formula-fed infants. The perinatal period is also the principal time for acquisition of the gut microbiome and the microbiome has been shown to influence the development of same systems that differ between breast and formula-fed infants (e.g. gastrointestinal, metabolic, immune, and cognitive). However, defining how nutrition influences gut development and host-microbe interactions has been limited by ethical constraints surrounding invasive sampling of infants. To overcome this limitation, we have developed a non-invasive method to assess intestinal epithelial gene expression using exfoliated epithelial cells and host-microbe interactions. Using these approaches, identified key gene networks that were differentially expressed in breast- and formula-fed infants. In addition, virulence genes in the infant fecal metagenome were associated with the expression of immunity and defense genes in exfoliated cells, demonstrating for the first time the potential for the microbiota to influence the host transcriptome in the human infant.

**Keywords:** microbiota, breastmilk, formula, immune

KL_144/3464

## HETEROGENEITY IN RESPONSE TO NUTRITION INTERVENTIONS DURING THE FIRST 1000 DAYS: EVIDENCE FROM RANDOMIZED CONTROLLED TRIALS USING LIPID-BASED NUTRIENT SUPPLEMENTS FOR MOTHERS AND INFANTS

Dewey, Kathryn G.

PhD. Professor. Department of Nutrition. University of California Davis. USA.

Meeting the high nutrient needs of pregnant and lactating women and young children in low-income countries is challenging because diets are dominated by staple foods with low nutrient density and bioavailability. Strategies to meet nutrient needs during the first 1000 days include increased intake of nutrient-rich foods,

improved complementary feeding practices, micronutrient supplements, and fortified products designed for these target groups. In the latter category, small-quantity lipid-based nutrient supplements (SQ-LNS, ~20 g/d, ~120 kcal/d) have been developed and evaluated for prevention of malnutrition among infants and young children, and pregnant and lactating women. Several SQ-LNS trials have been conducted. This lecture will summarize results from the International Lipid-based Nutrient Supplements (iLiNS) Project and from the Rang-Din Nutrition Study (RDNS) in Bangladesh. The iLiNS Project included 4 randomized controlled efficacy trials in 3 countries in Africa: Ghana, Malawi and Burkina Faso. Two trials began in pregnancy (the iLiNS-DYAD trials in Ghana and Malawi) and included maternal supplementation (pregnancy and 6 months postpartum) plus infant supplementation from 6 to 18 months of age. Two trials began in infancy, the iLiNS-DOSE trial in Malawi (from 6 to 18 months) and the iLiNS-ZINC trial in Burkina Faso (from 9 to 18 months). Of the 4 iLiNS Project trials, increased linear growth in response to SQ-LNS was seen in Burkina Faso (25% reduction in stunting) and Ghana (40% reduction in stunting), but not in Malawi. The lack of response in Malawi is likely linked to high rates of maternal and child inflammation and infection, and short maternal stature. The RDNS was a cluster-randomized effectiveness trial (n=4011) to compare 4 interventions in rural Bangladesh: a) combined maternal and child SQ-LNS; b) child-only SQ-LNS; c) child-only micronutrient powders (MNP); and d) control. Prenatal SQ-LNS reduced newborn stunting and small head size; the impact was greatest in younger mothers and those with household food insecurity. By 24 months, maternal and child SQ-LNS, but not MNP, improved child linear growth and head size. All three RDNS intervention groups experienced improved child motor and language development. Taken as a whole, the evidence suggests that SQ-LNS supplementation can promote fetal and child growth and development, but there is heterogeneity in these effects both within and across study populations. Heterogeneity may be explained by differences in: a) potential to benefit (baseline nutritional status and dietary adequacy; evidence of developmental delay or inadequate child stimulation), and b) potential to respond (other factors that constrain the ability to improve growth or development). Further research is needed to examine the role of infection and inflammation, the microbiome, environmental contaminants, maternal mental health and caregiver behaviors, and the long-term effects of prenatal nutrition and epigenetic influences on growth and development. Nutrition interventions may have a greater impact if they are delivered as part of a comprehensive strategy that addresses the multiple causes of stunting and poor development, including control of pre- and postnatal infection, care for women and children, and stimulation of early child development.

**Keywords:** Lipid-based nutrient supplements; infants; pregnant women; malnutrition; child growth
The role of agricultural practices in a region, harvesting practices, transport facilities, primary processing, saving carbon foot print back to the soil, value addition at different steps with co- and by-products have all a role to play in making available tons and tons of nutrients to the Folks from the Farm. This has principally to address the chain and correct with appropriate and adaptable Food Science and Technologies to reach the nutrients with a holistic approach of nutrition on a food based approach. This should also be of course, a well proved science based approach delivering large amount of benefits of the food in that region based on culture, traditional wisdom, sustainable agricultural practices, sustained varieties of agri-materials for varying weather and climate changes and with no fatigue to the soil through eco-practices. All this must result in healthy food to the population, of course, with food safety imbibed in it. The growth of a healthy society all around has to be differentiated from the normal nutrition programs which surpasses subsidized food for combating malnutrition, undernutrition of the mother and child and micronutrient deficient families irrespective of the economic strata. We find the NCDs are increasing year on year in spite of many programmes. The role that food with different forms of cooking and combination of foods, the sequence of food that is eaten, the fresh and the stored food, the potential of the parenteral nutrition and the first 1000 days of the child and mother from conception to delivery and after delivery with all the nutritional programmes falling under one umbrella of food and nutrition for Translational Nutrition appears to be very crucial. How will we manage these makes a huge difference in our approach to the problems of its Translational Nutrition and challenges, solutions and sustainable approach that will make the difference using appropriate, relevant and adaptable Food Science and Technology with Engineering inputs for scale up. The Value addition of Nutrition to a Food is more valuable than just value addition. It is this challenge that the Food Scientists, Technologists and Engineers must join hands with Nutritionists together and more forward to address the Nutritional Challenges.

"If Translational Nutrition matters to us on Food based approach, we shall matter more to it through Reach out of Nutrition on a Sustainable Approach through appropriate Food Science and Technology and Engineering!"

## Track 3: Public Health Nutrition and Environment

The nutrition transition, conceptualized as changes in the patterns of eating, drinking and moving and all the underlying technological and environmental causes, is understood at a basic level. The biological mismatches between our biology of taste and movement and our modern food system and movement-related technology have seen rapid gains in knowledge. While rapid shifts in all low and middle income countries (LMICs) physical activity domains are a major causal factor, increased activity is not the major solution. Improving our global diets are challenged by new rapidly changing shifts in the global food system in LMICs in the last several decades. After laying out our food systems earlier history, we examine the recent remarkable rapid changes in LMICs. The challenges posed for nutrition-related noncommunicable disease, including obesity prevention, are great. We have new actors increasingly controlling LMIC food production (agribusinesses, global and local food and beverage producers, food service companies, and food retailers) and subsequently our food purchases. Understanding the history of the food system changes and the way this has been linked with dietary changes and more recent acceleration of these dietary shifts is important. At the same time we are seeing important changes in our body composition which we have yet to fully understand. These body composition changes, of course, relate not only to diet shift but to increasing shifts in physical activity in all domains. Food policy changes are seen as the major option for prevention but they will not be adequate without shifting our culture of eating.

**Keywords:** Nutrition transition, global, food system, obesity prevention, food policy
Mexico has learned a number of lessons that could contribute to other countries' national obesity prevention efforts. In 2002, we documented an alarming rise in diabetes mortality. The finding was received with skepticism at a time when the main perceived health challenge was undernutrition and obesity was only considered a disease of affluence. In November 2016, the government declared a national epidemiological alert due to the diabetes considerable rise. For the past years, we have developed efforts to understand the potential determinants involved in this transition and international collaborations to evaluate policy options. Among these, a soda tax initiative, front-of-pack food labeling and food marketing regulations. The government has adopted some recommendations, but in many cases evidence-based policies have faced intense lobbying and opposition campaigns, mostly led by transnational food and beverage companies [1].

In 2013, a fiscal reform including a soda tax initiative was implemented in response to international reductions in oil prices and increasing inflation rates. Diverse evaluations have demonstrated a decrease in consumption [2] and we have modeled its potential health and economic benefits in the next 10-y [3].

Many developing countries are experiencing transitions with a number of similarities such as increasing participation from transnational companies, increasing availability of ultra-processed foods, lack of adequate regulation of commercial practices, poor nutrition literacy among the population and public health efforts focused mainly in overcoming undernutrition [4]. In this context, five lessons from our experience that should be considered are: a) obesity affects mostly vulnerable groups; however society as a whole pays the costs; b) international collaboration is necessary to modify the obesigenic environment; local efforts to develop evidence and policies have limitations, but there is a supporting international group of academia, civil society and funding agencies with solid expertise, c) obesity prevention requires interdisciplinary teams with experts in the fields of economics, social marketing, good lobbying, etc. Public health alone has a limited chance to achieve the desired outcomes; d) academia needs to develop evidence and provide it when a window of opportunity to support policies rises; and e) preventing and managing conflict of interests could be one of the most important steps to curve the NCDs global epidemic. Unhealthy food and beverage companies' actions that negatively influence and undermine public health efforts must be documented and widely disseminated to make transparency and accountability a social norm.

1. Barquera S, et al. Mexico attempts to tackle obesity: the process, results, push backs and future challenges. *Obesity reviews* :

an official journal of the International Association for the Study of Obesity. 2013;14 Suppl 2:69-78.

2. Colchero MA, et al. Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax. Health Affairs. 2017;36(3):564-71.

3. Sanchez-Romero LM, et al. Projected Impact of Mexico's Sug- ar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascu- lar Disease: A Modeling Study. PLoS Med. 2016;13(11):e1002158.

4. Barquera S, et al. Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double-burden of disease. Current Opinion in Lipidology. 2016:1

**Keywords:** Obesity, Prevention, Policy, Soda Tax, Conflicts of Interest, Nutrition Transition

Health is more dependent on the prevailing food system than acknowledged. This is for several reasons. First, it may or may not be available Second, it may not be safe. Third, it may not be acceptable. Fourth, it may not be affordable. Fifth, food itself is much more complicated than nutrient composition would suggest or aberrant nutrient intake might contribute to pathophysiology (Wahlqvist Food & Function 2016). Sixth, food plays a sociological as well as physiological role. Seventh, it is eaten at the end of an intricate system of production, transport, processing, packaging, storage and marketing any one of which may have health effects downstream. Eighth, it has effects on every body organ and system, not just the cardiovascular, gastrointestinal, musculoskeletal or immune system, for example. Ninth, it alters gene expression (epigenetics), and heretofore we have over-stated what is genetic inheritance and underestimated the intra-and inter-generational effects of food. Tenth, the growing understanding of our microbiomes provides for explanatory models of food-health associations previously arcane. Finally, we are ecological creatures and not separate from our environment whether through biorhythms, sensory inputs, energy regulation, microbiomic pathways, endocrine-phytonutrient linkages, locomotor activity, eco-immunology, and more (Wahlqvist ML, Ann Nutr Metab 2016).

The recognition of these food system inputs into human biology offers potentially greater cost-effectiveness in health care systems. We now know that a greater emphasis on plant-derived foods and food biodiversity reduces the prevailing burden of disease and its costs (Lo et al Amer J Managed Care 2013). In addition, the availability of public open space (POS) and gardens is associated with better mental health, longer lives and less so-called chronic disease (Mitchell and Popham, Lancet 2014). Better health outcomes are possible even in the face of risk factors like cognitive impairment, hypertension and obesity with a biodiverse diet, physical activi-
ty and POS (Wahlqvist APJCN, 2014). A deeper understanding of food and health would be represented by an ecosystem health disorder nomenclature (EHD) (Wahlqvist, APJCN, 2014). It has been suggested that we increasingly suffer what might be termed 'nature deficit disorders'. Given that modest exercise is necessary to access nature, and is associated with healthier and longer lives (Wen CP et al Lancet, 2011), the combination of a biodiverse diet, the social role of food and walking among nature and gardens has the prospects of health and economic advantage.

Yet new health risks and costs loom as ecosystems are lost and food systems compromised. One of the most pressing is that of oceanic contamination with microplastics, much of it derived from food and beverage packaging. They are now found in deep sea and coastal seafood whose health risk and benefit must therefore come under review.

An innovative food and health workforce with systems awareness could take a more socio-ecological approach to mitigate the challenges of climate change. Axiomatic will be that we need to appreciate how little we need and not seek how much we can get, in the interests of our ecological selves and a habitable planet.

**Keywords:** Ecosystem health disorders, nutritional economics

KL_144/3343

## IMPACT EVALUATION READINESS IN POPULATION-BASED NUTRITION PROGRAMS: THE EXAMPLE OF FOOD FORTIFICATION

(1)Neufeld, Lynnette M.; (2)Friesen, Valerie.

(1)Global Alliance for Improved Nutrition; (2)Global Alliance for Improved Nutrition. Geneva. Switzerland.

Food fortification, or the addition of essential vitamins and/or minerals to a food, is a cost-effective intervention designed to increase micronutrient intakes. Recent evidence confirms that food fortification programs in low- and middle-income countries improve a range of micronutrient deficiency-related outcomes in different population groups when there is high quality and consumption of fortified foods. Programs that did not show impact in the expected health outcomes tended to have low intake of the food, poor compliance with fortification and/or poor bioavailability of the selected fortificant.

High coverage is a prerequisite for impact of any intervention or program and many factors including availability, accessibility and acceptability of products/services may affect program coverage. Measuring coverage across the service delivery process and the factors that limit or facilitate it can be used to directly assess the potential of programs for impact and to identify solutions to improving potential. Considering a typical program impact pathway for food fortification, quality, coverage and utilization, are intermediate outcomes that should be assessed as part of on-going monitoring activities during the implementation phase of a program. Only when there is high enough coverage and utilization of adequately fortified foods for impact on nutritional status to be plausible should biochemical or functional outcomes be assessed.

Currently, such information on coverage and utilization is rarely available in nutrition programs due to gaps in program monitoring and/or process evaluation activities yet impact evaluations are still frequently undertaken, often at substantial expense.

Without measuring and understanding patterns of coverage and utilization, impact evaluations may have limited potential to capture the true contribution of food fortification in a population and subpopulation groups that may be at risk of inadequate micronutrient intake, and also to provide potential explanations if impacts are not observed. Impact evaluation readiness of all nutrition programs must be considered from the outset of program design. Program monitoring and evaluation activities should systematically include coverage assessments with clear criteria for minimum coverage levels to guide evaluators on when it is feasible to undertake impact evaluations.

As part of this short conference, we will present data from recent coverage assessments of food fortification programs (including wheat and maize flour, oil among other vehicles) in 10 countries and discuss implications for potential for biological impact across countries and among different sub-groups within countries. We will also use conclusions from this body of work to discuss implications for improving impact evaluation methodologies for population based programs.

**Keywords:** fortification, coverage, evaluation, multi-country, impact

KL_144/3066

## DECLINING CONSUMPTION OF ADDED SUGARS AND SUGAR-SWEETENED BEVERAGES IN AUSTRALIA: A CHALLENGE FOR OBESITY PREVENTION

(1)Brand-Miller, Jennie; (2)Barclay, Alan.

(1)PhD. Nutrition scientist. Charles Perkins Centre. University of Sydney; (2)PhD. Accredited Practising Dietitian, Sydney, Australia.

**Background:** Reducing intake of added sugars and sugar-sweetened beverages (SSB) has been the main focus of efforts to stall obesity. According to a global analysis, Australia and New Zealand experienced the single largest absolute increase in adult obesity since 1980 and the single largest increase in adult female obesity. More than 68% of Australian men and 56% of women are overweight or obese. While obesity has risen steeply, some evidence suggests that added sugars and SSB intake declined in Australia over the same timeframe.

