food in the context of eating out is critical if the right to adequate
food is to be fulfilled.

**Keywords:** celiac disease, feeding, human rights, food.

144/2290

FOOD INSECURITY AT HOME DECREASES DIEDATORY DIVERSITY IN MEXICAN ADULTS

**Background and objectives:** The lack of income to purchase food has the consequence that adults decrease the number, quantity and quality of food they consume and, in extreme cases, stop eating for a whole day. These changes affect the quality of life and health of the population.

The aim of this work is to describe the dietary diversity (DD) of Mexican adults aged 20 to 59 years according to the severity of household food insecurity (HFI).

**Methods:** The study included 2297 women and men 20-59 years based on data from the Mexican National Health and Nutrition Survey (ENSANUT 2012). A diet diversity index was constructed from a seven-day food frequency questionnaire. The index included nine food groups. HFI was measured with the Latin American and Caribbean Food Security Scale (ELCSA). According to the number of positive responses, households were classified into four categories: food security (FS), mild food insecurity (MFI), moderate food insecurity (MFI) and severe food insecurity (SFI).

The number of foods and food groups consumed by adults according to level of food insecurity was calculated. The proportion of adults consuming each food group according to each level of HFI was obtained. Differences between categories of food insecurity were calculated using linear and logistic regression models adjusted for sociodemographic variables.

**Results:** FS adults consume a greater diversity (5.6 groups) and number of foods (20) per day compared to adults in SFI (Diversity=4.8 groups and 16.2 foods). A lower proportion of adults in SFI consume meat and fish as well as milk and dairy products.

**Conclusions:** HFI in the country affects the quality of the diet of a significant fraction of the population. It is necessary to support the existing strategies in public policy to improve the quality of life of the Mexican population.

**Keywords:** Food security, dietary diversity, nutrition survey, adults

144/2292

LONGITUDINAL NUTRITION ANALYSIS WITH
NUTRIMETRY IN YUCATAN'S ELEMENTARY
SCHOOL CHILDREN 2014-2016

**Background and objectives:** Mexico is the first place in overweight and obesity in childhood, and Yucatan is among the first three places in the country, and also has one of the shortest height averages. Under this condition, Yucatán Government has implemented an Integral Program for Childhood Obesity Attention (PIAOIY) since 2010 which first step consists in assess some nutritional indicators at school, year by year to screening risk groups, and channeling them to appropriate health services. The objective of this study is present a longitudinal analysis of the program with Nutrimetry, combining BMI and height.

**Methods:** Yucatan's elementary school students measured for three consecutive years (2014-2016) were analyzed with Nutrimetry: according to WHO z-scores values were assigned, for height/age: z≤-2=1, z≥2=5, or 3 to the rest, and for BMI/age: z≤-1=0, 1≤z<2=6, z≥2=12 or 3 to the rest, values were crossed and 12 codes (1-3-5, 4-6-8, 7-9-11, 13-15-17) that combine underweight, normal-weight, overweight and obesity with short, normal and high heigh were obtained. Prevalences and changes over time were analyzed.

**Results:** Data of 6,011 students with a start age of 8.79 years (S.D.=1.33) were analyzed.

From the first to the third year, prevalence of low-height codes (1, 4, 7 and 13) decreased (mean=1.61); all high-height ones (5, 8, 11 and 17) increased (mean=0.11), and normal-height with overweight(9) and obesity(15) increased (mean=2.30), whereas those with normal-weight(6) and low-weight(3) first increased (mean=1.29) and then decreased (mean=1.73).

According to Nutrimetry first year classification, mean z-scores (BMI/Height) were compared with repeated measures ANOVA, in all codes except those with high-height p-value ≤0.05.

On the rest codes: z-height tend to increase yearly, but in underweight group, this was not significant every year. Z-BMI in underweight (1 and 3), and normal-weight (4 and 6) codes tend to increase, but it doesn't in overweight (7 and 9) and obesity (13 and 15) groups.

**Conclusions:** Prevalence of short-height is decreasing, but in underweight children, it is more complicated to fight against this condition.

Although in the overweight and obesity groups, z-BMI do not increase, the prevalence of these groups is still increasing, indicating that the approach should not only be interventional, but also preventive.

<footnote>(1)Mundo Rosas, Veronica; (2)Gallardo Medina, Delmy del Carmen;</footnote>

<footnote>(3)Quezada Sánchez, Amado David; (4)Shamah-Levy, Teresa.</footnote>

<footnote>(1)National Institute of Public Health. Mexico; (2)School of Public Health of Mexico. Mexico; (3)Information Center for Public Health Decisions. National Institute of Public Health. Mexico;</footnote>

<footnote>(4)2 Nutrition and Health Research Center. National Institute of Public Health. Mexico.</footnote>

<footnote>(1)Selem Solís, Jorge Enrique; (2)Alcocer-Gamboa, Alberto; (3)Hattori-Hara, Mónica.</footnote>

<footnote>(1)MPH. Medical Doctor. Tenabo's Health Center. Campeche
Ministry of Health. México.; (2)M.Sc. Medical Doctor. PIAOY
Program. Ministry of Education of the Government of the State
of Yucatan. México.; (3)Ph.D. in Psychology. PIAOY Program.
Ministry of Education of the Government of the State of Yucatan.
México.</footnote>
**Keywords:** Nutrimetry, Yucatan elementary school children, z-BMI, z-Height

**Further collaborators:** Integral Program for Childhood Obesity Attention (PIAOIY) group 2010-2016

## 144/2302

### ULTRA-PROCESSED FOODS AND ADDED SUGARS IN CHILEAN DIET (2010)

(1)Cediel, Gustavo; (2)Reyes, Marcela; (1)Louzada, Maria Laura da Costa; (3)Martinez, Euridice; (4)Monteiro, Carlos; (2)Corvalan, Camila;

(2)Uauy, Ricardo.

(1)Post-doctoral fellow. Department of Nutrition. University of São Paulo. Brazil; (2)Professor. Institute of Nutrition and Food Technology. University of Chile. Chile; (3)Doctoral fellow. Department of Nutrition. University of São Paulo. Brazil;

(4)Professor. Department of Nutrition. University of São Paulo. Brazil.

**Background and objectives:** A rapid simultaneous increase in sales of ultra-processed foods and obesity prevalence has been observed in Chile in the last decade. This study evaluated the consumption of ultra-processed foods in Chile and its association with the intake of added sugars in the diet, one important driver of obesity.

**Methods:** A probabilistic sample of 4920 individuals (>2y) from a cross-sectional dietary study carried out in Chile in 2010 was included. Food consumption was measured through 24-hour recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification). Gaussian regression analyses were used to estimate the association between energy contribution of ultra-processed foods and the energy intake of added sugars (as proportions of total energy intake). Poisson regression models were used to analyze the proportion of individuals consuming more than 5 and 10% of total energy from added sugars (World Health Organization, WHO, cutoffs) across quintiles of the energy share of ultra-processed foods.

**Results:** In the Chilean diet, ultra-processed foods represented 28.6±0.5% of total energy intake and 56.5±0.9% of added sugars intake. The mean percent of energy from added sugars was 13.5% and increased from 7.9±0.3% to 20±0.5% across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage points increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were 2.7 (95%IC: 2.3-3.2) times more likely to exceed the 10% upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was stronger among individuals between 2-19y (3.9 (95%IC: 2.7-5.9)).

**Conclusions:** Ultra-processed foods are important contributors to the excessive added sugars content of the Chilean diet. Actions aimed at decreasing the consumption of ultra-processed

foods emerge as useful tools for achieving WHO dietary recommendations on added sugars, especially among children and adolescents. Funding: FAPESP n°2016/13522-3

**Keywords:** Chile, food processing, ultra-processed foods, added sugars.

**Further collaborators:**

The Ministry of Health of Chile supplied the Database (Chilean National Dietary Survey, 2010).

## 144/2304

### NUTRITIONAL STATUS OF CHILDREN UNDER 5 YEARS IN TWO VULNERABLE TERRITORIES IN CALI - COLOMBIA

(1)Villamarín Betancourt, Eder Antonio; (2)Velasco, Carlos; (3)Jimenez, Abelardo; (4)Hernandez Carrillo, Mauricio; (3)Jiménez Urrego, Ángela María; (5)Luna, Monica; (6)Mendoza, Luis Alfonso; (5)Gulloso Pedroza, Leonel; (7)Lince Rivera, Catalina; (3)Cubides Munevar, Angela M.