**Objective:** To investigate recent trends in availability of sugars and sweeteners, and changes in dietary intake of total sugars, added sugars and SSB in Australia using multiple, independent data sources.

**Methods:** A comparison of relevant data published by the Food and Agriculture Organization of the United Nations (FAOSTAT), Australian government, academia and industry.

**Results:** FAOSTAT food balance sheets for Australia show per capita availability of added/refined sugars and sweeteners fell 16%
from 152 g/capita/day in 1980 to 127 g/capita/day in 2011 (P for trend = 0.001). In national dietary surveys in 1995 and 2011-12, added sugars intake declined markedly in adult men (from 72 to 59 g/day, -18%) but not women (44 to 42 g/day, NS). As a proportion of total energy, added sugars fell by 10% in adult males but non-significantly in adult females. Between 1995 and 2011-12, the proportion of energy from SSB (including 100% juice) declined by 10% in adult males and 21% in females. More marked changes were observed in children 2-18 y. National grocery sales data indicated that added sugars derived from carbonated soft drinks fell 26% between 1997 and 2011 (from 23 g/capita/day to 17 g/capita/day) with similar trends in non-carbonated beverages.

**Conclusions:** In Australia, 4 independent datasets confirm shorter and longer term declines in the availability and intake of added sugars, including those contributed by SSB. The findings challenge the widespread belief that energy from added sugars and sugars in solution are uniquely linked to prevalence of obesity.

**Funding:** University of Sydney

**Keywords:** Added sugars, sugar-sweetened beverages, food availability, obesity

**Conflict of Interest disclosure:** JBM is President of not-for-profit Glycemic Index Foundation, director of a GI testing service at the University of Sydney, and co-author of books about the GI.

## KL_144/3409

# INVOKING THE BASE OF THE ICEBERG: ORIGINS AND CONSEQUENCES OF ENDEMIC SHORTSTATURE (ERRONEOUSLY TERMED "CHRONIC UNDERNUTRITION")

Solomons, Noel W.

Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala City. Guatemala.

Protein-calorie (-energy) malnutrition (PEM) was once the monarch of human nutrition paradigms. Born in 1933, in observations by Ceciley Williams in West Africa, it came into relief as the focus of public health nutrition in the mid-1940s after the founding of the UN and its agencies: WHO and FAO. Attention would remain on clinical syndromes -kwashiorkor and marasmus- for the next three decades, until height/length came into play. This emerged from a classical article by John Waterlow entitled: "Classification and Definition of Protein-Calorie Malnutrition" (1972). This was linked to a concept that the clinical forms were the tip of an iceberg, with preclinical PEM manifested by altered anthropometry; this in turn related to the supply and consumption of macronutrients in the diet. Waterlow termed the process of height decline as linear "retardation" and the extreme status as "stunting", expressed as height-for-age. These were ascribed to the duration of nutritional deprivation, and "chronic malnutrition" became a synonym.

Militating against pure dietary origins of stunting, up to 40% arises in fetal life, with the most accelerated phase of retardation occurring during exclusive/ predominant breast-feeding. Supple-

mentation of neither protein nor micronutrients (individually or in combination) reverses the condition. Observations by Bogin & Varela-Silva and Penny (and confirmed at CeSSIAM) show that short-stature is driven by deficits in the length of the lower extremities, with the torso-length and head-circumference remaining relatively conserved.

Notably, also in the early 1970s, more nuanced nutritional concepts emerged, as one enunciated by Doris Howes Calloway "people eat foods, not nutrients", and another by Victor Herbert that, beyond the ingestion of nutrients, their absorption, retention and utilization were further determinants of nutritional status. These were brought to this present explanation of stunting's origins. Most likely, all of the amino acids, calcium and phosphorus for hydroxyapatite are available within the body from any diet with human (or bovine) milk. A parsimonious theory for the mechanical origins of retardation and stunting is failure of the utilization of nutrients essential for long-bone elongation due to impairment in the signally in the hormonal cascade regulating the epiphyseal growth-plates. The signallying pathway can be interrupted by inflammatory and stress hormones. The stress-inducing elements common to deprived settings include microbial saturation, ecto- and endoparasite infestation, recurrent infections, mycotoxins, poultry fecal toxins and adverse maternal psychosocial conditions, along with a potential role of malabsorption and systemic inflammation arising from environmental enteric dysfunction (EED), may constitute the constellation of mediators to disrupt long-bone elongation.

The epidemiological variation of stunting across continents, as well as within continents across nations and across areas within nations, suggest the possibility of genetic factors in resistance to or susceptibility for the antitrophic effects of the environmental factors.

So, 45 years after Waterlow's postulation of linear retardation and stunting as part of the preclinical manifestations of the PEM continuum somewhere in the base of the iceberg, their true origins remain submerged in uncertainty. Without a firm dietary explanation, however, "chronic malnutrition" is an unsuitable and outmoded descriptor worthy to be retired.

**Keywords:** height-for-age, stunting, protein-energy malnutrition, stress, bone growth

**Conflict of Interest disclosure:** Travel financed by Nestlé Research Center. Lausanne

## KL_144/2874

# STUNTING: CHALLENGES IN ESTIMATING PREVALENCE AND POTENTIAL SOLUTIONS

Martorell, Reynaldo.

Emory University. USA.

Stunting is a leading indicator used in policy formulation, social sector investment and program evaluation. For example, the World Health Assembly (WHA) established the goal of reducing the prevalence of stunting in 2010 by 40%, or to 100 million
stunted children, by the year 2025. Stunting is declining but too
slowly to meet this goal; by 2025, the decline will have been only
26% relative to 2010 and 171 million children are expected to be
stunted. Measurement error inflates the variance of height for age
Z-scores and overestimate the prevalence of stunting and there is
considerable noise in the country-level data. In addition, program
evaluation is compromised when measurement is poor and may
even make a successful program appear to be a failure. The pur-
pose of this lecture is to discuss options for improving data quality.
There are several diagnostics to identify the quality of measure-
ment. Proper training and supervision are effective in improving
the quality of measurement and several groups are working on
strengthening training manuals. Another potential solution is to
develop new technology to replace anthropometry. One such ex-
ample is being developed by Body Surface Technology (BST) and
Emory University. The system uses three -dimensional imaging (
3DI) taken with off the shelf gadgets (Video game technology –
Kinect- connected to an iPad ) and an app written by engineers
to create a three dimensional articulated model of the child from
which measurements such as length and head circumference can
be taken. The system is light and portable. We are comparing meas-
ures taken with 3DI with those obtained from anthropometry in
500 preschool children in Atlanta, with Gates Foundation funds.
The idea is that if 3DI is as good (similar accuracy and no bias) as
standardized anthropometry and assuming that 3DI requires less
training and time to provide accurate and valid length and other
measures, that it could substitute for anthropometry eventually
in surveys, with improvement in the estimation of stunting. Joel
Cockle is leading the data collection and analysis of the 3DI pro-
ject for his doctoral dissertation at Emory. A next step would be to
try 3DI in a developing country setting.

**Keywords:** Anthropometry, stunting, measurement error, 3-dimensional-imaging

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

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

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

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

**Results:** Results revealed that cultural factors and traditions had great influence on maternal and child feeding practices. Mothers' decisions were also highly influenced by the health workers, community and family members, religious leaders and Traditional birth attendants. This information was used to develop
appropriate and targeted intervention strategies for effective BFCI implementation.

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

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

**Conflict of Interest disclosure:** The authors of this abstract declare that this is an original 3 year intervention research and this presentation is based on findings, there is therefore no conflict of interest.

**Further collaborators:**

Koibatek Sub County Health management Team

# Track 4: Nutrition and Management of Diseases

KL_144/3382

## NEW INSIGHTS INTO OBESITY PREVENTION IN CHILDREN AND ADOLESCENTS

Moreno, Luis A.

GENUD research group. Universidad de Zaragoza. Zaragoza (Spain).

Obesity in children and adolescents has been increasing in the last decades, reaching unacceptable prevalence rates. Public health actions seem to start to be effective in some developing countries. However, more efforts are necessary to achieve the WHO goal of ending with the childhood obesity epidemic. Available evidence concludes the different types on interventions already implemented, have moderate effect in body composition indices, i.e. the body mass index (BMI). Interventions use to be effective in relation with the targeted behaviours, especially fruits intake and sedentary behaviours. Interventions combining different nutrition and physical activity related behaviours are more effective than those targeting isolated behaviours. Ideally, interventions should focus not only in children, but also in the families, the school and the community. The school is an appropriate setting in this population group, as children spend a significant part of their time taking lessons and participating in other school-related activities. Community activities seem to add to what is achieved with the other intervention components.

The main limitation of the studies on childhood obesity prevention is the lack of proper assessment of the process of the intervention and its relationship with the obtained efficacy. Different aspects related with the intervention context should be considered, such as contextual factors that shape theories of how the intervention works, contextual factors that affect implementation, intervention mechanisms and outcomes and causal mechanisms present within the context which act to sustain the status quo, or potentiate effects. The implementation process as how delivery is achieved, training, resources etc. should be considered as well as what is delivered, specifically its fidelity, dose, adaptations and reach. Mechanisms of impact such as participant responses to and interactions with the intervention, mediators and potential unexpected pathways and consequences should be also considered.

Innovative strategies are also promising for future intervention programs. They include social marketing approaches, the use of social networks in order to disseminate health related messages and to take profit of the peers influence, and the use of active games. Future studies should incorporate these promising approaches in order to develop the most effective strategies to tackle the childhood obesity epidemic.

**Keywords:** Obesity, prevention, child, epidemiology
KL_144/3037

# CHALLENGES IN THE CARE OF CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES

Mazza, Carmen.

Hopital JP Garrahan, Unit of Nutrition. Argentina.

The Diabetes Control and Complications Trial (DCCT) showed that improved metabolic control reduces the risk of long term complications in both adult and adolescent patients with type 1 diabetes (T1D).

The Epidemiology of Diabetes Interventions and Complications (EDIC) study further proved that good glycemic control had persistent beneficial effects on long term complications. Based on these results it was recommended to optimize glycemic control as early and close to normal as possible in all patients in order to prevent complications. Despite modern approaches to physiological insulin replacement, insulin analogs and insulin pumps, most children and adolescents fail to achieve optimal metabolic control and do not achieve the recommended Hb A1c target.

There is a need to identify current barriers and opportunities in diabetes care.

TEENs study of young people with diabetes provides a global approach to explore factors related to glycemic control & quality of life of T1D youths by age class (8-12, 13-18, 19-25 y/o) through multifaceted insights (health-care providers, T1D patients, families) 5960 participants from 20 countries of 5 continents and over 200 centers were included. TEENs study also explores the challenges of transition of care from pediatric to adult in the understudied young adult population. Results show that more than 70% of young people with T1D do not achieve glycemic control targets.

Factors associated with A1c target attainment included treatment approaches (frequent Blood Glucose Monitoring (BGM), carb counting, exercise, avoiding ketoacidosis, and glucagon availability) and family factors (avoiding diabetes-specific family conflict)

In agreement with the TEENs, the type 1 Diabetes Exchange register clinic network from the USA which compared adolescents with excellent vs poor control, showed that both groups differed substantially in diabetes management with excellent control group using insulin pumps, performing more blood glucose monitoring, missing fewer boluses and using meal -specific insulin: carbohydrate ratios than those in poor control.

With another perspective, Huidöre study registers 26 centers from Europe, USA, Japan and Australia evaluated between 1998 and 2009 and summarized in the paper Lessons from the Huidöre International Study Group on Childhood, from 2013. It shows the relevance of modality in applying therapeutic strategies and focusing on communication and visits regularity as predictors of Hb A1c levels

While the patients' expectations are a cure, minimally invasive treatments, and not having any limitations, HPC's goals are control to prevent complications for which we indicate intensive treatments, multiple insulin doses, frequent BGM and pumps.

Finding common goals, incorporating motivational techniques with patient-centered treatments, working as a multidisciplinary team to implement interventions that target modifiable factors may help optimize A1c levels; and providing added support and

education to youth with non modifiable factors (at risk demographic and family factors) may help overcome suboptimal control in youth with T1D.

**Keywords:** Key words: Type 1 diabetes, pediatrics, glycemic control, Hb A1c.

**Conflict of Interest disclosure:** Disclosures: Member of steering committee of TEENs Study: Advisor SANOFI; Advisor LILLY

KL_144/2876

# NUTRITION FOR INFLAMMATION: PUT OUT THE FIRE!

Escott-Stump, Sylvia.

RDN. Clinical Assistant Professor. Department of Nutrition Science. East Carolina University. Greenville NC. USA.

Inflammation is a major factor for the progression of diabetes, cardiovascular diseases, eye disorders, arthritis, obesity, autoimmune diseases, and inflammatory bowel disease. Pathological inflammation associated with autoimmune diseases is controlled by networked immune system genes. The nuclear factor kappa-B protein family, as well as signal transducers and activators of transcription 3 (STAT3,) activate over 500 gene products affiliated with inflammation, cell transformation, angiogenesis, and metastasis. Most chemo-preventive blockers act by inhibition of NF-κB and STAT3 pathways. These blockers have numerous side effects whereas plant-derived polyphenols do not. An anti-inflammatory Mediterranean diet supports lifelong health and a reduction in chronic inflammation.

**Keywords:** Inflammation, Plant polyphenols, Mediterranean diet

KL_144/3642

# BIOCHEMICAL PROFILE IN PATIENTS SUFFERING DIFFERENT TYPES OF CANCER AND AIDS

Slobodianik, Nora H.

PhD. University of Buenos Aires, School of Pharmacy & Biochemistry. Dept. Nutrition & Food Science. Argentina.

The aim of this lecture is to show the most important results obtained in our laboratory, related to the nutritional status evaluated through the use of biochemical parameters. Patients suffering from a) head and neck cancer (HNC, n=17), b) colorectal, esophagus or stomach cancer (GG, n=32) and c) HIV+/AIDS (n = 43), were included.

HNC were looked after at the Service of Gastroenterology (Carlos G. Durand Hospital), GG at the Angel Roffo Institute of Oncology and HIV+/AIDS at the Hellios Salud Centre. The study was approved by the University of Buenos Aires Ethics Committee, and all participants agreed to sign the written consent before recruitment.

Blood samples were collected from fasting patients. Specific plasma protein fractions Albumin, Transthyretin (TTR), Transferrin (Tr), C3 and C4 complement fractions (C3c, C4c). Ceru-
loplas⁻min (Cp), Haptoglobin (Hp), Fibrinogen and C-reactive protein (CRP) were measured by single radial immunodiffusion technique on agar gel layers (Binding Site, UK; Diffu-Plate, Bio-científica SA, Argentina).

IL-4 concentration and total antioxidant status (TAS) was determined by Elisa and by Randox Kit (UK), respectively in the HNC group. In addition, the fatty acid profile was analyzed on 58% of these patients.

The results (expressed as X±SD) were compared against reference values performed in a group of healthy subjects.

### HNN group

Data showed lower TTR, C3c, Tr and IL-4 levels together with higher Cp and Hp plasma concentrations than those from the reference values. These results pointed out to a depressed nutritional status and an inflammation process. Moreover, a decreased total antioxidant status and changes in essential fatty acids pattern were observed. These findings showed the importance of an early and periodic nutritional evaluation that could help to perform an adequate nutritional support concomitant to the specific treatment.

### GG group

Statistically significant decreases were shown in Tr, ApoB, C4c and TTR plasma concentrations together with concomitant increased albumin levels when data were compared with reference values. This behaviour suggests nutritional disorders associated with an hemoconcentration status in this group of patients. It is important to highlight that nutritional differences depend on diverse stages of the disease.

### HIV+/AIDS group

HIV+/AIDS patients showed changes in biochemical parameters, particularly an increase in Fibrinogen and ApoB together with a tendency to diminished TTR levels. These data could lead to a compromised nutritional status with an altered lipid profile.

The global analysis of the biochemical profile of individuals suffering from these different pathologies emphasize the importance of including the periodic evaluation of functional biochemical parameters in these patients, since the diagnosis of the pathology. This outcome would allow an early assessment to achieve an appropriate nutritional support, implemented along with the specific therapy, leading to the delay of the progression of the disease, and improving survival and quality of life outlook.

### References

O. Casbarien, P. Cresta, C. Silva, M.S. Feliu, A. Badía, N. López Delgado, A. Navigante and N. Slobodianik. Specific Nutritional Supplement (Supportan®) in the Supportive Care of the Radio-Chemotherapy Treatment of Head and Neck Cancers: Biochemical Parameters. Preliminary Study Endocrine, Metabolic & Immune Disorders - Drug Targets.13 (4), 348-50,2013.

M. Stambullian, M.S. Feliu, L.I. Cassetti and N.H. Slobodianik. Nutritional Status and Lipid Profile in HIV-Infected Adults. Endocrine, Metabolic & Immune Disorders - Drug Targets,15(4):302-7, 2015.

Casbarien, Octavio; Fabios, Elise; Slobodianik, Nora Haydée. Valoración nutricional en pacientes con cáncer de esófago, estómago y colorrectal. Bioquimica y Patología Clínica.Vol.80(3), 37-41, 2016.

**Keywords:** head and neck cancer, gastroenterology cancer, HIV+/AIDS, biochemical plasma profile, specific plasma proteins.

# Track 5: Nutrients and Nutritional Assessment

KL_144/2901

## BENEFICIAL EFFECT OF PROBIOTICS CONSUMPTION ON THE IMMUNE SYSTEM

(1)Perdigón, Gabriela; (2)Maldonado Galdeano, Carolina.

(1)Researcher from CONICET-CERELA and Tucumán University.
Argentina.; (2)Researcher from CONICET-CERELA and Tucumán
University. Argentina.

The gastrointestinal tract is one of the most active microbiologically ecosystems that play a crucial role for the functioning of the Mucosal Immune System (MIS). In this ecosystem, probiotic microorganisms, that enter orally can stimulate the Immune System and induce a network of signals, mediated for the whole bacteria or their cell wall structure (originated by the effect of antimicrobial substances from the Paneth cells): 1) to the intestinal epithelial cells or the immune cells associated, to the lamina propria; 2) the interactions induce the production of different cytokines or chemokine as MCP1 (macrophage chemoattractant) from the IEC, that in turn will send signals to the immune cells, which contribute to the MIS activation. We demonstrate: a) probiotic strains stimulate the mucosal immunity increasing the number of IgA +cells in the intestine, the activity of T cells, and induce immunomodulation by IL-10 release. We determined the importance of the probiotic viability b) that in the interaction with the epithelial cell and macrophages, Tol like receptors (TLRs), mainly TLR2 are involved, and also the mannose receptor, 3) probiotics favor the innate immune response, where macrophages and DCs play an important role, without inducing an inflammatory immune response, they only produce a slight increase in the cellularity of the lamina propria. We demonstrate the effectiveness of probiotics in Salmonella infection by an increase in the microbicidal activity of peritoneal and spleen macrophages. In malnutrition models with an improvement in the histology of intestine and thymus in both: undernutrition and obesity with an improvements in Immune System functionality. We determine in a respiratory allergy model, that a PFM diminished the levels of IgE by induction of Th1 balance, that favor the production of IgG instead of IgE. These biological mechanisms observed mediated by probiotic stimulation, open the door for the study of anti-inflammatory mechanisms. We demonstrated the anti-inflammatory effect of yogurt in IBD model, where we observed a decrease in the inflammatory cytokine IL-17. We conclude that probiotic strains, PFM and yogurt have an important role in the functionality of the MIS and in the immune surveillance, through the mechanisms of immunoregulation

**Keywords:** Probiotics, Functional foods, Intestinal Immune System, Immunomodulation.
It is still a debate whether public health aspects of diet should be addressed preferentially as single dietary component or as dietary pattern. The pattern approach has gained prominence during the past decade and the scientific community can find many scientific publications on this topic. Of particular interest had been statistical approaches that identify dietary patterns in a specific study population from empirical data and relate these patterns to disease risk.

The motivation to investigate dietary patterns instead of single components comes mainly from the observation that many of the components of dietary intake correlate with each other. This observation usually makes it difficult to interpret the health impact of a single component properly in view of the many alternatives. However, it is still not widely discussed how exploratively identified dietary pattern can be interpreted and why they exist in a study population. The interpretation of dietary pattern is getting even more complex when habitual dietary intakes had been used as prime data source. This is the case of nearly all studies conducted so far on dietary pattern.

Information on the course of food intake at the different eating occasions over a day is nowadays widely available due to the increased use of 24-h-recalls. The investigation of food intake at meal occasion is in line with the idea of foods eaten together as well as with the idea that a specific food consumption at a particular time during the day is meeting with a metabolism that is following a circadian rhythm. Thus, the analysis of meals regarding food intake and their patterns could help understanding the formation of food pattern on the habitual level but also understanding their immediate metabolic impact. In this way meal and meal pattern analysis open up a new promising research area.

In our group we recently analyzed with different statistical approaches (PCA and network analysis) how meal pattern relate to habitual pattern. We found that - in the German context - breakfast is the most stable meal but has less impact on the formation of habitual pattern than other meals particular if variation reduction methods are used to identify dietary pattern. Dinner is the meal with the highest impact on the formation of dietary pattern on habitual level. We also found that only part of the pattern identified in habitual data originate from foods eaten together at meals. Currently we are searching on how otherwise foods are combined at habitual level into a food pattern.

A statistically more comprehensive approach to investigate meals with a particular focus on foods being eaten and its health implication is multi-level analysis. This statistical approach is trying to trace the origin of variance at the different levels and also could relate this variance to covariates. The covariates can also include metabolic and health parameters measured at the individual level. First results from this investigation will also been presented in this lecture.

**Keywords:** Meal, meal pattern, dietary pattern, multilevel analysis

Obesity is a chronic intoxication with calories. Eating causes a pleasure sensation that starts with the sense of taste in the gustative receptors of the papillae in the tongue, mouth and pharynx.

There are specific receptors in the papillae for sweet, bitter, umami, salty and rancid.

In the last couple of years another set of receptors for fatty substances was discovered.

Foods with sweets and fatty components are the most stimulating.

This information is transmitted first to the Nucleus of the Tractus Solitarius, from there to the hypothalamus and higher centers in the brain, recently started to be discovered with fMRI research.

Similar receptors are also found in the intestine with sensations transmitted to the Central Nervous System mostly by ascending fibers of the Vagus nerve.

The overall sensation transmitted to the brain is one of gratification and reward.

The neurotransmitters in charge of these pleasurable sensations seem to be mostly dopaminergic, although serotonin, GABA and norepinephrine are also present in some of these pathways.

The hypothesis to be presented is that the pleasure sensation of eating is the main reason that makes obesity so common and resistant to treatments in a world of excessive calories offered by the food industry.

**Keywords:** Obesity, Taste, Gustatory Receptors, Pleasure sensation.
# Track 6: Functional Foods and Bioactive Compounds

KL_144/3384

## MOLECULAR MECHANISMS OF ACTION OF PROBIOTICS

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.

Probiotics are living microorganisms that confer a health benefit on the host when administered in adequate amounts, although dead bacteria and their components can also show probiotic properties. Bifidobacterium and Lactobacillus strains are the most widely used bacteria exhibiting probiotic properties and are included in many functional foods and dietary supplements. Beneficial effects of probiotics in allergy, intestinal-related diseases (IRD), chronic liver disease, urinary tract infections and respiratory infections have been reported, among others.

The current scientific evidence regarding to overweight and obese patients that received some probiotics and synbiotics shows a significant reduction in the abdominal adiposity and BMI; and also, probiotic supplementation produced an improvement in the metabolism of carbohydrates, as well as a reduction in the metabolic stress in patients with type 2 diabetes (T2D) and IRS. Moreover, an improved serum lipid profile was observed in patients with T2D after the consumption of synbiotics. The effects of probiotics in patients with non-alcoholic fatty liver disease (NAFLD) were primarily an improvement in the liver function and metabolic parameters, although there is some controversy on the effects of probiotics on those chronic diseases, which might be related to inappropriate design such as diversity, the use of several strains, and the small number of individuals receiving some interventions. Undeniably, further studies to evaluate the best dose-response effect of probiotics and synbiotics are needed, including following up with patients after the probiotic intervention to evaluate the persistence of their potential beneficial effects in obesity, IRS, T2D, and NAFLD.

Major mechanisms underlying the effects of probiotics include improvement of the gut barrier function, increased competitive adherence to the mucosa and epithelium, gut microbiota modification, and regulation of the gut associated lymphoid immune system. In this regard, probiotics communicate with the host through intestinal cell pattern recognition receptors, such as Toll-like receptors and nucleotide-binding oligomerization domain-containing protein-like receptors, which modulate important key signalling pathways, such as nuclear factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK), to enhance or suppress activation and influence downstream pathways. Some authors have also described the modulation of intestinal gene expression mediated by probiotics. In this regard, our group has recently shown that L. paracasei CNCM I-4034, B. breve CNCM I-4035 and L.

rhamnosus CNCM I-4036 are able to inhibit the expression of both Adamdec1, a gene involved in dendritic cell maturation, and Ednrb, a gene that codifies for endothelin B receptor involved in vasoconstriction/vasodilation and cell proliferation in the intestinal mucosa of the Zucker rats. Beyond understanding the molecular mechanisms of action for probiotics, further studies to evaluate the best dose-response-effect of probiotics, including following up with patients after the probiotic intervention and persistence of beneficial effects, are clearly needed.

**Keywords:** Lacobacilli. Bifidobacteria. Microbiome. Probiotics. Gene expression.

KL_144/3517

## FEEDING THE IMMUNE SYSTEM: THE DANONE INTERNATIONAL PRIZE FOR NUTRITION 2016

Calder, Philip C.

Faculty of Medicine, University of Southampton, Southampton, UK.

A well-functioning immune system is key to providing good defence against pathogenic organisms and to providing tolerance to non-threatening organisms, to food components and to self. The immune system works by providing an exclusion barrier, by identifying and eliminating pathogens and by identifying and tolerating non-threatening sources of antigens, and by maintaining a memory of immunological encounters. A breakdown in host defence increases susceptibility to infection while a breakdown in tolerance results in immune-mediated diseases like food allergy or autoimmunity. The immune system is complex involving many different cell types distributed throughout the body and many different chemical mediators some of which are involved directly in defence while others have a regulatory role. Babies are born with an immature immune system that fully develops in the first few years of life. Maturation factors in breast milk, acquisition of an "appropriate" microbiota, and exposure to environmental antigens for example from microorganisms and from are all important in early life immune maturation. Immune competence can decline with ageing. The sub-optimal immune competence that occurs early and late in life increases susceptibility to infection. Undernutrition decreases immune defences, making an individual more susceptible to infection. However, the immune response to an infection can itself impair nutritional status and alter body composition. Practically all forms of immunity are affected by protein-energy malnutrition, but non-specific defences and cell-mediated immunity are most severely affected. Micronutrient deficiencies impair immune function. The gut-associated lymphoid tissue (GALT) is especially important in health and well-being because of its close proximity to a large and diverse population of organisms in the gastrointestinal tract and its exposure to food constituents. There are strong interactions between the gut microbiota and the host GALT and it is considered that an altered gut microbiota can affect host immune responses. Strategies to modify the gut microbiota include prebiotics and probiotics and through such modifications host immune defence may be improved.

**Keywords:** Nutrition, immunity, life course, microbiota
KL_144/2893

# OLIVE POLYPHENOLS – IMPORTANT MEDIA-
TORS OF HEALTH BENEFITS OF THE MEDITER-
RANEAN DIET ?

Rowland, Ian.

PhD. Department of Food and Nutritional Sciences. University of Reading. UK.

There is extensive evidence that the Mediterranean diet is asso-
ciated with health benefits for cardiovascular disease, cancer and
type-2 diabetes. Extra virgin olive oil is often highlighted as an
important component of the diet's health promoting effects and
recent evidence suggests that the polyphenols present, including
oleuropein and hydroxytyrosol, may be the main factors involved.

We have been studying olive polyphenol extracts derived from olive oil or olive leaves to evaluate their influence on cardiovascu- lar health and on aspects of cancer development. Such polyphenol extracts improved vascular function and certain inflammatory markers in an acute intervention study. In a longer term (6 weeks) double blind, placebo controlled intervention, olive leaf polyphe- nols lowered blood pressure and decreased total and LDL-choles- terol and plasma triglycerides. Using a similar olive leaf extract, others have reported beneficial effects on insulin resistance and plasma glucose profile in oral glucose tolerance tests.

In vitro, olive polyphenols were also shown to inhibit DNA
damage in colon cells and to inhibit tumour cell invasion. In a
SCID Balb/c mouse model of metastasis, olive polyphenols mark-
edly inhibited the rate of growth and metastasis of an invasive co-
lon tumour cell xenograft

**Keywords:** Mediterranean diet, olive oil, olive polyphenols, cardiovascular disease,

**Conflict of Interest disclosure:** Research support: Comvita
New Zealand Ltd

Scientific advisory boards: Herbalife Nutrition Institute, Mc-
Cormick Science Institute, European Natural Soybean Associa-
tion, Alpro Foundation

ILSI Europe working group

chemiluminescence (LC-CL) detection and/or with tandem mass
spectrometry (LC-MS/MS) is employed with using synthetized
authentic standards. Nowadays it becomes possible to determine
total PCOOH, positional isomer, and stereo isomers of PCOOH in
human plasma, red blood cells (RBC), tissue organs and cultured
cells. High PCOOH concentration is confirmed in atheroscle-
rotic plasma with angiographically significant stenosis in which
PCOOH accelerates monocyte adhesion to ICAM-1. In Alzheimer
patients, aged RBC rich in PCOOH is found in peripheral blood,
and such PCOOH-rich RBC lacks CO2/O2 exchange function
that contributes to develop the senile dementia. The data further
indicate that radical and/or enzymatic oxidation, rather than sin-
glet oxygen oxidation, is recognized to cause oxidation of mem-
brane PC in our body. Age-dependent accumulation of PCOOH
is also confirmed in cultured human diploid cells, the microsomal
and plasma membrane of the rat hepatocytes, and the brain and
liver of the rat, and intensely in a mouse model for hepatitis C
virus associated hepatocarcinogenesis. Food nutrients generally
influence these membrane lipid oxidations, and moderate intake
of dietary antioxidants (vitamin E, C, carotenoid, polyphenols and
so on) would be recommendable.

**Keywords:** Lipid peroxidation, Oxidative stress, Aging, Senes-
cence, Alzheimer disease

KL_144/3339

# MEMBRANE LIPID PEROXIDATION IN HUMAN
NUTRITION AND AGING

Miyazawa, Teruo.

PhD., NICHe, Tohoku University, Japan.

Phospholipids are of critical importance in mammalian cell bi-
ology, both through providing a permeability barrier and acting as
substrates for synthesis of lipid mediators. Such membrane phos-
pholipid peroxidation receives attention in connection to evaluate
nutritional states and also to aging. For measuring phosphatidyl-
choline hydroperoxide (PCOOH) as a primary oxidation prod-
uct of membrane lipids, liquid chromatography combined with
# Track 7: Food Culture Practices and Nutritional Education

KL_144/3572

## WEIGHT LOSS USING A HEALTHY DIET AND EXERCISE PROMOTION TO PREVENT CARDIOVASCULAR DISEASE: THE PREDIMED-PLUS TRIAL

Salas-Salvadó, Jordi.