(1)Doctor. GISAP (public health research group). Universidad Santiago de Cali - Universidad del Valle. Colombia.; (2)Doctor and Magister. GISAP (public health research group). Universidad del Valle. Colombia; (3)Magister. GISAP (public health research group). Universidad Santiago de Cali - Universidad San Martín - Universidad del Valle. Colombia.; (4)Magister. GISAP (public health research group). Universidad San Martín - Universidad del Valle. Colombia.; (5)Magister. GISAP (public health research group). Universidad Santiago de Cali. Colombia.; (6)Doctor. GISAP (public health research group). Fundación Ciencias de la Salud. Colombia; (7)Doctor. GISAP (public health research group). Universidad Santiago de Cali - Universidad Javeriana Bogotá. Colombia.

**Background and objectives:** Introduction: child nutrition is fundamental for physical, cognitive, emotional and social development. The relevance of nutritional status lies on the fact that it is a direct reflection of a country's progress and inequalities. Objectives: definition of the nutritional status of children under 5 years in two vulnerable territories in Cali - Colombia.

**Methods:** prevalence study using cluster randomized sampling. Univariate analysis was performed taking into account de variable nature and distribution. For the qualitative variables frequencies, central tendency and dispersion were estimated. ANTRO software of the WHO was used for child growth standards. The variables used were BMI/age, length/age and weight/length.

**Results:** for the variable BMI/age; 12% of the patients were obese, 18% overweight, 8% underweight and 11% in underweight risk. In gender terms boys were predominantly overweight and girls underweight with statistical significance. For the variable length/age; 23% presented short size and 27% were in risk. Boys were more affected but girls were more at risk. For the variable weight/length; 11.9% were obese, 15.7% overweight, 12.6% low weight for length and 7.8% very low weight for length. Excess was more frequent in boys and low weight in girls.

**Conclusion:** in two vulnerable territories in Cali - Colombia one out of two children presents an inadequacy in nutritional status,
this implies that is mandatory to create interventions for children
under 5 years that prevent adverse consequences in the future.

**Keywords:** nutrition, status, prevalence, children, Colombia.

144/2314

FACTORS ASSOCIATED WITH MATERNAL PRO-FILE AND NEWBORNS WITH GASTROSCHISIS TREATED AT A REFERENCE CENTER IN THE CITY OF RIO DE JANEIRO

(1)Amaral, Yasmin; (2)Marano, Daniele; (3)Costa, Ana Carolina;

(4)Moreira, Maria Elisabeth.

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

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

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

**Background and objectives:** The increasing number of new cases of gastroschisis associated with lower mortality rate causes the increased prevalence of this disease, resulting in a significant increase of the costs of this malformation to the health systems.

Despite the high incidence of this malformation in Brazil, there is a shortage of national studies published in the literature. Therefore, this study aimed to trace the maternal profile and newborns with gastroschisis and the main associated risk factors.

**Methods:** Cross-sectional analysis of data collected in the period from January 2012 to July 2013, of all children with gastroschisis operated at the National Institute of Women's Health Child and Adolescent Fernandes Figueira (IFF). Maternal, obstetric and neonatal variables were evaluated.

**Results:** We found a higher prevalence of adolescent mothers (61.7%), brown (55.9%), single (76.3%) and gilts (81.7%). 73.3% of children were born by cesarean section, and the early majority (61.7%) and low birth weight (66.7%). The surgery steps for gastroschisis correction was the most frequent. The average length of stay was 43 days, 23 days to zero diet and 30 days for total parenteral nutrition. The survival rate was 91.7% and the most prevalent high diet was the exclusive breastfeeding (64.8%)

**Conclusions:** The results of this study show increased frequency of gastroschisis among infants born to young women, single, brown, gilts and eutrophic. It was also noted that the average length of stay as well as the zero diet differed in relation to other international studies. This can partly elucidated due to technological and socio-economic differences between Brazil and developed countries.

**Keywords:** Gastroschisis; Epidemiology; Child Health.

144/2323

ASSOCIATION BETWEEN AFFECTION AND NUTRITION IN INFANTS FROM 0 TO 12 MONTHS IN MARIO CORREA RENGIFO HOSPITAL

(1)Villamarín Betancourt, Eder Antonio; (2)Jiménez Urrego, Ángela María; (2)Cubides Munevar, Angela M; (3)Marín Ospina, Jessica;

(3)Vargas Prado, Daniela; (3)Arango Arias, Luz Stella; (4)Méndez Tex, Christian Camilo; (5)Pachón, Alejandra Torres; (6)Botero Carvajal, Alejandro; (7)Ochoa Paredes, Carolina.

(1)Doctor. GISAP (public health research group). Universidad Santiago de Cali - Universidad del Valle. Colombia.; (2)Magister. GISAP (public health research group). Universidad Santiago de Cali - Universidad San Martín - Universidad del Valle. Colombia.;

(3)Psicóloga Universidad Pontificia Bolivariana - seccional Palmira /Integrante del semillero de Investigación en Salud Mental y Psicoanálisis. Colombia; (4)Estudiante VII Semestre de Psicología Universidad Pontificia Bolivariana - Seccional Palmira / Integrante del Semillero de Investigación en Salud Mental y Psicoanálisis Universidad Pontificia Bolivariana - seccional Palmira. Colombia; (5)Estudiante X Semestre de Psicología Universidad Pontificia Bolivariana - Seccional Palmira / Integrante del Semillero de Investigación en Salud Mental y Psicoanálisis Universidad Pontificia Bolivariana - seccional Palmira. Colombia; (6)Docente - Investigador Universidad Pontificia Bolivariana - seccional Palmira - Coordinador semillero: Desarrollo Psicológico en Contexto - Integrante Grupo de Investigación en Pedagogía y Desarrollo Humano. Colombia; (7)Estudiante X Semestre de Psicología Universidad Pontificia Bolivariana - Seccional Palmira / Integrante del Semillero de Investigación en Salud Mental y Psicoanálisis Universidad Pontificia Bolivariana - seccional Palmira. Colombia.

**Background and objectives:** Introduction: few studies analyze the relationship between affection and inadequate alimentary habits, these are remarkably high in low income families where violence and chaotic surroundings are common and are predisposing factors for nutritional - affective repercussions of the minor. Objectives: explore the conditions that favors the affective bond in infants between 0-12 months of age that consult to Mario Correa Rengifo Hospital in Cali city.

**Methods:** mixed study, exploratory. A semi-structured interview was used, family Apgar and Massie- Campbell Scale for observation of mother - baby bonding indicator.

**Results:** 60% of the population of the study was considered as "Estrato 1" (classification system of Colombia depending on family incomes, 1 is the lowest and 6 is the highest). 33% of the families sleep in the same room with the baby. 85.71% of the mothers breastfeed the babies exclusively until the sixth month. 26.98% of the babies that don't breastfeed presents medical complications like malnutrition, intestinal infection and diarrea. 76.19% of the mothers spend most of their time with the baby.

**Conclusions:** There was a relationship between breastfeeding and mother sensibility and bonding. Positive relation between mother and child are important. The mother represents de whole for the baby, not only in the feeding aspect but also love and well-
being. It is important to continue the investigation for promoting breastfeeding in Cali - Colombia.

**Keywords:** Nutrition, bonding, affection, children, Cali

(1)Bordón Riveros, Claudia; (2)Benítez, Leyla; (2)Cantero, Eliana;

(3)Castillo, Ivana; (2)Elizeche, Lourdes; (2)Zayas, Ximena; (2)Miranda, Katherine; (2)Galeano, Brenda; (2)Vidal, Tamara; (2)Martínez, Orfido.

(1)Nutritionist. Paraguay; (2)Estudiante. Universidad Catolica Nuestra Senora del Asuncion. Catedra de Evaluación Nutricional en Comunidades. Paraguay; (3)Nutricionista. Universidad Católica Nuestra Senora del Asuncion. Docente Catedra de Evaluación Nutricional en Comunidades. Paraguay.

**Background and objectives:** Food security in families would have a positive impact on the quality of food and on proper nutrition of its members. It is related to better growth and development of children. Also, it may impact on the work capacity.

The aim of the study was to evaluate the perception of food security in vulnerable families of San Cayetano and surroundings neighborhood during January - 2017.

**Methods:** A cross sectional study carried out on the head of the household of vulnerable families in the neighborhood of San Cayetano and surrounding areas during January 2017. The ELCSA validated questionnaire was used to measure the perception of food security.

**Results:** We evaluated 47 families, of which 35 families had at least one member younger than 18 years.

The median number of member of the families was 5.5 person (minimum 1 - maximum 10). The median of number of children younger than 5 years was 1.5 (maximum 4 - minimum 0). The heads of household were predominantly female (n = 39).

Only 10% (n = 5) of the families had the perception that they had food security. Of those who presented food insecurity, the highest percentage corresponded to those with mild food insecurity (45%, n = 21).

**Conclusions:** The majority of families evaluated presented some level of food insecurity. This situation is relevant because of the characteristics of their vulnerability situation that may worsts in the case of inundation.

**Keywords:** food security, vulnerability, ELCSA

**Further collaborators:**

Andrea Reyes, Gabriela Adorno, Araceli Valdez, Rafael Figueredo.

(1)Pajuelo Ramírez, Jaime; (2)Miranda Cuadros, Marianella; (3)Bernui, Ivonne.

(1)MSc. Medical Doctor. Instituto de Investigaciones Clínicas. Universidad Nacional Mayor de San Marcos. Perú; (2)MSc. Nutritionist. Centro Nacional de Alimentación y Nutrición. Instituto Nacional de Salud. Perú; (3)MSc. Biologist. Centro de Investigación de Bioquímica y Nutrición. Universidad Nacional Mayor de San Marcos. Perú.

**Background and objectives:** One-third of Peru's population lives above 2000 meters above sea level. There is evidence that children in these communities have a higher prevalence of growth retardation than other Peruvian children. Besides, it is a worry that obesity of these children might be increased, for these reasons the objective was to determine the influence of residence altitude on stunting and obesity in Peruvian children under five years of age.

**Methods:** Secondary analysis of the National Monitoring of Nutrition Indicators (2007-2010). The children (n = 3835) were weighed and carved. Stunting was defined as the Z Size / Age score less than -2SD, and the Obesity with Z score / Weight greater than 2 SD from the WHO growth reference. The cutoff point for altitude was 2500 meters above sea level. The poverty intervening variable had two categories: "poor" those with one or more Unsatisfied Basic Needs (NBI) and "non-poor" those who did not have any NBIs.

**Results:** In the first level of altitude (<2500 meters above sea level), the stunting was more prevalent in children older than 24m (13.3%) and in the poor (20.5%), while obesity was highest in children younger than 24m. (11.1%) and non-poor (8.5%). In the second level (≥ 2500 meters above sea level), stunting predominated in children older than 24m. (32.5%) and in the poor (35.8%). As for obesity, it was higher in children under 24m. (5.8%) and in the poor (4.5%). For stunting living in cities that are below 2500 meters above sea level, being less than 24 months and being considered not poor represented a protective factor. While for obesity living in cities below 2500 meters above sea level meant having 3 times more Risk of being obese, in the same way, having less than 24 months represented 2 times more risk of being obese.

**Conclusions:** The stunting is mainly located in the populations of higher altitude, in the majors of 24 months and in the considered as poor, whereas the obesity in the populations of lower altitude, in the children of less than 24 months and in the non-poor group.

**Keywords:** altitude, stunting, obesity, malnutrition
PERCEPTIONS OF MOTHERS ABOUT SCHOOL
BREAKFAST PROGRAM AT AN EDUCATIONAL
INSTITUTION IN LIMA, PERU

(1)Apaza Quispe, Mercedes Lucia; (2)Delgado Pérez, Doris.

(1)Nutritionist. Universidad Nacional Mayor de San Marcos. Peru;

(2)PhD. Nutritionist. Centro de Investigación en Bioquímica y Nutrición. Universidad Nacional Mayor de San Marcos. Peru.

**Background and objectives:** Feeding during the school years is critical for the child and the breakfast is an important part of a good diet is breakfast; School Food Program from Peru provides school breakfasts, but we do not know if parents consider this type of breakfast to be optimal. The present study aimed to investigate mother's perceptions, concerns, and attitudes about school breakfast program in an educational institution in Lima, Peru.

**Methods:** Qualitative research approach and grounded theory method. Four focus groups and seven in-depth interviews with a total 31 volunteer mothers of 6-8-year-old children. Mothers were asked their views about the school breakfast program, the attitudes about the food that the program offers their children. Conversations were tape-recorded and transcribed for thematic analysis.

**Results:** The mothers perceived that eating school breakfast improves health, academic performance and eating habits of children, also acknowledged the financial support to the family and the support offered to the mother; on the other hand, they perceived that at often times, children have breakfast both at their houses and at school, which, combined with junk food, could cause diseases. They also reported that the school breakfast had an inadequate variety, while their perceptions of safety, nutritional value and acceptability were varied. Regarding attitudes, mothers showed favorable attitudes to the consumption of school breakfast. However, some mothers showed favored the consumption of breakfast at home.

**Conclusions:** Mothers perceived both pros and cons of school breakfast, as well as positive and negative views regarding its quality.

**Keywords:** School, breakfast, perceptions, attitudes, children

REGULAR MONITORING OF BABY FRIENDLY
HOSPITALS STRENGTHEN THE IYCF PRACTICE
IN BANGLADESH

(1)Roy, Swapan Kumar; (2)Jahan, Khurshid; (3)Salam, Suraya Bintay;

(3)Chaklader, Hasina; (4)Ara, Ferdous; (5)Laboni, Fatema; (6)Khatoon, Soofia.

(1)MBBS, MSc, Dip in Biotech, PhD, FRCP. Senior Scientist. Chairperson. Board of Trustees. Bangladesh Breastfeeding Foundation. Chairperson. Nutrition Foundation of Bangladesh. Bangladesh; (2)MSc. Director. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (3)MSc. Program Manager. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.;

(4)MSc. MPhill. Senior Program Officer. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.; (5)MSc. Research Officer. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.;

(6)MBBS, FCPS, Fellowship in Neonatology, MHPEd. General Secretary. Board of Trustees. Bangladesh Breastfeeding Foundation (BBF). Bangladesh.

**Background and objectives:** Revitalization of Baby Friendly Hospital Initiative (BFHI) program has been started since 2012 and continued till 2016 throughout the country and certified 592 health facilities (HFs) in Bangladesh. To uphold the government investment and initiative, continuous monitoring is ongoing for bringing sustainability of Infant and Young Child Feeding (IYCF) practices in Bangladesh.

The main objective of BFHI monitoring is to strengthen the Baby Friendly Hospital (BFH) practices.

**Methods:** The revitalized BFHs (60 District hospitals, 414 Upazilla Health Complex (UHC), 64 Maternal and Child Welfare Center (MCWC) and 56 tertiary hospitals) are being continuously monitored through direct observation method following a structured monitoring tool by the 15 trained divisional officer in eight divisions of Bangladesh. Necessary information and technical support were also provided to the BFHs to strengthen BFHI committee, LMC/ breastfeeding Corner and practice of 10 steps of BFHI.

**Results:** From September 2016 to February 2017, a total of 97% (576) Baby Friendly Hospitals of eight divisions were monitored. According to the monitoring report, 75% (432) HFs are practicing the 10 steps of BFHI. Active BFHI Committee was found in 42% (241) HFs. Though the LMC was established in all HFs but 30% (178) of them were observed as functional. Compliance of Breast Milk Substitute (BMS) Act was increased and reduced violation. BMS products and leaflets were found only in 3% (17) HFs though representative of the BMS Company was not found in these HFs during Monitoring.

**Conclusions:** All Baby Friendly Hospitals are not following the indicators in all extents, therefore a strong and continuous monitoring system need to strengthen the BFHI practices as well as the IYCF movement in Bangladesh.

**Keywords:** Baby Friendly Hospital Initiative, BFHI, Monitoring, Lactation Management Centre, BFHI Committee.
NUTRITIONAL STATUS AND NUTRITIONAL
KNOWLEDGE ABOUT INFANT AND MATERNAL
NUTRITION AMONG PREGNANT AND MOTHERS
IN QUICHE, GUATEMALA

(1)Nozue, Miho; (2)Chihara, Shoko; (3)Léon, Juana; (3)Mazariegos, Roberto; (4)Juárez, Alejandra; (5)Martínez, Glenda; (6)Hishida, Yuko.