Director Human Nutrition Unit. Department of Biochemistry & Biotechnology. School of Medicine. Rovira i Virgili University. Reus, Spain.

Since there are no clinical trials demonstrating that sustained weight loss over >2 years with diet and changes in lifestyle reduce the risk of cardiovascular disease, we have designed the PREDIMED-PLUS Study, an intervention trial on primary prevention of cardiovascular disease in patients with metabolic syndrome and overweight or obesity.

The PREDIMED-PLUS Study is a parallel group, multi-centre, randomised, primary prevention trial (PREDIMED-PLUS) on men aged 55-75 years and women 60-75 years, with a body mass index ≥27 to <40 kg/m² and meeting at least 3 criteria for the metabolic syndrome. The objective of the present research is to compare the cardiovascular effect of two interventions: a) intensive weight-loss intervention on lifestyle program with hypocaloric Mediterranean diet, physical activity and behavioural therapy, b) non intensive care with recommendations on Mediterranean diet following the usual care of medical physicians. The principal end-points are: 1) a composite of major hard clinical cardiovascular events, and 2) weight loss and weight maintenance at long term. Other secondary end-points include the incidence of several chronic conditions or diseases secondary to obesity and metabolic syndrome.

Recruitment of participants began in September 2013, and finish in November 2016, with 6,874 participants randomized to the trial. The final results will be available from 2020.

We hypothesize that an intensive weight-loss lifestyle intervention, including physical activity, based on the traditional Mediterranean food pattern is a sustainable long-term approach for weight reduction among overweight/obese adults and that the achieved lifestyle changes will exert beneficial effects on cardiovascular disease incidence, according to our experience and to research by other investigators. The rationale for the proposed investigation is that it can provide a new, affordable, and sustainable approach to reduce excess cardiovascular morbidity and mortality among overweight/obese adults, beyond what was already observed in the PREDIMED I trial.

At the IUNS Congress, we will present the results of the PREDIMED-PLUS pilot study in the first 600 participants randomized to the trial.

**Keywords:** Weight loss, diet, exercise, cardiovascular disease.

**Conflict of Interest disclosure:** Jordi Salas-Salvadó reports serving on the board of and receiving grant support through his institution from the International Nut and Dried Fruit Council, and Eroski Foundation. Reports serving in the Executive Committee of the Instituto Danone Spain. Has received research support from the Instituto de Salud Carlos III, Spain; Ministerio de Educación y Ciencia, Spain; Departament de Salut Pública de la Generalitat de Catalunya, Catalonia, Spain; European Commission. Has received research support from California Walnut Commission, Sacramento, CA, USA; Patrimonio Comunal Olivarero, Spain; La Morella Nuts, Spain; and Borges S.A., Spain. Reports receiving consulting fees or travel expenses from Danone; California Walnut Commission, Eroski Foundation, Instituto Danone - Spain, Nuts for Life, Australian Nut Industry Council, Nestlé, Abbott Laboratories, and Font Vella Lanjarón. He is on the Clinical Practice Guidelines Expert Committee of the European Association for the study of Diabetes (EASD), and served in the Scientific Committee of the Spanish Food and Safety Agency, and the Spanish Federation of the Scientific Societies of Food, Nutrition and Dietetics. He is a member of the International Carbohydrate Quality Consortium (ICQC), and Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD.

KL_144/3572

## SUSTAINABLE DIET FOR A SUSTAINABLE WEIGHT

Raben, Anne.

Professor, Dep Nutrition, Exercise and Sports, University of Copenhagen. Denmark.

To achieve and maintain a sustainable body weight is a challenge, especially in the westernized world. Overweight and obesity have reached epidemic levels with ensuing increases in type-2 diabetes and cardiovascular diseases. An abundance of energy-rich, easily available foods and lack of physical activity are major reasons for these effects. A high protein intake has been shown to increase weight loss and improve weight maintenance compared to a low protein intake (1). A high-carbohydrate diet has also been shown to induce weight loss, although not to the same extent (2).

In recent years, increasing attention has been put on the environmental impact of different foods, and when comparing eg CO₂ emission for legumes with meat, the CO₂ equivalent (in kg) is 30 times increased (3). Therefore, a replacement of protein from animal sources such as beef and pork with protein from vegetable sources, such as legumes, would be an environmental-friendly approach. This could also lead to an increased intake of dietary fiber, which in most countries is not yet at the recommended level. We examined if a meal based on vegetable sources (legumes) was comparable to a meal based on natural animal sources (pork and veal) regarding satiety and energy intake. The conclusion was that vegetable-based meals (beans/peas) influenced appetite sensations favorably compared to animal-based meals (pork/veal). Interestingly, a vegetable-based meal with lower protein content
was as satiating and palatable as an animal-based meal with higher protein content (4). A recent meta-analyses including 21 studies also supports that dietary pulses can be a beneficial weight-loss strategy (5).

Potatoes are a predominant staple in most diets of the West-
ern world and the primary non-grain food item produced global-
ly. Potatoes have a high glycemic index, but compared with other
carbohydrate sources, they have a low energy density and conse-
quently a low glycemic load. Furthermore, potatoes provide po-
tassium, vitamin C, phosphorus, magnesium, folate, dietary fiber,
and polyphenols. Evidence from meal test studies has suggested
that intake of boiled potatoes increases satiety compared with in-
take of other preparations of potatoes or carbohydrates such as
rice, bread, and pasta on an energy-equivalent basis. How these
short-term effects translate into long-term effects is, however, not
yet clear. We conducted a systematic review to evaluate the asso-
ciation of intake of potatoes and risk of obesity, T2D, and CVD
in healthy adults. We found only observational studies and the 13
identified studies did not provide any convincing evidence to sug-
gest such associations (6). Still, there is a need for well-designed
long-term, randomized controlled trials in this field.

In conclusion, it is worth considering that an increased pro-
portion of vegetable sources could be a possible way to achieve a
sustainable diet for a sustainable weight.

References:

1. Astrup et al. IJO (20 Jan 2015) doi:10.1038/ijo.2014.216.

2. Skov et al. IJO 1999;23(5):528-36.

3. Carlsson-Kanyama, Gonzalez. AJCN 2009 May;89(5):1704S-9S.

4. Kristensen et al. FNR 2016. http://dx.doi.org/10.3402/fnr.v60.32634

5. Kim et al. AJCN 2016, doi: 10.3945/ajcn.115.124677.

6. Borch et al. AJCN 2016 doi:10.3945/ajcn.116.132332.

**Keywords:** Animal and vegetable protein, potatoes, obesity, type-2 diabetes.

evidence that they also predict and possibly influence outcome
of cancer once diagnosed. Most of the evidence supporting these
conclusions comes from higher income countries, and while is ex-
pected to increase more in low income settings over the coming
decades, little resource is directed to building the infrastructures
necessary to explore the specific aspects of nutrition and cancer
prevention and care in these settings.

National and international agencies for nutrition and for cancer exist to prosecute agendas relating to professional, research, care and policy aspects, but there is little structured coordination between them. Developing structured collaborations between nutrition and cancer activities offers the possibility of improved prevention and care, saving lives and money. Establishment of cancer registries with basic nutritional information, and of a core nutritional status assessment as routine in cancer care, would be simple initial projects.

A new collaboration between IUNS, UICC, IARC and IAEA
will be described as a model for how progress might be made.

**Keywords:** Cancer, capacity building, international collaboration.

KL_144/3390

GASTRONOMY AT THE INTERSECTION OF NU-
TRITION AND EDUCATION

Varela-Moreiras, Gregorio.

Professor of Nutrition & Food Science. Faculty of Pharmacy. CEU San Pablo University, Madrid (Spain). President Spanish Nutrition Foundation (FEN).

In March 2014, the European Parliament approved the Res-
olution on the European gastronomic heritage: cultural and ed-
ucational aspects, that was impulsed by the Spanish Nutrition
Foundation (FEN) cojointly with the Royal Academy of Gastron-
omy mainly based on the following principles: developments in
recent years have highlighted that diet, in its broadest sense, is
extraordinarily important in modern society; it is essential to in-
corporate learning about diet and nutrition, taste workshops and
a knowledge and culture of food and gastronomy into the vari-
ous national education systems; It is also evident that gastrono-
my and cooking have become an increasingly important form of
artistic and cultural expression, that food and good cooking are
one of the fundamental pillars of family and social relationships
and that satisfaction at meal times is of course essential in sensory
and psychical terms, as it is a substantial element of psychological
and emotional balance, education in nutrition and gastronomy,
including respect for nature and the environment, should include
the participation of families, teachers, the educational community,
information channels and all education professionals; and finally,
that it is not only possible but necessary to combine healthy eating
with gastronomy. Therefore, the aim of this lecture is not only to
explain and debate the development, approval of this Resolution
at European level, but also to share and discuss the recent achieve-
ments in this field in Spain to be extrapolated to the rest of Europe
and worldwide.

**Keywords:** Gastronomy; Education in Nutrition; Healthy Gastronomy; Culinary Skills

KL_144/2889

BUILDING CAPABILITY AND CAPACITY IN NU-
TRITION: CANCER AS A MODEL

(1)Wiseman, Martin; (2)Jackson, Alan; (3)Allen, Kate.

(1)FRCP. FRCPATH. FAFN. Medical Doctor. Nutritionist. World Cancer Research Fund International and University of Southampton. UK.; (2)FRCP. FRCPath. FRCPCH. FAfN. Medical Doctor. University of Southampton. UK.; (3)PhD. Science Director. WCRF International. London. UK.

The appropriate detection, diagnosis and management of nu-
tritional problems in public health and clinical care is impeded by
the lack of an adequately resourced workforce who are appropri-
ately trained in nutrition. In addition, necessary infrastructure for
addressing nutritional problems is often lacking. The link between
nutrition and cancer offers an example both of the problems and
of potential solutions.

There is abundant evidence that nutritional factors are central
to the causation and prevention of several cancers, and mounting
# Track 8: Agriculture, Food Science and Safety

KL_144/3391

## NUTRITION-SENSITIVE AGRICULTURE – WHAT DOES IT MEAN AND WHICH IMPACT IT CAN HAVE IN ADDRESSING ACTUAL MALNUTRITION PROBLEMS

Charrondiere, U. Ruth; Rahmanian, Maryam; Unver, Olcay; Hemrich, Guenter; Toppe, Jogeir; Muir, Giulia; Dahdouh, Sergio; Rolle, Rosa; Mottet, Anne; Scherf, Beate.

FAO.

Food production is immensely important but undervalued in the food system approach aiming to improve malnutrition. Nutrients that are not produced through agriculture, cannot be conserved or consumed. They would have to come from fortification or supplementation, or would remain in insufficient amounts leading to micronutrient deficiencies or undernutrition, or if available in excess will lead to overweight/obesity and waste of resources.

Agriculture includes large-scale monoculture with high productivities and market access, and small-scale farming or pastoralism, where most of the biodiversity is conserved but having lower productivity, market access and income. Important challenges are climate change; environmental degradation; loss of biodiversity; lack of agricultural research for non-stables and minor species; water scarcity; and urbanization. Most agriculture is geared more towards quantity, income and industrial requirements than towards nutritional quality or consumers' preferences (including taste and strive towards agro-ecological products). Previously, it was thought that if energy needs are covered the micronutrient needs will be fulfilled; or that economic/agricultural growth will automatically lead to improved nutrition – we know today that these are wrong.

Ways forward to meet nutritional requirements while producing foods sustainably could be to simultaneously increase diversification; higher production/use of species, varieties and breeds rich in micronutrients; use resources efficiently; integrate value chains; and reduce food loss and waste. They all aim to produce more diverse and nutritious foods and sell them at decent prices, hopefully resulting in the consumption of sustainable diets. A multi-sectorial approach is most efficient (following the principle 1+1=3) because change is most likely to be efficient if all elements of the food system are moving into the same direction, i.e. production is linked with consumer and environmental demands, enhanced by appropriate value chains, programmes and policies (e.g. agriculture, trade, health, nutrition, education) and nutrition education. FBDG are central here and can inform consumers and policies.

Examples are integrated systems coupled with improved water management: aquaponics (integrated fish-poultry-vegetables system); rotation or intercropping (e.g. pulses and cereals); valuing

wild foods often coming from the forest; home-based animal husbandry; crop-livestock-fish integration for improved use of manure and crop residues; or promoting insect consumption. Efficiency will be enhanced by producing foods and varieties rich in micronutrients and ensuring high overall productivity and income. Key elements are mainstreaming biodiversity and the use of FAO's new tool Nutrient Productivity Scale combining yield, food composition and human nutrient requirements. These, together with agro-ecological approaches could achieve efficient resource use. An increased production without taking into account value chain and transportation leads to high losses in income, foods and inputs. Therefore improving value chains is essential, e.g. cold chains for fruits, vegetables and animal-based foods. Another possibility is the use of micronutrient-rich fish by-products for human nutrition.

For all these steps, food composition data are needed at food and variety level for raw, cooked and processed foods – but in 99% of cases they are absent. Investments in their generation could be highly beneficial.

Once agriculture is more nutrition-sensitive, many of the global malnutrition problems can be solved.

**Keywords:** nutrition-sensitive agriculture, food system, malnutrition, food composition

KL_144/3307

## WHY EXPERIENCING FOOD INSECURITY HAS BAD CONSEQUENCES FOR CHILDREN AND HOW WE CAN PREVENT THEM

Frongillo, Edward.

Department of Health Promotion, Education, and Behavior, University of South Carolina, United States.

Children experience food insecurity when households are food-insecure. Children's experiences of food insecurity differ from those of adults. Children are cognitively, emotionally, and physically aware of food insecurity, and take responsibility for managing food resources through participation in parental strategies, initiation of their own strategies, and generation of resources to provide food for the family. Even when household food insecurity is mild or moderate, these experiences are associated with many negative consequences for children, including behavior problems, poor health, disrupted social interactions, delayed development, shame, poor school performance and absenteeism, lower physical activity, altered daily activities, and poor or less healthy diets. The paths through which these consequences occur are both nutritional and non-nutritional. Non-nutritional paths may involve psychological and social effects of and responses to the stress that food insecurity places on families. The traditional lens for child food insecurity concentrates attention on food, hunger, and malnutrition, but, to guide effective intervention, we should also attend to other interconnected domains of children's daily lives, including food-related challenges within the psycho-social, family, educational, and community domains in which child development unfolds. Understanding why experiencing food insecurity has bad
consequences for children and knowledge about these mecha-
nisms can guide effective and beneficial actions to prevent them.

**Keywords:** Children, food insecurity, interventions, development, stress.

KL_144/3479

HOW TO MAKE FOOD SYSTEMS MORE NUTRITION-
SENSITIVE

Haddad, Lawrence.

Executive Director. Global Alliance for Improved Nutrition (GAIN). United Kingdom.

Poor quality diets affect more than 1 in 3 people worldwide. Diets are imbalanced in terms of the quantity and sources of calories consumed and in the excess consumption of certain components such as added sugar, salt and some forms of fats. So it is no surprise that diet related factors account for 6 of the top 11 risks behind the global burden of disease. Income growth and urbanization are not going to make it any easier to purchase healthy diets in the future. Increased income allows the increased consumption of foods that are health promoting as well as foods that are not. Urbanisation puts a premium on convenience and this can lead to the excess consumption of highly processed foods. Global and national food systems are part of the problem and part of the solution. What we produce, how we store, process, market and retail food affects its availability, affordability and desirability—and hence its consumption. The quality of consumption of food by key groups – infants and women for example— is well below the minimum standards required. The food system commands large resource flows which can be guided towards advancing nutrition, through a combination of positive and negative incentives, at all stages of the food system. At the moment low and middle income countries are on course to follow the damaging pathway that the high income countries have taken. This presentation stresses that policymakers have choices to make, outlines the options available to them, urges them to take decisive action to make their food systems become more nutrition sensitive, and outlines the consequences of not changing course.