(1)PhD. Nutritionist. Tokoha University. Japan; (2)Nutritionist. Jiyu Gakuen. Japan; (3)BSc. Nutritionist. Dirección de Área de Salud El Quiché. Ministerio de Salud Pública y Asistencia Social. Guatemala; (4)BSc. Nutritionist. Dirección de Área de Salud Ixil. Ministerio de Salud Pública y Asistencia Social. Guatemala; (5)MD. PhD. Independent consultant. Guatemala; (6)MPH. IC Net Limited. Japan.

**Background and objectives:** Guatemala is one of the countries of high rate of maternal mortality and under 5 mortality in Latin America. However specific reason which supposed to relate malnutrition in Guatemala is further consideration.

The aim of this study is to clarify nutritional status and nu-
tritional knowledge among pregnant and to examine nutritional
knowledge and attitudes for infants among mothers. Further, to
detect methodology to improve nutritional status and nutritional
knowledge among pregnant and mothers.

**Methods:** Two non-consecutive days for 24-hour dietary recall and self-reported height and weight were obtained from pregnant. Knowledge, Attitudes and Practices (KAP) survey for nutrition were conducted from both pregnant and mothers. All survey were conducted between August and September, 2016.

**Results:** Underweight 2nd trimester pregnant was 13.4% and 3rd trimester pregnant was 12.6%. Illiterate pregnant was 48.0%. Only 8.0% of 2nd trimester pregnant and 3.6% of 3rd trimester pregnant consumed energy more than estimate energy requirements.

Infant who exclusively breastfed were 73.7%. Mothers did
not feel difficult to breastfeed her baby exclusively for six months
(94.6%).

**Conclusions:** Present study clarified malnutrition of preg-
nant and very limited nutritional knowledge among pregnant and
mothers.

It is needed to consider high rate of illiteracy to develop mate-
rials about nutritional education to improve nutritional status of
pregnant, mothers and infant in the next period of proyect.

Keywords: Nutrition, KAP survey, pregnant, infant, Guatemala

**Further collaborators:**

Naoe Sato (PhD)1), Keiko Kobayashi (PhD)2), Shino Nishimagi (MSc)2), Mayumi Togawa (BSc)1), Waldemar Vélez (MD)3), Sandra Carballo (MSc)4), Adrián Chávez (MD)5), Luis Castellanos (MD)6)

1) IC Net Limited. Japan

2) Koei Research Institute. Japan

3) Dirección de Área de Salud El Quiché, Ministerio de Salud Pública y Asistencia Social, Guatemala

4) Dirección de Área de Salud Ixil, Ministerio de Salud Pública y Asistencia Social, Guatemala

5) Viceministerio Técnico, Ministerio de Salud Pública y Asistencia Social, Guatemala

6) Sistema Integrado de Atención de Salud, Ministerio de Salud Pública y Asistencia Social, Guatemala

OPINION OF SENIOR UNDERGRADUATE STUDENTS OF A NUTRITION PROGRAM ON THE CONTRIBUTION OF SUPERVISED INTERNSHIP IN THE DEVELOPMENT OF PROFESSIONAL SKILLS AND COMPETENCES

(1)Garcia Peloggia de Castro, Adriana; (2)Fraga Guimarães, Andrea.

(1)PhD. Nutritionist. Curso de Nutrição. Centro Universitário São Camilo. Brazil; (2)MSc. Nutritionist. Curso de Nutrição. Centro Universitário São Camilo. Brazil.

**Background and objectives:** The National Curricular Guidelines (Brazil) establish that supervised internships in undergraduate nutrition programs should be developed in three basic areas: collective feeding, public health and clinical nutrition. Additionally, professional training must provide them with knowledge to develop the following general skills and competences: health care; decision-making; communication; leadership; administration and management and permanent education. Hence, our aim was to determine the opinion of senior undergraduate students in a nutrition program of a private educational institution of the city of São Paulo on the contribution of the supervised internship in the development of skills and competences required by the National Curricular Guidelines.

**Methods:** Students graduating in 2016 were asked about the contribution of each area of supervised internship in the skills and competences development. The five-point Likert scale was adopted with the items: totally agree, partially agree, indifferent, partially disagree and totally disagree. The responses were analyzed by means of the average ranking (AR), ranging from 1 to 5, and the closer to 5, the higher the level of agreement. AR below 1.5 constitutes level of "total disagreement", AR between 1.5 to 2.5 is "partial disagreement", AR 2.5 to 3.5 is "indifference", AR 3.5 to 4.5 is "partial agreement" and AR greater than 4.5 is "total agreement". The research was approved by the institution's Ethics Committee.

**Results:** The study had 102 participants. In the collective feed-
ing area, 58 answered totally agree and 32 partially agree, with
AR 4.37 (partial agreement). In the clinical nutrition area, 77
answered totally agree and 22 partially agree, with AR 4.70 (total
agreement). In the public health area, 67 answered totally agree
and 27 partially agree, and AR 4.53, also represented total agree-
ment level.

**Conclusions:** The supervised internship allows the students to experience a professional practice. Although it seems to positively influence the development of the professional identity on students in all three basic areas, the levels of agreement were higher in the clinical nutrition and public health.

Keywords: Nutritionist. Internships. Professional practice.
# PREVALENCE OF INSULIN RESISTANCE AND RISK OF METABOLIC SYNDROME AMONG YOUNG ADOLESCENTS IN KUALA LUMPUR

**Background and objectives:** Insulin resistance, one of the consequences of central obesity, has been proposed to be the metabolic mediator of metabolic dysfunction, such as hyperlipidemia, hypertension, and impaired glucose, which may progress to cardiovascular diseases and type II diabetes. As metabolic alteration is one of the factors that seem to affect obese children and adolescents, therefore, this study aimed to evaluate the prevalence of insulin resistance and the effects of dysregulated glucose homeostasis with metabolic component among children.

**Methods:** Subjects comprised 207 boys and 201 girls aged 9-14 years old in Kuala Lumpur. Anthropometric measurements included weight, height, waist circumferences (WC), skinfold at 5 sites namely biceps, triceps, subscapular, iliac crest and medial calf; body composition was assessed with bioelectrical impedance technique. WHO 2007 BMI-for-age growth reference was used to group subjects into overweight/obese (O/O) and non-overweight/obese groups (non-O/O). Blood pressure (BP) was taken, fasting blood glucose (FBG), triglycerides (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), total cholesterol (TC) and insulin were determined in overnight fasting blood sample. The International Diabetes Federation 2007 criteria for children were used to identify metabolic syndrome (MS) risk while homeostasis model assessment method was used to calculate insulin sensitivity (IR).

**Results:** Girls was found to have significantly higher TC (P<0.05), higher skinfold: biceps (p<0.001), triceps (p<0.001), subscapular (p<0.001), iliac crest (p<0.001) and medial calf (p<0.001) compared to boys. MS was found in 2.5% among the adolescents, with 7.9% among O/O subjects. Prevalence of insulin resistance was 14.5%, with 39.7% among O/O subjects. Adolescents with larger WC [OR:19.3 (95%CI: 9.7, 38.5)], high FBG [OR: 8.0 (95%CI: 2.2, 29.2)] and high TG [OR: 4.6 (95%CI: 1.2, 17.2)] were found to have higher risk of developing IR compared to adolescents who did not have poor biochemical profiles.

**Conclusions:** We conclude that Insulin resistance was strongly related to metabolic risk and may be used as an indicator to assess

children's risk for MS. Appropriate intervention programs should be planned to increase awareness and to promote healthy lifestyles in order to prevent central obesity among children and thus lower metabolic syndrome risk.

**Keywords:** children, insulin resistance, metabolic syndrome

# NUTRITIONAL STATUS AT BIRTH IS ASSOCIATED WITH BMI IN YOUNG ADULTS. TWO COHORTS STUDY IN CHILE

**Background and objectives:** Studies in developed countries have shown that nutritional status at birth was related with early symptoms of chronic disease however, controversy remains whether the Body Mass Index (BMI) in adulthood is also dependent on the nutritional status at birth. As we are following two bidirectional cohorts born 15 years apart –a period of hasty economic growth–in Chile, we aim at evaluating if a differential association between nutritional status at birth and adult BMI would be observed in those cohorts.

**Methods:** Cohort 1 (n=999), born in 1974-78 was evaluated in 2001-02; Cohort 2 (n=746 as yet), born in 1988-92 is being evaluated in 2014-17. Weight and length were collected from birth records so that birth and BMI at birth are surrogates of nutritional status at birth; weight and height in adult life are being assessed concurrently as they grow old. Analyses used multivariate linear regression adjusting by sex and stratifying by cohort as an effect modifier.

**Results:** Mean birth weight (±SD) was 12.95 (±1.39) in Cohort 1 and 13.52 (±2.89) in Cohort 2, while BMI at 24-28 were 25.8 (±4.46) and 27.4(±5.6) respectively, all differences significant (p <0.001). Multivariate linear regression reveals that for 1 unit increases of newborn's BMI adult's BMI rise by 0.196 whereas as birth weight increased by 1 kg adulthood BMI rose 1.35 (95% CI 0.88 to 1.83) in adulthood. Cohort effect does not modify the observed effect as shown through stratified analysis.

**Conclusions:** These data show a direct–rather than Barker's inverse– relationship between birth weight or BMI at birth and BMI in adult life. It seems that both BMI and weight at birth are good predictors of overweight in young adults thus, being useful early alert for children growth surveillance.

**Keywords:** Birth weight, Adult Nutritional Status, cohort study

**Conflict of Interest Disclosure:** Financed by the National Research Funds (Chile) Grant # 1140453. None

<footnote>(1)Wee, Bee Suan; (2)Awang Mahmud, Bulgiba; (3)Noor, Mohd Ismail;</footnote>

<footnote>(4)Liu, Ailing; (5)Deurenberg, Paul; (6)Poh, Beekoon.</footnote>

<footnote>(1)Bsc. MSc. PhD. Nutritional Sciences Programme. School of Healthcare Sciences. Faculty of Health Sciences. Universiti Kebangsaan Malaysia. Kuala Lumpur. Malaysia; (2)MBBS. MPH. MApp. Stat. PhD. Julius Centre University of Malaya. Faculty of Medicine. University of Malaya. Kuala Lumpur. Malaysia; (3)BSc. MSc. PhD. School of Hospitality. Tourism and Culinary Arts. Taylor's University. Subang Jaya. Malaysia; (4)MD.PhD. National Institute of Nutrition and Food Safety. Chinese Center for Disease Control and Prevention. Beijing. China; (5)PhD. Nutrition Consultant. The Philippines.; (6)BSc. PhD. Nutritional Sciences Programme. School of Healthcare Sciences. Faculty of Health Sciences. Universiti Kebangsaan Malaysia. Kuala Lumpur. Malaysia.</footnote>

<footnote>(1)Vasquez, Ximena; (2)Bustos, Patricia; (3)Ramirez, Marcela;</footnote>

<footnote>(4)Zumelzu, Elinor; (5)Amigo, Hugo.</footnote>

<footnote>(1)Msc. Nutrition. Pediatrician. Department of Nutrition. University of Chile. Chile; (2)PhD. Pediatrician. Department of Nutrition. University of Chile. Chile; (3)Student Msc. Physician. José Joaquin Aguirre Hospital. University of Chile. Chile;</footnote>

<footnote>(4)Msc. Pediatrician. University of Chile; (5)PhD. Public health. Department of Nutrition. University of Chile. Chile.</footnote>
**Background and objectives:** Recent years the communication of healthy lifestyle has changed a lot. The spread of free access of internet for many people gave opportunity to get information about health even from unverifiable sources, where there is no health care professional control.

Our goal was with this study to collect data among the Hungarian adults regarding their nutritional knowledge, believes, and misbelieves, food safety, labelling, healthy lifestyle and other habits.

**Methods:** A representative study with a questionnaire for 1,019 participants in Hungary (CAPI=569 and CAWI=450). The sample was representative for Hungarian population in terms of age (15-69), sex, region and settlement type. The study was carried out between June and July in 2016.

**Results:** Three quarter of the respondents feels informed about healthy diet (62%).

Barriers to a healthier lifestyle are: money (66%), willpower (39%), healthier products (36%). Half of the respondents are unaware of the recommended daily energy intake (48%) and also their own actual intake (57%). 42% finds that certain food types are unhealthy by their nature.

Unhealthy food is characterized by artificial ingredients (47%) and lack of freshness (28%). About half of the consumers claim reading the labels (61%) (but mostly when buying a new product), and considering the indicated nutritional information. For them, the most important info are ingredients (51%) and the expiry date (41%). Nutritional facts are less frequently mentioned (39%).

**Conclusions:** Proper nutrition and physical activity are fundamental to achieve or maintain good health. However, the average consumer is often reluctant to give up on good (familiar) taste, alcohol and convenience. Low physical activity level is general. Moreover, many of them are not able (or willing to) spend more money on food. The lifestyle-related diseases mean serious medical, public health and economic problems, and they require higher public awareness and political support.

**Keywords:** facts, misbelieves, attitude, nutritional habits

**Background and objectives:** According to its new guidelines, the World Health Organization recommends reducing the intake of free sugars to less than 10% of the total energy intake in adults and children. Following these recommendation, Morocco has recently developed a plan of sugar reduction in order to reinforce prevention of non-communicable diseases which is a major problem at the national level. The present study is a masterpiece of this national strategy since its objective is to determine the threshold of perception of sugar taste in the Moroccan population.

**Methods:** The study involved 199 people who tested 9 solutions containing different concentrations of sucrose: 0; 0.111; 0.333; 1; 3; 9; 27; 81; 243 mmol/l. The panelists evaluated the samples per session using the blind Alternative Forced Choice method. The test is repeated twice when consumers perceive the sweet taste for confirmation of the threshold of perception. Informations on age, sex, height, weight and Body Mass Index was collected and transcribed on SPSS software for statistical processing.

**Results:** The results showed that 40.20% of the testers had a threshold of perception of the sweet taste at 27 mmol/l (9.24g/l) of sucrose. Only 25.62% and 15.07% of the testers have a threshold of perception of sweetness respectively at 9 mmol/l (3.08g/l) and 3 mmol/l (1.03g/l). A proportion corresponding to 7.53% of the testers perceived the sweet taste only from the solutions containing 81 mmol/l (83.17g/l) of sucrose. The khi2 test shows a significant correlation between the perception of the sweet taste and the age of testers (p value = 0,050) and the perception of the sweet taste and the BMI (p value = 0,021). The sexe has no significant effect on the threshold of perception of the sweet taste (p value = 0.610).

**Conclusions:** The results obtained explain the pronounced taste of Moroccan children and adults for sweet. who takes 2.7 times more sugar compared to a Caucasian for which the thresh-

<footnote>(1)Benkirane, Hasnae; (2)Taboz, Youness; (3)Benajiba, Nada;</footnote>

<footnote>(4)Khadmaoui, Abderrazzak; (5)Bouziani, Amina; (5)Guennoun, Yasmine; (5)Bajit, Habiba; (6)Bentahila, Nawal; (7)Barkat, Amina;</footnote>

<footnote>(2)Aguenaou, Hassan.</footnote>

<footnote>(1)PhD. Joint Nutrition and Food Research Unit. URAC 39. University Ibn Tofail. National Center of Energy, Sciences and Nuclear Techniques. Morocco; (2)PhD. Joint Nutrition and Food Research Unit. URAC 39. University Ibn Tofail. National Center of Energy. Sciences and Nuclear Techniques. Morocco; (3)PhD. Clinical Nutrition Program. Department of Health Sciences. College of Health and Rehabilitation Sciences. Princess NourahBintAbdulrahman University. Riyadh. KSA.; (4)PhD. Laboratory of Engineering and Biometrics. Faculty of Science. Kenitra. Morocco; (5)PhD Student. Joint Nutrition and Food Research Unit. URAC 39. University Ibn Tofail. National Center of Energy. Sciences and Nuclear Techniques. Morocco; (6)Doctor. Research Group on Infant Feeding and Nutrition (GANIM). Morocco; (7)PhD. Health and Nutrition Research Team of the Mother Child Couple. Faculty of Medicine and Pharmacy of Rabat. Mohammed V University of Rabat. Morocco.</footnote>
old of perception of sweet taste is 10 mmol/l. The national plan for the reduction of sugar consumption will take this into account in order to gradually reduce the sugar content in processed foods.