**Keywords:** Diet, food systems.

KL_144/3357

INVESTING IN NUTRITION: WHAT WILL IT BUY?

Shekar, Meera.

PhD. The World Bank. USA.

Ensuring optimum nutrition—particularly during the 1,000-
day period from pregnancy to a child's second birthday—can al-
ter an individual's development trajectory and maximize her or

his productive potential. Chronic malnutrition has important
lifelong consequences for health and cognitive development. Be-
ing stunted (low height-for-age) in early childhood is associated
with a delayed start at school, reduced schooling attainment and
substantially decreased adult incomes at both the individual and
country level. These consequences add up to overall gross domes-
tic product (GDP) losses of 4 to 11 percent in Africa and Asia.
Importantly, chronic undernutrition can be transmitted through
an inter-generational cycle, where malnourished mothers are
more likely to have stunted children. There is a strong body of
evidence that shows high economic returns to investing in nu-
trition. Scaling up these proven nutrition-specific interventions
can ensure that mothers are healthy and well-nourished and that
they can provide optimal nutrition to their children, that children
realize their full physical and cognitive development potential,
and that women's productivity is not hampered by illness, espe-
cially anemia. Furthermore, investments in nutrition are highly
cost-effective and among the best value-for-money development
actions. In 2016, the World Bank, Results for Development In-
stitute, and 1,000 Days, with support from Bill & Melinda Gates
Foundation (BMGF) and the Children's Investment Fund Foun-
dation (CIFF) released innovative, in-depth economic analyses
and developed a global investment framework for achieving four
of the six global nutrition targets (for stunting, wasting, anemia,
and exclusive breastfeeding). To scale up the package of key nutri-
tion-specific interventions to reach the global nutrition targets, an
investment of about $70 billion is needed over the next 10 years,
in addition to what low and middle income countries currently
spend on nutrition. Combined with improvements in underlying
determinants of malnutrition, over the next decade, investing in
these nutrition-specific interventions would reduce the number
of stunted children in low and middle income countries in 2025
by 40%, compared to the 2015 baseline. In addition, the scale up
of this package of interventions would allow to prevent over 3.7
million child deaths and 265 million of cases of anemia in women
of reproductive age. It would also allow to treat 91 million addi-
tional cases of severe acute malnutrition in children and result in
105 million additional babies being exclusively breastfed. Finally,
the investment framework also showed very high returns on every
dollar invested in nutrition: from $4 in returns for treating acute
malnutrition (wasting) to $11 for preventing stunting, $12 for the
treatment and prevention of anemia, and $35 for increasing the
prevalence of exclusive breastfeeding. Not only do investments in
nutrition produce substantial economic benefits, but they also lay
the groundwork for the success of investments in other sectors.

**Keywords:** Nutrition, Stunting, Benefit-cost, Economic benefits, Cost-effective
Track 1: Advances in Nutrition Research

PS_144/26

THE BIOLOGY OF THE FIRST 1,000 DAYS OF LIFE

EPIGENETICS, NUTRITION AND INFANT HEALTH

(1)James, Philip; (2)Silver, Matt; (3)Prentice, Andrew M.

(1)RNutr (Public Health). MRC International Nutrition Group. MRC Unit The Gambia.; (2)PhD. Bioinformatician. MRC International Nutrition Group. MRC Unit The Gambia.; (3)PhD, FMedSci, MRC Unit The Gambia & MRC International Nutrition Group. London School of Hygiene & Tropical Medicine. London. United Kingdom.

The field of epigenetics is currently garnering a great deal of interest, exploring how our very molecular make-up in the form of modifications to the genome can be altered by factors as diverse as ageing, disease, nutrition, stress, alcohol and exposure to pollutants. Epigenetic changes have previously been implicated in the aetiology of a variety of diseases, notably in the development of certain cancers and inherited growth disorder syndromes, but the exploration of its role in fetal programming is still in its infancy. This review focuses on how nutritional exposures during pregnancy may affect the infant epigenome, and the impact that such modifications may have on the long-term health of the child. We start by describing some key concepts in epigenetics and discuss windows of epigenetic plasticity in the context of the Developmental Origins of Health and Disease (DOHaD) hypothesis. We then review some of the key mechanisms by which nutrition can affect the epigenome, with a particular focus on the role of one-carbon metabolism. We finish by outlining some of the child health outcomes that have been linked to epigenetic dysregulation and discuss possible next steps that need to be realised if insights into the basic science of epigenetics are to be translated into tangible public health benefits.

**Keywords:** Epigenetics; maternal nutrition; methyl donors; developmental programming; DNA methylation

**Conflict of Interest disclosure:** The authors declare no conflicts of interest.

BEFORE AND BEYOND THE 1,000 DAYS: A ROLE FOR PRECONCEPTION NUTRITION

(1)De Regil Velez, Luz Maria; (2) Snyder, Taylor; (3) Martinez, Homero;

(4)Wuehler, Sara.

(1)Nutrition International. Canada.; (2)MPH, Director. Maternal & Infant Health Consulting. Salt Lake City, USA; (3)PhD. Senior Advisor Micronutrient Forum. Nutrition International. Canada;

(4)PhD. Senior Technical Advisor. Nutrition Information System. Nutrition International. Canada.

A woman's health, nutritional status, and lifestyle prior to pregnancy, referred to as preconception health, influence pregnancy outcomes for both mother and baby. Preconception interventions should begin early and continue through the reproductive years because many maternal risk factors are rooted in childhood and adolescence.

The supply and availability of nutrients to the developing fetus are based on maternal nutritional status, physiological requirements and her ability to build and maintain nutrient stores. The mother's nutritional status can also influence gene expression (namely, related to reproductive organs, eggs, and sperm) by disrupting highly regulated processes through which specific genes are turned on and off at certain time intervals during fetal development. Energy and both macro and micronutrients, particularly folic acid, iron, iodine, zinc, vitamin A, and vitamin B12; play essential roles in organ growth and development, and are critical to the development of the fetal brain and nervous system.

Nutrition interventions during the preconception period focus largely on micronutrients and include supplementation, dietary modification, fortification of staple foods and condiments, point-of-use fortification, and biofortification. Complementary public health actions include interventions and strategies to reduce the incidence of infectious diseases, reduce alcohol consumption and smoking, delay the age of the first pregnancy, support optimal inter-pregnancy intervals, improve the nutrition and health of male sexual partners, and decrease male partners' unhealthful habits. This presentation focuses predominantly on the role of preconception weight and micronutrient nutrition on pregnancy outcomes, reviewing relevant biological factors, and recommended interventions to address dietary gaps.

**Keywords:** Preconception; Nutrition; Birth weight; Epigenetics
# NUTRITIONAL REGULATION OF THE GROWTH PLATE

Lui, Julian

Staff Scientist, Section on Growth and Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maryland, USA

Abstract Elongation of the long bones is what primarily makes children grow taller, and it is driven by a process called endochondral ossification that takes place at a cartilaginous structure found near the ends of long bones called the growth plate. A thorough understanding of the normal physiology of the growth plate, and how various endocrine, paracrine, and intracellular mechanisms collectively regulate growth plate function is important for deciphering the causes of childhood growth failure and designing new therapeutics.

Malnutrition remains as one of the leading causes of child-
hood growth attenuation globally. Nutritional status serves as
a physiological permissive signal to partially shut off childhood
growth under suboptimal conditions. Interestingly, when nutri-
tional status improves, body growth often occurs at a rate greater
than normal for the chronological age of the malnourished child,
a phenomenon also known as catch-up growth. Catch-up growth
helps bring the child closer to his/her original growth trajectory.
However, in many cases, catch-up growth is incomplete, lead-
ing to a permanent growth deficit. Our recent studies on growth
plate senescence, or how growth plate function declines with age,
have improved our understanding of the mechanism of catch-up
growth, and might provide new insights into developing better
nutritional and therapeutic regimens for more complete catch-up
growth in children with malnutrition and growth disorders.

**Keywords:** Growth plate, cartilage, catch-up growth, malnut-
trition, hormone

PS_144/93

ADDRESSING CHILD MALNUTRITION: NEWER MEASURES TO ADVANCE PREVENTION AND TREATMENT OUTCOMES

PROTEIN QUALITY, AMINO ACIDS AND GROWTH:
HISTORICAL CONTEXT, NEW TECHNIQUES AND
MEASURES

Kurpad, Anura Vishwanath.

MD, PhD. Professor of Physiology and Nutrition. St John's Medical College. Bangalore. India.

The recent re-evaluation of human indispensable amino acid (IAA) requirements by the WHO/FAO/UNU in 2007, showed that the daily requirement of important and potentially limiting IAA such as lysine was higher than earlier thought. This has had an impact on protein quality in terms of the amino acid score, where cerebral proteins, which are the mainstay of the daily protein intake in

many low and middle income countries (LMIC), now would have
a lower quality, due to their lower lysine content. In turn, protein
quality impacts human health, as it is important for linear growth
and the prevention of stunting in children, and possibly also to
mental development. Protein quality is an important factor in
healthy diets. With the use of nationally representative household
protein consumption data in India, the percentage of the popula-
tion at risk of quality protein deficiency was found to vary between
4% and 26% among different age groups and between the urban or
rural sector. Mitigating these risks requires a greater intake of high
quality proteins, such as pulses and milk, and that food subsidy
policies move beyond cereals and become more quality conscious.

The measurement of protein quality is based on an assessment of the indispensable amino acid content in relation to the pattern of their requirement, along with a term for the intestinal digestibility of protein into its constituent amino acids, and their subsequent absorption. This was measured by the oro-fecal balance of the fed protein. However, the digestion and absorption of protein occurs in the small intestine, while colonic (large intestinal) bacteria confound the oro-fecal balance. Therefore, protein digestibility should ideally be measured by measuring the oro-ileal balance of the fed protein. In addition, oro-ileal digestibility varies by IAA and should therefore be defined for each IAA. It has been proposed that protein quality should be measured for each IAA from each digestible IAA content (using specific IAA oro-ileal digestibility) in relation to the requirement pattern, in what is called the Digestible Indispensable Amino Acid Score, or DIAAS.

The measurement of the oro-ileal balance of IAA is difficult in human subjects, and usually impossible without intubation or intestinal fistulation. However, it can be performed in a relatively non-invasive manner, by a dual tracer technique, in which an intrinsically isotope-labelled test protein is simultaneously fed with a different isotope-labelled ‘reference’ protein, whose digestibility is known. This relatively non-invasive method offers a way to measure digestibility in vulnerable groups, and will be more relevant in settings where environmental enteric dysfunction (EED) already affects nutrient absorption. Current research into measuring plant protein digestibility in children in relation to EED and growth, is ongoing.

**Keywords:** Protein quality, digestibility, growth, IAA

**Further collaborators:** Farook Jahoor, Dept of Paediatrics, Baylor College of Medicine, Houston, USA

PS_144/1004

GUT MICROBIOTA TARGETS IN NUTRITION

FUNCTIONS AND DYSFUNCTION OF THE GUT MICROBIOTA

Doré, Joël.

Research Director. French Research Institute in Agricultural Sciences INRA (France). Gut Microbiota for Health.

The human intestinal tract harbours a complex microbial eco-
system which plays a key role in nutrition and health. Interactions
between food constituents, microbes and the host organism derive
from a long co-evolution that resulted in a mutualistic association.

Recognized functions of the dominant gut microbiota relate to a
contribution to nutrition via provision of key vitamins such as B12
and K and short chain fatty acids as well as a major implication in
the breakdown of fibers and the bioconversion of plant-born pheno-
lics. It also contributes to trophic functions of the gut, modulation
tissue renewal and mucus production in quantity and composition.
Finally, it regulates the vigilance of the immune system.

Current investigations into the human faecal metagenome are
delivering an extensive gene repertoire representative of func-
tional potentials of the human intestinal microbiota. The most
redundant genomic traits of the human intestinal microbiota are
identified and thereby its functional contribution. These obser-
vations show a unique segregation of the human population into
individuals with low versus high gene-counts or microbiota rich-
ness. It significantly expands our ability to look for dysfunctions
and specificities of the microbiota associated with human diseases
and to ultimately validate microbial signatures of prognostic and
diagnostic value in immune mediated diseases.

As an example, the microbiota is a key player in the development
of obesity, the overall phenotypic characteristics are worse in indi-
viduals with low gene counts (LGC) microbiota, which represent
25% of overweight to moderately obese subjects and up to 75% of
extreme obese (candidates for bypass surgery). LGC patients present
a low grade inflammatory context also associated with insulin-re-
sistance, and the worst response to a dietary intervention in terms
of weight loss or improvement of biological and inflammatory char-
acteristics. Conversely, a calorie restricted diet, with low fat, high
protein and especially high-diverse fiber content, was able to correct
the low gene count microbiota, raising by more than 25% the gene
count during a 6 weeks intervention. Gastric bypass surgery rapidly
corrects average gene richness and restores higher proportions of
symbionts that appear deprived in extreme obesity. The effects seem
durable over a 12 months follow up.

The human intestinal microbiota should hence be regarded
as a true organ, amenable to rationally designed modulation for
human health. Dysbiosis and dysfunctions appear in essence as
alterations of man-microbes symbiosis which trigger interest in
the application of functional metagenomics to better understand
the crosstalk between intestinal symbionts and food constituents
on the one hand, and human cells and tissues on the other hand.

**Keywords:** Microbiota; functions; metagenome; obesity; dysbiosis

**Conflict of Interest disclosure:** Worked on the topic with Danone, Cargill, Novo Nordisk, Enterome BioScience, MaaT Pharma

DYSBIOSIS IN FUNCTIONAL BOWEL DISORDERS

Enck, Paul.

Dept. of Internal Medicine VI. University Hospital Tuebingen. Gut
Microbiota for Health. Gut Microbiota & Health section.

Functional bowel disorders (FBD) resemble a group of diseases
of the gastrointestinal tract (esophagus to anus - swallowing prob-
lems to defecation disorders) that are without a clear pathogenesis,
that are quite frequent, and bothersome for the individual; best
know is probably the “irritable bowel syndrome” (IBS). Because
many FBD symptoms are associated with eating and elimination,
is has very early been assumed that food eaten on the one hand,
and bacteria involved in its processing may play a key role in FBD
origin and/or its clinical picture. But only recently we have been
able to explore the role of the gut microbiota in FGD, due to pro-
gress in microbiological analytic techniques.

The term “dysbiosis” implies that the microbiota - the com-
munity of microorganisms living in an environment, e.g. in the
human gastrointestinal tract - is unbalanced, that the composition
of the different bacterial genera living there regularly (called: com-
mensal bacteria, to distinguish them from pathogen bacteria) is
disturbed, that some or many bacteria are missing and others may
become more prevalent or dominant. While we have learned of
many new bacterial species and their role in health and disease,
unfortunately the proper “balance” of the several hundred differ-
ent bacterial species (and the total of trillions of bacteria) is un-
known, as is the role of single bacterial species and their metabolic
functions for a healthy gut.

There are different ways to explore the role of the gut micro-
biota and its balance or unbalance (dysbiosis) is FGD. For one,
we can compare the microbial composition in a group of patients
with FGD, e.g. with IBS to a group of healthy volunteers, but in
such a study extreme care has to be taken that the “controls” are
not only of similar age and gender, but also of the same cultur-
al background and nutritional habit, since these factors affect the
microbial composition and diversity. Studies have shown that the
microbiota in FGD is different from that of healthy controls, but
the recorded differences are not necessarily specific for FGD, they
may also occur in other diseases.