**Keywords:** Threshold of perception. Sweet taste. Morocco.

144/2417

DIETARY QUALITY AND FOOD PROCESSING LEVELS IN SUBSTANTIAL OUT-OF-HOME EATERS AND NON-SUBSTANTIAL OUT-OF-HOME EATERS

**Background and objectives:** Consumption of convenient ready-prepared foods and eating out-of-home has raised in low- and-middle income countries. Eating out-of-home has been associated with unhealthy dietary patterns rich in processed and ultra-processed foods. The aim of this study is to compare the dietary quality and foods processing levels between Substantial out-of-home (SOH) and Non-substantial out-of-home (NSOH) eaters.

**Methods:** A cross-sectional study was performed among 779 adolescents from an urban and a rural area in Ecuador (2008-2009). Two non-consecutive 24-hour recalls were used to estimate dietary intake; eating out-of-home was defined when food items were prepared in any place different than: the student home and relative's or friends home. Participants were classified as SOH eaters if they obtained more than 25% of their daily energy intake out-of-home; meanwhile, those who obtained ≤25% of daily energy intake out-of-home were identified as NSOH. Food processing levels were categorized using the NOVA Brazilian classification into non-processed, culinary ingredients, processed and ultra-processed foods. Two sample t-test was used to compare mean daily energy intake, energy density and macronutrient energy %, as well as energy % intake by food processing levels between SOH and NSOH eaters.

**Results:** Overall, 71.89% of participants were classified as SOH eaters. Total energy intake (1927 kcal vs. 1825 kcal; p = 0.01), energy density (1.82 kcal/g vs. 1.62 kcal/g; p = 0.00) and total fat %

(24.7% vs. 22.1%; p = 0.00) intakes were higher among SOH eaters compared with NSOH eaters. In addition, SOH eaters obtained less energy from non-processed food (48.4% vs. 60.7%; P<0.001) but more energy from processed (4.5% vs. 2.2%; P<0.001) and ultra-processed (34.7% vs. 22.5%; P<0.001) foods when compared with NSOH eaters.

**Conclusions:** A great percentage of our population were SOH eaters and their dietary quality was considerably unhealthy. SOH eaters consumed more processed and ultra-processed foods, which are associated with the development of non-communicable diseases. Therefore, out-of-home preparation places should be considered when establishing nutritional policies.

**Keywords:** eating-out-of-home, food processing levels, dietary quality

144/2421

ULTRA-PROCESSED FOODS CONSUMED BY CHILDREN BELOW FIVE YEARS OF AGE IN THE CITY OF RIO DE JANEIRO, BRAZIL

**Background and objectives:** The prevalence of obesity and non-communicable chronic diseases has increased rapidly worldwide. Scientific evidence indicates that these outcomes are associated to the inversion of dietary patterns, identified by the substitution of traditional food by ultra-processed and ready-to-eat foods and beverages. Our aim was to characterize ultra-processed foods (UPF) consumed by children below five years of age assisted at the public health care system in the city of Rio de Janeiro, Brazil.

**Methods:** A descriptive, cross-sectional study was performed in a probabilistic sample of children between six and 59 months assisted in the Unified Health System (n=539). Twenty-four-hour dietary recalls were applied and all mentioned UPF and their respective brands were listed. A market research was conducted aiming the collection of data about UPF's nutritional composition. These products were grouped by similarity (e.g. cookies and crackers, sugary drinks, etc.), and groups were characterized, among others, in relation to: energy, fat and sodium, per 100 g (or 100 ml) and per portion reported by the manufacturers. For this, the mean portions of each group's products were calculated.

**Results:** A total of 387 UPFs were reported, of which: sugary drinks (97); Cookies and crackers (69), Ice-cream, sweets and candies (58); yogurts and dairy beverages (39); snacks and chips (15), and instant cereals (15). Considering the analysis per 100g and / or per portion, the products that presented the worst nutritional profile in relation to energy (E), lipids (L) and sodium (S) were: E

<footnote>(1)García García, Ana Angélica; (2)Zúñiga Carpio, Gabriela Alexandra;</footnote>

<footnote>(3)Córdova Jimbo, Diana Paola; (4)Ramírez Jimbo, Patricia Liliana;</footnote>

<footnote>(5)Morillo Argudo, Diana Alexandra; (4)Andrade Muñoz, Diana Jesús;</footnote>

<footnote>(6)Donoso Moscoso, Silvana Patricia; (7)Andrade Tenesaca, Dolores Susana; (8)Ochoa Avilés, Angelica.</footnote>

<footnote>(1)BSc. Engineer. Department of Biosciences. Cuenca University. Ecuador.; (2)MSc. Nutritionist. Department of Biosciences. Cuenca University. Ecuador.; (3)BSc. Laboratorist. Department of Biosciences. Cuenca University. Ecuador.; (4)MSc. Engineer. Department of Biosciences. Faculty of Chemistry Science. Cuenca University. Ecuador.; (5)BSc. Medic. Department of Biosciences. Cuenca University. Ecuador.; (6)MSc. Biochemist. Department of Biosciences. Faculty of Chemistry Science. Cuenca University. Ecuador.; (7)MSc. PhD. Engineer. Department of Biosciences. Faculty of Chemistry Science. Cuenca University. Ecuador. Ecuador.; (8)PhD. Medic. Department of Biosciences. Faculty of Chemistry Science. Cuenca University. Ecuador.</footnote>

<footnote>(1)Avelar, Carine; (2)de Moraes, Milena Miranda; (3)Damião, Jorginete de Jesus; (3)de Castro, Inês Rugani Ribeiro.</footnote>

<footnote>(1)BSc. Nutritionist. Department of Social Nutrition. State University of Rio de Janeiro. Brazil; (2)PhD. Nutritionist. Posdoctoral fellow. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.; (3)PhD. Associate professor. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.</footnote>
/ L / S - instant noodles, chips, processed meats and fast food fries; E / L - cookies and crackers, cakes and popcorn; L / S - creamy cheese; E: ready to eat "farofa"; S - margarine, instant seasoning and tomato sauce.

**Conclusions:** There is a wide range of UPF consumed by the study population. Nutritional profile of these UPF presents characteristics that are harmful to children's health. This evidence supports the revision of the Food Guide for Children under Two Years, conducted by the Brazilian Ministry of Health and currently in progress.

**Keywords:** Ultra-processed foods; nutritional profile; Macronutrients; Sodium.

144/2423

ACCEPTABILITY AND FEASIBILITY OF A NUTRITION EDUCATION INTERVENTION TO PROMOTE CONSUMPTION OF PULSE BASED FOOD PRODUCTS IN CHILDCARE CENTRES IN SASKATCHEWAN: A PILOT STUDY

(1)Ramikie, Renee; (2)Hailelassie, Hiwot; (3)Froehlich Chow, Amanda; (4)Shand, Phyllis; (5)Bird, Yelena; (6)Engler-Stringer, Rachel; (7)Vantanprast, Hassanali; (8)RAMDATH, DAN; (7)Henry, Carol.

(1)BSc. College of Pharmacy and Nutrition. University of Saskatchewan. Canada; (2)M.Sc. College of Pharmacy and Nutrition. University of Saskatchewan. Canada; (3)PhD. College of Kinesiology. University of Saskatchewan. Canada; (4)PhD. College of Agriculture and Bio resources. University of Saskatchewan. Canada; (5)PhD. School of Public Health. University of Saskatchewan. Canada; (6)PhD. College of Community Health and Epidemiology. University of Saskatchewan. Canada; (7)PhD. College of Pharmacy and Nutrition. University of Saskatchewan. Canada; (8)PhD. Guelph Research Development Centre. Agriculture and Agri-Food Canada. Guelph. Canada.

**Background and objectives:** The consumption of nutritionally beneficial foods during the early years, can lead to healthy eating habits that continue into adulthood. One type of food high in nutritional value are pulse crops. However, despite the nutritional benefits of pulses they are not widely consumed by the young children within the Canada. The study objective was to evaluate the acceptability and feasibility of a pilot pulse based nutrition education curriculum entitled "Pulse Discovery Tool Kit" (PDTK) among 2 to 5 years old children. The kit is designed to promote healthy eating habits and promote pulse consumption within childcare centres.

**Methods:** The study was conducted in two childcare centres in Saskatchewan, over a 3-month period. The intervention included weekly lesson plans, a food service guide, pulse recipes and parent's newsletter. Data was captured on feasibility and acceptability of the PDTK through sensory evaluations, lesson plan evaluations, teachers' and cook's interviews and individualized plate waste.