Another approach to explore the role of the gut microbio-
ta in FGD is to challenge the existing “flora” with novel bacteria
(probiotics) or with nutritional substrates that stimulate bacterial
growth (called prebiotics), especially in randomized clinical trials
(RCT) where only a fraction of patients receive the true challenger,
while the other receive a placebo. This has been done excessively in
FGD, especially in IBS, with more than 60 trials including several
thousand patients. These studies have produced mixed outcome:
some probiotics appear to be better than others, and some appear
to work only for a part of the IBS symptoms and not for all. An ex-
treme of this approach is the transfer of an entire microbiota from
one healthy person to another, called fecal microbiota transplanta-
tion (FMt). This has rarely been tested in FGD, but is not without
risk in benign disorders.

More experimentally designed approaches will be presented,
but are currently not yet approved for clinical purposes.

**Keywords:** Dysbiosis; functional bowel disorders; IBS
**Conflict of Interest disclosure:** PE has received research grants from SymbioPharm, has served as advisor for Almirall, SymbioPharm, Allergan, GA, TEVA, AstraZeneca, Heel, Boehringer, Biocodex, UCB, Ferring, and has received speaker fees from Almirall, Chiesi, Bayer/Steigerwald, Boehringer, Heel during the last 3 years (2014 to 2017)

## THE GUT MICROBIOTA IN OBESITY, METABOLIC SYNDROME AND T2D

Hansen, Torben.

Professor of Genetics of Human Metabolism. The Novo Nordisk Foundation Center for Basic Metabolic Research. Faculty of Health and Medical Sciences. University of Copenhagen.

We are not alone. Recent findings have demonstrated that the gut microbiome complements our human genome with at least 100-fold more genes. In contrast to our Homo sapiens-derived genes, the microbiome is much more plastic, and its composition changes with age and diet, among other factors. An altered gut microbiota has been associated with several diseases, including obesity and diabetes, but the mechanisms involved remain elusive. In order to understand the impact of gut microbes on human health and well-being we have described the Illumina-based metagenomic sequencing assembly and characterisation of 3.3 million non-redundant microbial genes from faecal samples of 124 European individuals. Nearly 10 million genes are now described in a recent updated gene catalogue. The extensive gene catalogue has enabled us to perform studies of association of the microbial genes with human metabolic phenotypes.

Several studies have suggested that altered gut microbiota composition and function are associated with overt type 2 diabetes, obesity and atherosclerosis. However, in a recent study we questioned previously reported associations between gut microbiota and type 2 diabetes by demonstrating that metformin, the first-line of choice for treatment of hyperglycaemia in type 2 diabetes, confounds this relationship. Accordingly, although gut microbial signatures can be used with high accuracy to distinguish metformin-treated patients with type 2 diabetes from healthy controls, this is not the case when attempted in metformin-naïve patients indicating that drug treatment is an important factor to take into account when evaluating associations of microbiome composition to disease. New data in treatment naïve individuals indicate that gut microbial signatures are altered in individuals with impaired glucose regulation and that low bacterial diversity is associated with elevated levels of biomarkers of poor metabolic health, including markers of glucose regulation, insulin resistance, inflammation, obesity, and dyslipidaemia.

**Keywords:** Gut microbiota; obesity; metabolic syndrome, T2D

## MODULATION OF THE GUT MICROBIOTA, CURRENT APPROACHES AND PATHOPHYSIOLOGICAL SIGNIFICANCE

Verdú, Elena.

Associate Professor at the Division of Gastroenterology Dep. of Medicine at McMaster University. Gut Microbiota for Health.

The gastrointestinal tract represents an enormous interface with the environment. It has its own unique immune system that accounts for over one third of the body's immunological cells. The number of autochthonous bacteria (1014) living on mucosal surfaces exceeds the number of cells forming the human body. Indeed, the size of the genome of the intestinal microbiota exceeds the human genome by 2-3 orders of magnitude. It is evident from studies on germ-free animals that the human genome is insufficient to maintain efficient bodily function. For example, germ-free mice have a rudimentary mucosal immune system because of the absence of stimulation by enteric bacteria. Germ-free mice also consume 30% more calories than conventionalized mice, as they are inefficient in harnessing all energy sources in the diet. It is also evident that the behavior of germ-free mice differs from that of conventionalized mice, and becomes normalized following bacterial colonization. Thus, there is an axis of communication between dietary constituents, commensal bacteria, mucosal immune activity, gut physiology and brain function. In this context, it is easy to envisage how altered interactions between diet and bacteria could produce dysregulated inflammation and disease. There is general consensus that genetic susceptibility is insufficient to cause chronic inflammatory disorders such as IBD, and that environmental factors, such as alterations in composition or metabolic function of the colonic microbiota, play a role in driving and maintaining inflammation. Even in celiac disease, a condition with a clear dietary trigger, gluten, and a known HLA association, alterations of the small intestinal microbiome have been recently implicated as modulators of disease risk. A microbiota associated with disease has been referred to as "dysbiotic". However, a specific disease-microbiota signature has been difficult to define and, how specific dysbiosis contributes to inflammation is unknown. Despite this, therapies targeted at modulating the microbiota with the objective to prevent or treat gastrointestinal inflammation have emerged. These include probiotic supplementation, fecal matter transplantation or modification of specific dietary-microbiota interactions. The potential and limitations, as well as gaps in knowledge, regarding these approaches will be discussed.

**Keywords:** Intestinal microbiome, inflammation, probiotics, FMT, dysbiosis

**Conflict of Interest disclosure:** EFV received grant support from Nestle Research Center, unrelated to the topic of this lecture.
APPLICATION OF GEOSPATIAL TECHNOLOGIES
FOR ANALYSIS OF CARDIOMETABOLIC DISEASES
RELATED TO FOOD AND NUTRITION

Alvarez Di Fino, Eliana Marina.

MSc. Nutritionist. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Instituto de Altos Estudios Espaciales Mario Gulich. Comisión Nacional de Actividades Espaciales (CONAE). Universidad Nacional de Córdoba. Argentina.

In last decades, the rapid changes in levels and composition of dietary and activity/inactivity patterns in transitional societies are related to a number of socioeconomic and demographic changes. To solve this situation it is necessary to study this epidemiological behavior from different approaches. In this context, geospatial technologies -understood as a set of tools used to obtain, process, store, analyze and represent data centered in a geographical, temporal and spatial context- have provided a new analytical approach.

The aim of this conference is to present the results obtained in an
exploratory study through different geospatial tools to analyze the
distribution of overweight and obesity in Córdoba city, Argentina.

Epidemiological data (prevalence of obesity and overweight in 2013) were obtain from 79 Primary Health Care centers in the city. A surrounding area with radius of 1000 m around each point was considered as its zone of influence, and used to explore the environmental conditions around it.

For this study we used a multispectral SPOT 5 image. This com-
mercial high-resolution optical imaging Earth observation satel-
lite provides a 10 meters resolution image with four spectral band
on: green (0.50 - 0.59 µm), red (0.61 - 0.68 µm), nearest infrared
(0.78 - 0.89 µm) and middle infrared (1.58 - 1.75 µm). All imag-
es used were supplied by National Commission on Space Activities
(CONAE), and the SPOT image was acquired in January 2013.

As a first step, we focus our attention on exploring the possibil-
ity to describe social strata used to describe the social dimension
and economic access to food.

To evaluate the environmental parameters in this area, a land cov-
er map is required, and it was decided to exploit the SPOT 5 image
using spectral and spatial features for classification. Specifically, tex-
tural features based on the Grey-Level Co-Occurrence Matric (GLC).

By using land cover maps as well as statistical and spatial in-
formation, the existence of statistically significant relationships
between the prevalence of obesity and overweight according to
the data from the health centers, and the geophysical variables ob-
tained from the satellite image was explored. Specifically, in addi-
tion to the environmental variables such as the above mentioned
NDVI, the Normalized Soil Index (NSI), and the distance from
water bodies and crops were included. For this analysis, different
tools were used -like machine learning technique called Maximum

Entropy Modeling (MaxEnt)- and the free software SatScan that analyzes spatial, temporal and space-time data using the spatial, temporal, or space-time scan statistics.

**Keywords:** Geospatial technologies, spatial analysis, nutritional epidemiology

**Further collaborators:**

Scavuzzo CM, PhD

Gamba P, PhD

Defagó MD, PhD

PROSPECTIVE ANALYSIS: ELIMINATING ARTIFICIAL TRANS FATTY ACIDS IN ARGENTINA AND ESTIMATED EFFECTS ON THE BURDEN OF CORONARY HEART DISEASE

Elorriaga, Natalia.

MSc. Nutritionist. Centro de Excelencia en Salud Cardiovascular para América del Sur. Instituto de Efectividad Clínica y Sanitaria. Argentina.

Consumption of TFAs alters the plasma lipid profile in such a way that it increases the risk of coronary heart disease (CHD). A 2% increase in energy intake from TFAs may increase the risk for a coronary event by up to 23%. Other potential adverse effects of TFAs include systemic inflammation, endothelial dysfunction, insulin resistance and arrhythmias. Based on these adverse effects, several countries have implemented policies to reduce industrial TFA consumption.

In Argentina, before 2004, artificial TFAs were present in most
sweet or salty solid snack foods, such as biscuits. Be-tween 2004
and 2014, Argentina implemented several policies to reduce artifi-
cial TFAs. After 2004, the industry voluntarily reformulated foods
by replacing approximately 40% of TFAs from partially hydrogen-
ated vegetable oils. Regulations enforcing mandatory labelling of
artificial TFAs in food were introduced in 2006 and the country's
food code was amended, such that, by the end of 2014, industri-
ally-produced TFAs in food should not exceed 2% of total fats in
vegetable oils and margarines and 5% of total fats in other foods.

To estimate potential reductions in annual CHD events, disab-
bility-adjusted life years (DALYs) and associated health-care costs
attributable to reductions in artificial TFAs we used a model.

We built a policy model including baseline intake of TFA, the
oils and fats used to replace artificial TFAs, the clinical effect of
reducing artificial TFAs and the costs and DALYs saved due to
averted CHD events.

To calculate the percentage of reduction of CHD, we calculat-
ed CHD risks on a population-based sample before and after im-
plementation. The effect of the policies was modeled in three ways,
based on projected changes: (a) in plasma lipid profiles; (b) in lipid
and inflammatory biomarkers; and (c) the results of prospective co-
hort studies. We also estimated the present economic value of DALYs
and associated health-care costs of coronary heart disease averted.

We estimated that projected changes in lipid profile would avert
301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million
United States dollars (US$) in health-care costs annually. Based on
the adverse effects of TFA intake reported in prospective cohort studies, more deaths and CHD events would be averted annually.

In conclusion, even under the most conservative scenario, reduction of TFA intake must have had a substantial effect on public health.

**Keywords:** Trans fat, model, health outcomes, costs, Argentina

## COMPUTER TOOLS FOR FOOD INTAKE DETERMINATION IN NUTRITIONAL EPIDEMIOLOGY OF CARDIOMETABOLIC DISEASES

Defagó, Maria Daniela.

PhD. Nutritionist. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud INICSA-CONICET. Argentina.

The relationship between diet and disease has been studied for more than a century and diet has been shown to play an important role in the development of chronic diseases of high prevalence, such as cardiometabolic diseases. In this sense, nutritional softwares have been emerged for different research needs in food intake studies.

According each technological development, the software selection includes several aspects such as alimentary questionnaire format, accessibility, adaptability, intuitive system, support contact, information about food databases and result reports. In response of Argentina food research needs, a software called Interfood v.1.3 was development. The program is based on three fundamental components: first, a food frequency questionnaire (FFQ) to obtain the food intake profile about 242 foods more frequent in the country; second, a food composition table database (FCD) based on food composition tables of Latinfoods-Argenfoods, the Food and Agriculture Organization and the USDA Food Composition Databases. The reporting includes 131 compounds (macro/micronutrients and phytochemicals) per 100 g of food. The third component is a relational database, which through the interaction between FFQ and FCD calculates the amount of each of the foods, nutrients and phytochemicals consumed by day, week and month. The information is obtained on a Microsoft Excel format basis applicable to its subsequent analysis in other programs.

One strength of Interfood is its focus in fatty acids and bioactive compounds, nutrients related in prevention and pathogenesis of cardiometabolic diseases. Also, like other softwares developed by researchers of the region, prioritizes the use of local food databases. Nutritional softwares allow easy management of food and nutritional information and can be used in epidemiological studies in different geographic areas, socioeconomic levels and age groups. In conclusion, technological advances in computer sciences can be incorporated into the methodological tools in nutritional epidemiology of cardiometabolic diseases and other pathologies related to diet.

**Keywords:** Nutritional softwares, dietary assessment, nutritional epidemiology

**Further collaborators:**

Perovic NR, PhD

Aguinaldo CA, BS

Actis AB, PhD

## DESIGN AND OBJECTIVES OF THE SOUTH AMERICAN YOUTH/CHILD CARDIOVASCULAR AND ENVIRONMENTAL (SAYCARE) STUDY

(1)González-Zapata, Laura Inés; (2)Barbosa Carvalho, Heráclito; (3)Moreno, Luis A.; (4)Melo Silva, Andrew; (5)Berg, Gabriela; (6)Estrada-Restrepo, Alejandro; (7)Delgado, Carlos; (8)Bove, Maria Isabel; (9)Rosario de Sousa, Maria da Luz; (10)Torres-Leal, Francisco; (11)de Moraes Forjaz, Cláudia; (2)Ferreira De Moraes, Augusto César.

(1)PhD. Nutritionist. School of Nutrition and Dietetics, University of Antioquia, Medellín. Colombia.; (2)PhD. University of São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, SP, Brazil.; (3)PhD. Md. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.; (4)School of Medicine. University of São Paulo. YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group. Department of Preventive Medicine. São Paulo. Brazil.; (5)School of Pharmacy and Biochemistry. University of Buenos Aires. Buenos Aires. Argentina.; (6)MSc. School of Nutrition and Dietetics, University of Antioquia, Medellín. Colombia.; (7)School of Medicine. Department of Pediatrics. Universidad Nacional Mayor de San Marcos (UNMSM). Instituto Nacional de Salud del Niño (INSN). Neonatal Unit. Lima. Perú.; (8)Health and Welfare Institute. School of Psychology. Catholic University of Uruguay.; (9)Piracicaba Dental School. University of Campinas. Department of Community Dentistry. Piracicaba. SP. Brazil.; (10)Center for Health Sciences. Federal University of Piaui. DOMEN (MetabOlic Diseases, Exercise and Nutrition) Research Group. Teresina. Brazil.; (11)Exercise Hemodynamic Laboratory. School of Physical Education and Sport. University of São Paulo. São Paulo. SP. Brazil.

The South American Youth/Child cArdiovascular and Environmental Study (acronym: SAYCARE Study) is an observational multicenter feasibility study was carried out in seven South American cities: Buenos Aires (Argentina), Lima (Peru), Medellín (Colombia), Montevideo (Uruguay), Santiago (Chile), São Paulo and Teresina (Brazil). The study children and adolescents (3 to 18 years). In this feasibility phase we performed quality controls, develop valid and reliable measurement methods to obtain information from: social and environmental factors, family environment, food intake, preference and food choices, physical activity and sedentary behaviors body composition, oral health, lipids and cardiovascular health biomarkers. After the developing we measured the reliability and a validity coefficient of these methods by several analyzes: kappa coefficients for categorical variables and intraclass correlation coefficients for quantitative variables, which were complemented by the development of Bland-Altman. The correlations were calculated by Spearman and Pearson correlation coefficients for nonparametric and parametric variables respectively. Our total sample is composed with 237 children (preschool and school children) and 258 adolescents, provided data during 1stphase
measurements. The results of the SAYCARE study are expected to
provide higher accuracy of the assessment of cardiovascular dis-
ease risk factors (eating behaviors, body composition, physical ac-
tivity, sedentary behaviors, lipid profile and cardiovascular health
biomarkers, oral health, social conditions, environmental factors
and home environment) and of their determinants in children and
adolescents aged 3-18, from seven South American cities.

**Keywords:** Reliability, validity, children, cardiovascular dis-
eases, risk factors.

ASSESSING DIETARY INTAKE IN CHILDREN AND ADOLESCENTS: DEVELOPMENT OF A FOOD FREQUENCY QUESTIONNAIRE

(1)Saravia, Luisa; (2)González-Zapata, Laura Inés; (3)Rendo-Urteaga, Tara; (4)Ramos, Jamile; (5)Sadalla Collese, Tatiana; (6)Bove, Maria Isabel; (7)Delgado, Carlos; (8)Tello, Florencia; (9)Gonçalves Sousa, Ederson Dassler; (10)Ferreira De Moraes, Augusto César; (10)Barbosa Carvalho, Heráclito; (11)Moreno, Luis A.

(1)Nutritionist. MSc. School of Nutrition. PhD Student. University of La Republica. Montevideo. Uruguay; (2)PhD. Nutritionist. School of Nutrition and Dietetics, University of Antioquia, Medellín. Colombia; (3)Nutritionist. MSc. PhD. University of São Paulo. School of Medicine. YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group. Department of Preventive Medicine. São Paulo. Brazil; (4)Nutritionist. MSc. School of Nutrition. University of Mogi das Cruzes. Mogi das Cruzes. Brazil; (5)Nutritionist. MSc. University of São Paulo. School of Medicine. YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group. Department of Preventive Medicine. São Paulo. Brazil; (6)Nutritionist. MSc. PhD. Health and Welfare Institute. School of Psychology. Catholic University of Uruguay. Montevideo. Uruguay; (7)MD. MSc. PhD. Instituto de Salud y Nutrición del Niño. Lima. Peru; (8)Nutritionist. School of Nutrition. University of Buenos Aires. Buenos Aires. Argentina; (9)Federal University of Piaui. Department of Biophysic and Physiology, Metabolic Diseases, Exercise and Nutrition Research Group. Teresina. Piaui. Brazil; (10)PhD. University of São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, SP, Brazil; (11)PhD. Md. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.

Global epidemic levels have been reach by non-communica-
ble diseases (including obesity) in children and adolescents. South
American children under 5 years have an estimated prevalence of
overweight of about 7%; in school age children, overweight and
obesity prevalence ranged from 15% to 36.9%, and among adoles-
cents from 16.6% to 38%.

Food Frequency Questionnaires (FFQs) are often used in ep-
idemiological studies to evaluate long-term food consumption.
They should be created and validated in the specific population in
which they will be used.

The aim of this study is to describe the process of development
of a FFQ, to assess dietary intake to be used in children and ado-

lescents from six countries of South America and to assess their
feasibility in the target population.

**Methods:** A semi-quantitative FFQ was designed to be self-administered and to assess the dietary intake over the past three months among children and adolescents aged 3 to 17 years from seven cities of six South American countries: Buenos Aires (Argentina); Lima (Peru); Medelin (Colombia); Montevideo (Uruguay); Santiago (Chile) and Sao Paulo and Teresina (Brazil). In order to compile the food list, multiple approaches were considered. Eleven food groups were included (cereals, tubers, vegetables, fruits, oils, meat and derivate, fish and eggs, milk and dairy products, legumes, beverages, sugar products and miscellanea). To determine the frequency categories of the questionnaire, Willet's proposal of a nine response category, was adopted. A food photo booklet was produced.

**Results:** In order to develop the FFQ, national food consumption surveys and several local studies were considered. Experts from all the cities involved in the SAYCARE study completed the food lists for every country. A preliminary common core food list was developed that included food items that represent at least 30% of the children/adolescent's total food intake and appear in at least two of the six countries involved. Countries' food items were included to the common core. At the end, Medelin had 55 food items, 58 for Santiago, 60 for Montevideo, 63 for Lima and Buenos Aires, 67 for Sao Paulo and 68 for Teresina. It was developed in Spanish and translated to Portuguese.

345 children and 357 adolescents were considered for analy-
sis. Food consumption (in grams per day) for male children con-
sumption of crackers, sweet cookies, filled sweet cookies, pork,
milk, yoghurt and fruit juices was lower in the older one than in
the younger one. Female children consumption of sweet cookies
and yoghurt was lower and packed juice was higher in the older
one, compared with the younger children. In male adolescents soft
drinks consumption was lower in the younger one, compared with
the older one. In female adolescents cookies, filled cookies, fried
potatoes, pork and canned fish consumption was lower in the old-
er one, compared with the younger one.

**Conclusion:** A culturally appropriate, semi quantitative FFQ, was developed in order to assess dietary intake in children and adolescents of the SAYCARE Study.

**Keywords:** Food intake, children and adolescents, food fre-
quency questionnaire, development
## VALIDITY OF A FOOD FREQUENCY QUESTIONNAIRE DESIGNED FOR SOUTH AMERICAN CHILDREN AND ADOLESCENTS BY THE HEALTHY DIET SCORE

(1)Collese, Tatiana; (2)Rendo-Urteaga, Tara; (3)Saravia, Luisa; (4)Monsalve-Alvare, Julia María; (5)González-Zapata, Laura Inés; (6)Tello, Florencia;

(7)Martínez-Oliván, Beatriz; (8)Torres-Leal, Francisco;

(9)Moreno, Luis A.; (10)Ferreira De Moraes, Augusto César; (10)Barbosa Carvalho, Heráclito.

(1)PhD student. Nutritionist. YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group. Department of Preventive Medicine. University of São Paulo/School of Medicine. Brazil.; (2)PhD. Nutritionist. YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group. Department of Preventive Medicine. University of São Paulo/School of Medicine. Brazil.;

(3)Nutritionist. School of Nutrition. University of La República. Uruguay.; (4)Nutritionist. School of Nutrition and Dietetics/ University of Antioquia. Colombia.; (5)PhD. Nutritionist. School of Nutrition and Dietetics, University of Antioquia, Medellín. Colombia.; (6)Nutritionist. Escuela de Nutrición. Facultad de Medicina. Universidad de Buenos Aires. Argentina.; (7)Nutritionist. GENUD (Growth, Exercise, NUTrition and Development) Research Group. Faculty of Health Science/Instituto Agroalimentario de Aragón (IA2). University of Zaragoza-CITA. Spain; (8)PhD. Metabolic Diseases Exercise and Nutrition (DOMEN) Research Group. Federal University of Piauí. Brazil.; (9)PhD. Md. Faculty of Health Sciences. University of Zaragoza, Zaragoza, Spain.; (10)PhD. University of São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, SP, Brazil.

**Background:** The Healthy Diet Score was developed by the American Heart Association as one component of cardiovascular health to assess adherence to dietary guideline recommendations. **Objective:** To validate the SAYCARE food frequency questionnaire (FFQ) to assess the Healthy Diet Score. **Methods:** A sample of 409 (50.93% female) children and 270 (53.58% female) adolescents (aged 3-18 years) from the SAYCARE study were included in this validation analyses. The children's parents/guardians or the adolescent themselves answered the FFQ and three 24-hour-dietary-recalls. Children and adolescents were given one point when they ate ≥ 400mg of fruits & vegetables, and drunk < 70 kcal of sugar-sweetened beverages per day. If they did not meet these recommendations no point was scored. Therefore, these eating components were summed up and classified according to the Healthy Diet Score, adapted into poor (zero points), intermediate (one point), and ideal (two points). To estimate the validity of the FFQ the weighted cohen's kappa, and the sensitivity and specificity analyses were applied, using the 24-hour-dietary-recall as a reference method. **Results:** The proportions of the Healthy Diet Score were 41.56% poor, 50.86% intermediate, and 7.58% ideal for children; and were 42.96% poor, 50.37% intermediate, and 6.67% ideal for adolescents. The FFQ validity coefficients were: k=0.110 (73.59% of agreement) and k=0.165 (76.48% of agreement), and sensitivity of 70.53%; 69.23% and specificity of 19.58%; 41.43% for children and adolescents, respectively. **Conclusions:** The SAYCARE food frequency questionnaire presents fair agreement and validity for two components of the Healthy Diet Score (fruits & vegetables and sugar-sweetened-beverages).

**Keywords:** Validity; Food Frequency Questionnaire; 24-hour dietary recall; Healthy Diet Score; Pediatrics.

## ASSESSING THE DETERMINANTS OF DIET IN THE SAYCARE STUDY: REPEATABILITY AND RELIABILITY OF A BODY IMAGE SCALE

(1)Restrepo-Mesa, Sandra; (2)González-Zapata, Laura Inés;

(2)Aristizabal, Juan; (3)Skapino, Estela; (4)Sadalla Collese, Tatiana;

(5)Azzaretti, Leticia; (6)Nascimento-Junior, Walter; (7)Moreno, Luis A.;

(8)Ferreira De Moraes, Augusto César; (8)Barbosa Carvalho, Heráclito;

(9)Estrada-Restrepo, Alejandro.

(1)Professor. Colombia.; (2)PhD. Nutritionist. School of Nutrition and Dietetics, University of Antioquia, Medellín. Colombia.;

(3)MsC. Nutritionist. School of Nutrition, Universidad de La Republica, Uruguay.; (4)MsC. Nutritionist. University of São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, Brazil.; (5)MsC. Nutritionist. School of Nutrition, Medicine Faculty, University of Buenos Aires, Argentina.; (6)Federal University of Piauí, Center for Health Sciences, Teresina, Brazil.;

(7)PhD. Md. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.; (8)PhD. University of São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, SP, Brazil.; (9)MsC. School of Nutrition and Dietetics, University of Antioquia, Medellín. Colombia.

**Background and objective:** In children and adolescents, overweight and obesity are associated with body image dissatisfaction. Low body image may trigger unhealthy behaviors, such as, following a very low energy diet, and doing extreme exercise routines. Given the high prevalence of overweight and obesity in South American youth, this study aimed to evaluate validity and reliability of a body image scale in children and adolescents from the SAYCARE Study.

**Materials and methods:** 228 children (3 to 10 years old) and 142 adolescents (11 to 17 years old) answered the SAYCARE questionnaire twice, two weeks interval. Children and adolescents body weight and height were measured following standard procedures. Children parents/guardians answered the questions: "Do you think that your son is: Lean, little bit lean, healthy weight, little bit overweight, overweight?". "Choose the figure (13-body image scale developed by Gardner) that best represents your child's physical appearance". Adolescents answered these questions themselves. Repeatability was evaluated between the first and the second response of every child or adolescent. Validity was assessed comparing the answers against the body mass index classification developed by the World Health Organization. Kendall's tau-c coefficient and weighted Kappa statistics were calculated and interpreted according to Landis and Koch.

**Results:** In children, the repeatability to the question "Do you think that your son is? was acceptable (K=0.337) but showed poor validity (k=0.176). For the Gardner scale the repeatability was deficient (K=0.124) with poor validity (K=-0.018). In adolescents, the repeatability to the question "Do you think that your son is? was notable (K=0.709) with acceptable validity (K=0.268). For the Gardner scale the repeatability was notable (K=0.599) but the validity was poor (K=0.023).
**Conclusions:** The questionnaire answered by parents or guardians showed acceptable repeatability but failed to assess child's body weight adequacy. The adolescents questionnaire showed good repeatability and validity to assess physical appearance by using direct questions, but not through the Gardner body image scale.

**Keywords:** Body image rating scale, body mass index, body image perception, South American

## PA ASSESSMENT IN CHILDREN AND ADOLESCENTS FROM SOUTH AMERICA: METHODOLOGICAL ASPECTS

(1)Moreno, Luis A.; (2)Ferreira De Moraes, Augusto César; (2)Nascimento Ferreira, Marcus Vinicius; (2)Toazza-Oliveira, Paulo Vinícius; (3)Forjaz, Claudia L.M.; (4)Aristizabal, Juan; (5)Santaliestra-Pasías, Alba M.;

(6)Lepera, Candela; (7)Nascimento Junior, Walter Viana; (8)Skapino, Estela; (9)Delgado, Carlos; (10)Barbosa Carvalho, Heráclito.

(1)PhD. Md. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.; (2)University of São Paulo, School of Medicine, YCARE (Youth/Child c Cardiovascular Risk and Environmental) Research Group, Department of Preventive Medicine, São Paulo, SP, Brazil; (3)Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil; (4)Grupo de Investigación en Fisiología y Bioquímica (PHYSIS), Universidad de Antioquia, Medellín-Colombia; (5)University of Zaragoza, Faculty of Health Sciences - GENUD (Growth, Exercise, Nutrition and Development) Research Group, Zaragoza, Spain;

(6)School of Nutrition, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; (7)Federal University of Piaui, Center for Health Sciences, DOMEN (MetabOlic Diseases, Exercise and Nutrition) Research Group, Teresina, PI, Brazil;

(8)MsC. Nutritionist. School of Nutrition, Universidad de La Republica, Uruguay.; (9)Universidad Nacional Mayor de San Marcos (UNMSM), School of Medicine, Department of Pediatrics; and Instituto Nacional de Salud del Niño (INSN), Neonatal Unit, Lima, Perú; (10)PhD. University of São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, SP, Brazil.

Physical activity (PA) is one of the most important determinants of obesity and cardiovascular risk factors in children and adolescents. In the majority of the countries, and especially in urban areas, children and adolescents have low levels of PA and the proportion of children complying with PA recommendations (60 minutes per day of moderate-vigorous PA) is also very low, especially in girls. There are several methods to assess PA in children and adolescents. The most widely used are the questionnaires. The reference method for free-living PA assessment is the doubly labelled water method. There are also some objective methods providing a good compromise between accuracy and feasibility; they are movement sensors (accelerometers) and heart rate monitoring. In the SAYCARE feasibility study, two methods were used: questionnaires and accelerometers. Questionnaires are self-reported and they measure the routine activities of the last week in three different PA domains (PA at school, PA at leisure time and active

commuting). The perceived intensity is measured in three levels: light, moderate and vigorous. Accelerometers provide objective measures of total PA and the time spent in the different intensities. For both methods, the optimal accuracy and reliability should be achieved. The main goals of this study is to provide methodological aspects related with the use of a questionnaire adapted to be used in children and adolescents in seven centres in six countries and to compare the results with those obtained with accelerometers in four centres in three countries in South America.

For reliability assessment 161 children (49.8 % females) and 177 adolescents (58.3 % females) were studied. Questionnaires were completed by the parents or caregivers in the case of the children's sample and by the adolescents themselves. They filled in the questionnaire twice, two weeks apart. In children, the questionnaire showed good reliability for moderate-vigorous PA (rho = 0.56), and very good for vigorous PA (rho = 0.89); however, reliability for moderate PA was moderate (rho = 0.37). In adolescents, the questionnaire showed good reliability for moderate-vigorous PA (rho = 0.60), and very good for vigorous PA (rho = 0.93); however, reliability for moderate PA was also moderate (rho = 0.36). Results obtained with the questionnaire were compared with those measured with accelerometers in 82 children (54.4 % females) and 60 adolescents (55.7 % females). In children, correlation between moderate-vigorous PA assessed both with the questionnaires and the accelerometers was moderate (rho = 0.44) and it was good for moderate PA (rho = 0.61). In adolescents, correlation between moderate-vigorous PA assessed both with the questionnaires and the accelerometers was very good (rho = 0.88) and the same apply for vigorous PA (rho = 0.65).

In conclusion, measurement of PA using both questionnaires and accelerometers is feasible in children and adolescents in urban areas of six countries in South America, with a good reliability, especially when considering vigorous PA.