**Results:** Sensory analysis revealed that majority of the children liked the pulse recipes, 44% liked the green split pea spread

initially, which was increased to 56% during a repeated taste testing session. The lesson plan evaluations and the teachers' interviews indicated that most of the lesson plan activities could be implemented into existing curriculum and had excellent nutrition concepts. Cooks from both centres believed that it was feasible to include recipes from the PDTK into their regular menus and expressed no barriers to cooking and serving pulses within their facilities. Measurements of the individualized plate waste indicated that the pulse recipes had lower amounts of saturated fat, calories and sodium in comparison to regular recipes.

**Conclusions:** The pilot testing of the PDTK showed that it was both acceptable and feasible to implement this model within childcare centres to improve pulse consumption for children 2-5 years old.

**Keywords:** Pulse Discovery Tool Kit, Nutrition Education, Childcare centres

144/2424

SCALING UP A COMMUNITY-BASED GRAINBANK INTERVENTION FOR IMPROVED INFANT AND YOUNG CHILD FEEDING (IYCF) IN ETHIOPIA

(1)Sako, Binta; (2)Leerlooijer, Joanne N.; (3)Lelisa, Azeb; (4)Hailemariam, Abebe; (5)Brouwer, Ingeborg; (6)Tucker Brown, Amal; (7)Osendarp, Saskia.

(1)PhD. Independant Consultant. Brussels. Belgium; (2)PhD. University of Applied Sciences. Utrecht. The Netherlands; (3)Senior Programme Officer. Micronutrient Initiative. Addis Ababa. Ethiopia; (4)Nutrition Project Officer. UNICEF. Addis Ababa. Ethiopia; (5)PhD. Nutritionist. Division of Human Nutrition. Wageningen University. The Netherlands; (6)MSc. Nutrition Specialist. UNICEF. Addis Ababa. Ethiopia; (7)PhD. Nutritionist. Division of Human Nutrition. Wageningen University. The Netherlands. Micronutrient Initiative. Canada.

**Background and objectives:** Child malnutrition remains high in Ethiopia and inadequate complementary feeding is a contributing factor. In this context developing partners designed a community-based intervention to provide locally-made quality complementary food for children 6-23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities in the same regions. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention.

**Methods:** Eight study sites were selected to perform 52 key informant interviews (KII) and 31 focus group discussions (FGD) with purposely selected informants. A total of 52 KIIs and 31 FGDs were performed. For analysis, we used a framework describing six elements of successful scaling up: socio-political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale up process.

**Results:** A strong political will, the alignment of the intervention with national priorities and the integration with the healthcare
system were instrumental in the scaling up process. The participa-
tory approach in decision making reinforced ownership at com-
munity level, and knowledge acquired through program training
motivated mothers and women's groups to participate. However,
the management of the complex intervention, limited human re-
sources and lack of incentives for female volunteers proved chal-
lenging. In the bartering model, the barter rate was accepted but
the bartering was hindered by unavailability of cereals, and limited
financial and material resources to contribute (like firewood) at
community level threatening the sustainability.

**Conclusions:** Scaling up strategies for nutrition interventions require sufficient time, thorough planning and assessment of the community's capacity to contribute human, financial and material resources.

**Keywords:** Ethiopia, IYCF, scaling up implementation, com-
munity-based, process evaluation.

144/2425

IMPROVING THE MINIMUM ACCEPTABLE DIET AMONG INFANTS

(1)Ouma, Cyprian; (2)Tanimoune, Mahamadou.

(1)WFP. Kenya; (2)PHN. Nutritionist. WFP. Rwanda.

**Background and objectives:** In Rwanda, there is a positive correlation between adequate food intake and child stunting. Children under 2 years with adequate infant and young child feeding have about half the prevalence of stunting as those without adequate food. Appropriate complementary feeding of children 6 to 24 months remains extremely low. We assessed the impact of multi sectoral nutrition programme on meeting the child minimum acceptable diet (MAD).

**Methods:** A cross-sectional survey was conducted to collect data on the targeted population in the two districts between August and September 2016. Two-stage sample stratification by district and wealth category was done and 1679 children were sampled aged 6-23 months. Effects of 1000 days campaign, cooking demonstration, growth monitoring, distribution of nutrition booklets, Micro-Nutrient Powders (MNP), complementary interventions with fortified blended food supplements on MAD to under 2 years children were assessed.

**Results:** Children enrolled in complementary intervention were able to improve minimum acceptable diet from 2 to 6 times with children 6 to 23 months meeting the MAD ranging between 16.7% for 6-11 months and 21.5% for 12-17 months with an overall rate of 19.2%, higher than baseline rate (12.1%). In households that received MNP, the 27.5% of the children attained MAD with those who consumed MNP prior to survey increasing to 31.7%. In complementary feeding using fortified blended food supplements in poor households, 37.6% of children that consumed CSB++ the day before the survey met the MAD compared to 7.8% of those who did not consume reaching the minimum acceptable diet. 30.6% of Households that received these booklet met the minimum acceptable diet.

**Conclusions:** Children receiving high quality diet are less like-
ly to be stunted and inclusion of one UN interventions in future
nutrition programs improves the children Minimum Acceptable
Diet.

**Keywords:** micro nutrient powders, minimum acceptable di-
et, stunting

144/2430

PREVALENCE OF FOOD ALLERGY AND COM-
MON FOOD ALLERGENS AMONG ECUADORIAN
ADOLESCENTS: A CROSS SECTIONAL STUDY

(1)Morillo Argudo, Diana Alexandra; (2)Andrade Tenesaca, Dolores Susana; (3)Rodas Espinoza, Claudia Rosana; (4)Tesfalem Gebreegziabher, Lukas; (5)Córdova Jimbo, Diana Paola; (6)Zúñiga Carpio, Gabriela Alexandra; (7)García García, Ana Angélica; (8)Ochoa Avilés, Angelica.

(1)MD. Department of Biosciences. Cuenca University. Cuenca. Ecuador.; (2)Eng. MSc, PhD. Department of Biosciences. Faculty of Chemistry Sciences. Cuenca University. Cuenca. Ecuador.; (3)MD. Immunologist. Faculty of Medicine. Azuay University. Cuenca. Ecuador.; (4)MD, MSc. Ghent University. Ghent. Belgium; (5)BSc. Department of Biosciences. Cuenca University. Cuenca. Ecuador.; (6)Nutritionist. MSc. Department of Biosciences. Cuenca University. Cuenca. Ecuador.; (7)Eng. Department of Biosciences. Cuenca University. Cuenca. Ecuador.; (8)MD, PhD. Department of Biosciences. Faculty of Chemistry Sciences. Cuenca University. Cuenca. Ecuador.

**Background and objectives:** Food allergy (FA) affects millions of people around the world and is an important risk factor for fatal anaphylaxis in adolescents and young adults. In developing countries little is known about FA. Therefore, the objectives of this study are to determine the prevalence of FA as well as to identify the most common food allergens among Ecuadorian adolescents.

**Methods:** The study involved 1379 school-going adolescents from Cuenca (n= 917) and Santa Isabel (n= 462) cantons. Parents and adolescents filled-out a self-reported questionnaire to assess sociodemographic characteristics and history of food-associated allergic symptoms either self-perceived or identified by physician. IgE mediated food sensitization was measured by skin prick test (SPT) using food commercial allergens. Positive SPT was defined when the wheal size was ≥ 3 mm that negative control. Self-perceived FA was defined when the participants reported perceived food-associated symptoms and had a positive SPT; meanwhile, physician diagnosed FA was defined with a positive SPT and a concomitant food-associated symptoms identified by a physician. Prevalence rates of FA are reported in percentages with confidence intervals (CI). Differences in FA by gender were estimated using Chi-Square tests.

**Results:** Self-perceived FA was prevalent among 1.02% (95% CI 0.49-1.54) of the participants. Physician diagnosed FA was prevalent in 0.44% (95% CI 0.04-0.68) of the adolescents. The
most frequent food allergens were shrimp (0.73%; CI 0.28-1.18), followed by milk (0.2%; CI 0.07-0.35), walnut (0.2%; CI 0.07-0.35), peanut (0.2%; CI 0.07-0.35), soybean (0.07%; CI 0.07-0.21), meat (0.07%; CI 0.07-0.21), fish (0.07%; CI 0.07-0.21) and tomato (0.07%; CI 0.07-0.21). The reported prevalence were not different according with the participants' gender.