**Keywords:** Physical activity, child, adolescents, cardiovascular risk factors
BLOOD SAMPLE COLLECTION AND PRE-ANALYTICAL SAMPLE PROCESSING

(1)Berg, Gabriela Alicia; (2)Lopez, Graciela; (3)Serruya, Raphael; (4)Barchuk, Magali; (5)Gaitan-Charry, Diego; (5)Torres-Leal, Francisco; (6)Moreno, Luis A.; (7)Carvalho, Heraclito; (8)de Moraes, Augusto.

(1)PhD. Biochemist. Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Bioquímica Clínica 1, Buenos Aires, Argentina; (2)Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Bioquímica Clínica 1, Buenos Aires, Argentina;
(3)University of São Paulo, School of Medicine – YCARE (Youth/ Child and cArdiovascular Risk and Evironmental) Research Group, São Paulo, SP, Brazil; (4)Médico y Cirujano. MSc Nutrición. Doctor en Nutrición y Alimentos. Profesor Asistente, Escuela de Nutrición y Dietética - Universidad de Antioquia; (5)PhD. Federal University of Piaui, Center for Health Sciences, DOMEN (MetabOlic Diseases, Exercise and Nutrition) Research Group, Teresina, Brazil; (6)PhD. Md. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.; (7)PhD. MD. University of São Paulo, School of Medicine – YCARE (Youth/Child and cArdiovascular Risk and Evironmental) Research Group, São Paulo, SP, Brazil; (8)Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.

Overweight and obesity are independent risk factors for cardi-
avascular diseases, associated with other risk factors such us hy-
perlipidemia, hyperinsulinemia and insulin resistance. In clinical
epidemiological multicenter studies, the managing of the correct
selection of biomarkers that will ensure the identification of these
risk factors is required and it is considered the “pre pre analytical
stage”. Moreover, the concentration of these biomarkers in blood
samples depends on several factors, including those inherent to
the individual, such as age and gender, ethnic and cultural diver-
sity, sociological, psychological, environmental factors and others
referred to pre analytical conditions. Besides, the quality assurance
and harmonization of all procedures in the pre analytical stage,
the drafting of the informed consent and the standardization of
patient preparation is very important in order to reduce error
comparison between different laboratories. The SAYCARE Study
was held in children and adolescents (3 to 17 years) from seven
South American cities: Sao Paulo and Teresina (Brazil), Buenos
Aires (Argentina), Santiago (Chile), Montevideo (Uruguay), Lima
(Peru) and Medellin (Colombia). The aim of SAYCARE was to de-
velop methods to collect reliable, comparable and validated data
about cardiovascular health biomarkers, lifestyles and environ-
mental, social and familial factors. Regarding blood samples col-
lection, investigators from each participating center were involved
in the planning and development of the protocol, which included
the study design, the impact of pre analytical conditions on dif-
ferent blood biomarkers and the stability of these biomarkers ac-
cording to time and frozen storage of the samples and transport
at reference laboratory in Sao Paulo for it biochemical evaluation.
Different blood biomarkers were evaluated in 474 fresh samples
of serum, in different country centers: glucose, total-cholesterol,
HDL-cholesterol, LDL-cholesterol, triglycerides, iron, and hs-
CRP. We also evaluated the stability of different biomarkers ac-
cording to time and frozen storage within this pilot study across

the concordance of the results obtained from the 49 blood samples
measured in two different centers. An excellent concordance and
correlation between different centers were observed, in most of
the evaluated parameters. This concordance is a consequence of
the strict compliment of the pre analytical conditions previously
established in the SAYCARE study.

**Keywords:** SAYCARE, blood sample collection, pre-analytical blood sample procesing, blood biomarkers,

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REDUCTION OF SALT CONSUMPTION IN DIETS FOR COMBATING NCDS FOR BETTER HEALTH AND WELLNESS

POLICY AND TECHNICAL ISSUES OF SODIUM REDUCTION – CHALLENGES AND GLOBAL PERSPECTIVES

Prakash, Vishwesihwaraiah.

(Vice president, IUNS), Mysore, India.

The intake of Salt has been a matter of many discussions both
from the Nutritionists point of view and the Clinicians point of view
and from the point of combating NCDs on diet based approach. The
consumption pattern of salt and its relation to the over all health sta-
tus of the individual is a well established fact with most consumers.
In this connection over the last eight years plus IUNS has been able
to address this globally in several regions with workshops on Salt
Reduction. A few publications have also emerged as a result of this
and has captured the attention of Regulators and Academia. This
is basically restricted to added salt to the food while cooking and
also on the table largely keeping the figure of 5 gms. per day recom-
mended by WHO. However this does not take into consideration
the invisible salt in food as well as the climatic conditions and the
Regional lifestyles. This is only a generic recommendation rather
than customizing for a region based on life style. Regulators in many
countries have recently come in with measures such as high tax,
banning high consumption of salt by either pegging the level of salt
in the processed foods or discouraging their purchase thus bringing
about large awareness amongst the public for low consumption of
salt in the interest of health and wellness.

Having said this the final solution may not be in the immediate
horizon but will take a long way and thus one must bring in aware-
ness of the problems of high salt consumptions at a very young age
in schools to ensure at least the next generation if it can peg salt
consumption to not more than 2 to 3 gms. a day it would be won-
derful. Perhaps at that time we can take the agenda back to WHO
to refix the recommended daily salt intake minimum to a lower
level. The focus also is to manage the electrolyte balance in order
that the entire concept of consumption of salt is holistically seen
for the body. Regulations alone may not change the mind set but
working together of Regulators, Industries, manufacturers of Pro-
cessed Foods, Consumers and NGO's and media has a very large
role to play by networking and working in synergy in the Global Salt Reduction Programme from the bottom of the Pyramid approach and Top down approach in this agenda.

**Keywords:** Low Salt, WHO, Awareness, Processed Foods, NCDs

## REDUCING SALT INTAKE IN WEST AFRICAN COUNTRIES: CONTROVERSIES AND CHALLENGES

Steiner-Asiedu, Matilda.

University of Ghana. Ghana.

In recent times West African countries just like other countries across the globe are experiencing an alarming increase in non-communicable diseases including hypertension. Apart from overweight/obesity, high dietary salt intake has been recognized to be one of the major contributory factors to the high prevalence of NCDs in the sub-region. This evidence was the consensus at the salt reduction forum held by the West African Health Organization (WAHO) on Salt Reduction in West Africa, July 17 2013 in Bobo-Dioulasso, Burkina Faso. Generally the average salt intake exceeds the WHO recommendation of <2 g/day sodium (5 g/day salt). The increasing trend of hypertension in West Africa as documented by various epidemiological studies is therefore not surprising. The population is also in a dilemma since high salt intake are influenced by traditional food systems, social, environmental, economic and industry practices as well as globalization of market systems. This presentation therefore discusses the controversies and challenges surrounding salt intake reduction in the West African Sub-region and calls for nutrition and public health interventions that consider multi-sectorial and multi-disciplinary approaches backed by government efforts.

**Keywords:** Salt, intake, west-Africa, hypertension, challenges

## DIET COMPOSITION AND SODIUM INTAKES-A LOOK AT CHINA'S DATA

Yang, Yuexin; Gao, Chao; Ting, Gangqiang.

National Institute of Nutrition for Health. China.

The latest National Chroinc Diseases and Nutrition Survey data released by National Health and Family Planning Commission (NHFPC) China, Sodium intake shows that overall the population is still consuming too much salt and not enough fruit, milk. population-based blood pressure levels and prevalence of hypertension are increased rapidly in the past decades in China. Meanwhile, sodium intake, is a major risk factor for hypertension. The studies is conducted to collect information on sodium intake, the reason of analysis and the national strategy making.

The study is an once every two years survey designed to assess the food composition, food consumption of a China representative sample living in private households. Salt content in food measured, Salt and condiment intake information of aged 18 years upwards was collected by the 3-condecutive days-24-hour dietary recall and food weighting method, the sodium content the average salt intake

was calculated based on energy percentage of family members. And Industry Salt Reduction strategy design by trend analysis.

The report development the food sodium content data for the nutrition survey. The development work involved food analyses and recipe calculation. And presents the results combined and supersedes the previous report published by China CDC 2012 which covered the salt intake during 2010-2012. The average salt intake for aged 18 years and above was 10.5g /day from national survey in 2010- 2012. Compared to 30 years of data, it can be found that it continues to decline. The average salt intake was 12.0g /d in 2002, and 13.9g /d in the year 1992 respectively. But the salt intake of Chinese all redidents was still in higher level than 6g/d, which is the salt intake goal from national dietary guideline.

For diet towards the 6g a day goal. A slat reduction plan including set the 10% reduction target in the year 2018, And a target for food industry by the 2020-2030 to encourage companies to reformulate recipes, including to use FOP and guide people choose lower salt options – through promotional and other activities; Push the catering and takeaway sector by setting new maximum targets for the most popular dishes and chips.

The daily average salt intake among Chinese adult was still in high level, and salt reduction plan should be gradually by consumer education and public policy.

**Keywords:** Salt content, intake, targets

## ADDRESSING CONSUMER CHALLENGES IN REDUCING SODIUM INTAKES

van het Hof, Karin; Zandstra, Liesbeth.

PhD. Nutritionist. Unilever R&D. Vlaardingen. The Netherlands;

PhD. Unilever R&D. The Netherlands.

Globally, average dietary salt intake is much higher than the recommended World Health Organization level of less than 5 grams of salt per day. As part of its Sustainable Living Plan, Unilever set itself the challenging target of helping consumers to cut their salt intake to this recommended level of 5 grams a day. The challenge here is to achieve further reductions in the salt content of our foods, while maintaining good taste, stability and texture to ensure consumers will like (or even prefer) these reformulated products. Moreover, a change in consumer behaviour is also required. Reducing salt in products is often perceived to negatively influence the taste, making it hard to encourage consumers to use these products without adding salt back at the table. In order to increase the effectiveness and health impact of efforts in this area, an approach is required that is directed at both manufactured foods as well as consumer behaviour. The presentation will address aspects that are relevant from a consumer perspective, such as communication, taste perception, acquired preferences and salt usage. These are crucial insights to consider in developing effective salt reduction strategies and/or policies.

**Keywords:** Consumer, sodium reduction, salt

**Conflict of Interest disclosure:** Both authors are employees of Unilever, a manufacturer of Food and Beverages products.
# CURRENT INTAKE OF SALT AND ITS REGULATIONS IN INDONESIA

Hardinsyah, Ridwan.

Professor in Nutrition. Department of Community Nutrition.
Bogor Agricultural University. Indonesia. Food and Nutrition
Society of Indonesia.

Indonesia, a tropical developing country in the South East Asian Region, is now facing a double burden of malnutrition and increasing incidence of non-communicable diseases. Cardiovascular diseases, especially stroke and coronary heart diseases are the main cause of death in Indonesia. Epidemiological and clinical studies showed that high intake of salt, sugar and fat are part of risk factors for cardiovascular diseases. One of the strategies by WHO to reduce incidence of non-communicable diseases is to limit the intake of sugar, salt and fat. In line with the strategy, the Indonesia government through Ministry of Health formulated the new dietary guidelines for Indonesians, in which messages include to limit intake of sugar, salt and fat. The MH also issued a regulation number 30/2013 on Sugar, Salt and Fat Information for Labeled Packed Foods and Fast Food, that will be implemented from 2019. Ten years ago (2007), the mean intake of salt among Indonesian was 5.6 g/cap/d, which is now increased to 6.3 g/cap/d from both visible and invisible sodium. Based on Total Diet Survey by MH, 52.7% of Indonesian population had sodium intake exceed the limit sodium intake recommended by the MH. Regarding age groups, the highest prevalence of high sodium intake was among teenagers, and the lowest among children under-five years. In Indonesian diets, the salt intake predominantly from the non-label packed foods, especially from family foods and food away from home such as salted dried fish, salted soybean sauce, chilly sauce, meat ball soup, fried rice, porridge, fried foods, snacks and spices. The data on salt or sodium intake in Indonesia may suffered from estimation bias, since the data derived from the food consumption survey. The salt data are from visible and non visible salts, which is more likely under-estimated. The weaknesses of the salt intake data are inherent in the weakness of food data collection using one-day and seven-day food recall, there is no standard recipe on the utilization of salts of Indonesian foods, there is no data on sodium content of Indonesian foods, not all packed food provide information on sodium content. It is difficult and facing a great challenge from the stakeholders while the regulation is in placed without strong or adequate evidence about where we are now, what is the specific targets and how to achieve the targets. This implies that more detail data on sodium content of Indonesian foods and sodium education efforts need to be done before the implementation of the salt regulation.

**Keywords:** Indonesia, salt intake, sodium intake, related regulation

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# LATIN AMERICAN SURVEY OF NUTRITION AND HEALTH (ELANS): MAIN RESULTS ON INTAKE, PHYSICAL ACTIVITY AND SEDENTARISM IN EIGHT COUNTRIES

## INTRODUCTION TO ELANS: NUTRITION AND HEALTH SURVEY IN URBAN POPULATION FROM EIGHT LATIN AMERICAN COUNTRIES

(1)Rigotti, Attilio; (2)Fisberg, Mauro; (3)Kovalskys, Irina; (4)Gómez Salas, Georgina; (5)Cortes, Lilia Yadira; (6)Yepez Garcia, Martha Cecilia; (7)Pareja, Rossina Pareja; (8)Herrera-Cuenca, Marianella.

(1)MD. PhD. Centro de Nutrición Molecular y Enfermedades Crónicas. Departamento de Nutrición y Diabetes. Escuela de Medicina. Pontificia Universidad Católica. Santiago. Chile;

(2)Fundação Jose Luiz Egydio Setubal. Hospital Infantil Sabara. Instituto Pensi. Universidade Federal de São Paulo, São Paulo. Brazil; (3)International Life Science Institute. Buenos Aires.

Argentina; (4)Departamento de Bioquímica. Escuela de Medicina. Universidad de Costa Rica. San José. Costa Rica; (5)Departamento de Nutrición y Bioquímica. Pontificia Universidad Javeriana.

Bogotá. Colombia; (6)Colegio de Ciencias de la Salud. Universidad San Francisco de Quito. Quito. Ecuador; (7)Instituto de Investigación Nutricional. Lima. Perú; (8)Centro de Estudios del Desarrollo. Universidad Central de Venezuela (CENDES-UCV)/ Fundación Bengoa. Caracas. Venezuela.

The ongoing epidemiological transition is leading to increased burden of obesity-associated chronic diseases worldwide, including the Latin American region. These disease conditions are determined by inadequate lifestyle involving unhealthy food intake and physical inactivity, which have not been consistently evaluated in Latin American countries. Aim: The purpose of ELANS (Estudio Latinoamericano de Nutrición y Salud) was to obtain high quality data on food intake, physical activity and nutritional status in Latin America. Methods: A multicenter cross-sectional survey was performed between November 2014-July 2015 in nationally representative samples of major urban populations from 15 to 65 years old in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Diet was assessed by two 24-h food recalls using the multiple pass method and the Nutrition Data System for Research (NDS-R) software. Physical activity was analyzed by the long version of IPAQ in the total sample and a subsample was subjected to triaxial accelerometry. Anthropometric measurements included body weight, height as well as neck, waist and hip circumferences. Statistical analyses were applied to total sample data and to each separate country. Findings: ELANS included 9,218 individuals (48% men and 52% women) with validated data. The age distribution of the sample was 13, 38, 28 and 21% for 15-19, 20-34, 35-49 and 50-65 years old, respectively. 42% of the subjects enrolled were from low socioeconomic level (SEL), 43% from medium and 15% from high SEL. 60% of participants had primary school education, whereas 29% attended middle-high school, and 9.5% had college or high-