**Conclusions:** FA was prevalent among Ecuadorian adolescents. More important food allergens identified in this population (shrimp, milk, walnut, peanut) are similar than those reported in developed countries. Monitoring adolescents with self-perceived FA is crucial to identify and prevent fatal anaphylaxis.

**Keywords:** adolescent, Ecuadorian, food allergen, skin prick test.

(ka). For continuous variables intra-class correlation coefficients (ICC) were calculated. The values of PA, k, ka and ICC were classified according to the criteria of Landis & Koch (1977).

**Results:** 73.5% and 65% of the 204 items evaluated presented a substantial or near perfect agreement, respectively, for the inter-observer test and the test-retest. Considering the ka, both the inter-observer test and the test-retest showed that 93% of the items presented substantial or near-perfect agreement. Of the 176 items also assessed by means of PA, 100% showed substantial or near-perfect agreement for the inter-observer test and the test-retest.

**Conclusions:** The instrument presented excellent performance in the context in which it was applied.

**Keywords:** food environment, instrument, reliability, university

144/2434

DEVELOPMENT AND EVALUATION OF THE RELIABILITY OF AN INSTRUMENT FOR ASSESSING THE UNIVERSITY FOOD ENVIRONMENT

**Background and objectives:** The organizational food environment, including the university, has been recognized as strategic for health promotion, since the foods offered there influence the eating habits of the individuals who attend these spaces. There are few studies on the evaluation of the performance of instruments used to assess university food environment. In developing countries, up to this moment there were no studies. This study proposes an instrument to assess the university food environment and evaluates its reliability in public universities in Brazil.

**Methods:** A checklist was prepared for the assessment of the university food environment, containing the following blocks: characterization of establishments, observation of the environment, availability, price, nutritional information and advertisements of healthy and unhealthy food markers. A convenience sample (n=64) of establishments with different characteristics distributed on seven campuses of three different public universities located in the state of Rio de Janeiro was studied. Data were collected from November 2015 to February 2016 by trained fieldworkers. The reliability of the instrument was examined by inter-observer and test-retest tests. For categorical and counting variables, instrument stability was estimated by calculating percent agreement (PA), kappa and prevalence- and interviewer bias-adjusted kappa

144/2435

UNIVERSITY FOOD ENVIRONMENT: CHANGE IN TIME IN A BRAZILIAN UNIVERSITY

**Background and objectives:** The food environment is characterized by the availability of food and drink to individuals. The organizational food environment, including the university, has been recognized as strategic for health promotion. Studies suggest that the University food environment (UFE) represents a barrier to healthy eating practices. We did not identify studies that evaluate changes in UFE over time. This study evaluated the availability of healthy food (HFM) and unhealthy food (UFM) markers over time in a public university in the State of Rio de Janeiro.

**Methods:** Data collection took place in 2011, 2012 and 2016, through a census of food retailers. A checklist (psicometrically tested for reliability and content validity) was used to evaluate the availability of HFM (fruit juice, fruits, vegetables, meals per kilo or meals per plate) and UFM (sugary beverages, salads, sandwiches, savory snacks and candies). Analyses were performed comparing the relative frequencies of the studied variables observed in each year.

**Results:** 15, 17 and 25 establishments were evaluated, respectively, at each time point. The availability of HFM has been reduced over the years: juices: 66.7, 58.8 and 44.4%, vegetables: approximately 47% in the first two years and 32% in the last one, fruits: 40%, 47.1% and 24%, meals per kilo or meals per plate: 26.7%, 23.5% e 20%. As for the UFM, there was stability in the availability of sugary beverages (100% in all years) and sandwiches (~ 80%) and reduction in the availability of savory snacks (93.3%,

<footnote>(¹)Franco, Amanda da Silva; (²)Rugani Ribeiro de Castro, Inês;</footnote>

<footnote>(³)Canella, Daniela; (⁴)Pereira, Alessandra Pereira; (⁵)Santos, Claudia</footnote>

<footnote>Roberta Bocca dos; (⁵)Rodrigues, Lúcia; (⁶)Barbosa, Roseane Moreira</footnote>

<footnote>Sampaio; (⁷)Tavares, Letícia Ferreira.</footnote>

<footnote>(¹)PhD. Nutricionist. Municipality of Duque de Caxias. Brazil;</footnote>

<footnote>(²)PhD. Associate professor. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.; (³)PhD. Associate professor.</footnote>

<footnote>University of the State of Rio de Janeiro. Brazil; (⁴)Professor.</footnote>

<footnote>UNIRIO. Rio de Janeiro. Brazil.; (⁵)PhD. Associate professor. Federal</footnote>

<footnote>University of the State of Rio de Janeiro. Brazil; (⁶)PhD. Associate professor. Fluminense Federal University. Brazil; (⁷)PhD. Associate professor. Federal University of Rio de Janeiro. Brazil.</footnote>

<footnote>(¹)Franco, Amanda da Silva; (²)Perez, Patricia; (³)Rugani Ribeiro de</footnote>

<footnote>Castro, Inês; (⁴)Farias, Silvia; (⁵)Oliveira, Ana Lúcia de; (⁶)Ferreira,</footnote>

<footnote>Amanda Peixoto; (⁵)Santos, Cleide Braz dos; (⁵)Rocha, Karla da Silva;</footnote>

<footnote>(⁵)Cruz, Kelly Veloso da.</footnote>

<footnote>(¹)PhD. Nutricionist. Municipality of Duque de Caxias. Brazil;</footnote>

<footnote>(²)PhD. Associate professor. University of the State of Rio de Janeiro. Brazil; (³)PhD. Associate professor. Department of Social Nutrition. State University of Rio de Janeiro. Brazil.; (⁴)MSc.</footnote>

<footnote>Nutricionist. University of the State of Rio de Janeiro. Brazil;</footnote>

<footnote>(⁵)Undergraduate student. University of the State of Rio de Janeiro. Brazil.</footnote>
82.4 and 72% respectively) and candies (93.3%, 88.2 and 84.0%, respectively).

**Conclusions:** The food environment is dynamic. There was a worsening in the availability of HEM and stability of some UEM at the university studied, representing a barrier to the promotion of adequate and healthy food, since favorable environments are important factors for healthy eating practices. Analyzing the same food environment over time, the present study reveals how much it can change and points out the need to develop interventions that improve this environment focusing on promoting adequate and healthy food and ensuring food and nutritional security.

**Keywords:** food environment, university, time trend

144/2436

PLAYGROUND SIZE AND LEVELS OF PHYSICAL ACTIVITY IN FIRST GRADE CHILDREN OF BUENOS AIRES. DATA FROM MINISALTEN STUDY

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

(4)Kovalskys, Irina.

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

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

**Background and objectives:** Schools with more space to play have greater potential to increase children's physical activity levels. The study aim was to examine if the playground size influences the levels of physical activity (PA) in a sample of first grade children of Buenos Aires.

**Methods:** This data correspond to the baseline assessment (June to November 2015) of MiniSALTEN Study (obesity prevention program targeting first grade children at public primary schools). All children of first grade attending to the 12 public primary schools from the city of Buenos Aires participating in MiniSALTEN were invited to participate. The levels of PA were measured using ActiGraph wGT3X-BT accelerometers for 7 consecutive days (24 hours). Accelerometers outcomes were: time in light, moderate and vigorous PA (minutes/day) determined by Evenson et al.'s cut points. Time in moderate to vigorous PA (MVPA) (minutes/day) was also determined. Accelerometer data were analyzed using the ActiLife 6.11.8 software. For classifying the playground size and school characteristics a scale was used and they were classified in small (S), medium (M) and large (L). Descriptive statistical analyzes of the variables measured for the total were made. Data were processed using IBM SPSS Statistic 18.

**Results:** Sample: 185 children (mean age = 6.7 years, 94 girls and 91 boys) wore accelerometers, 26 children were at S playgrounds, 105 at M and 54 at L. Children spent 7.4 more minutes/

day in MVPA in a larger space compare to a small one (S: 63.2, M: 63.8 and L: 70.6 minutes/day, p = 0.158) as well as more time in vigorous PA (17.9, 16.6 and 20.1 minutes/day respectively, p = 0.100). Also light PA and moderate PA increases progressively according the size of the space (light PA: 333.4, 355.1 and 363.3 minutes/day respectively, p = 0.034; moderate PA: 45.3, 47.2 and 50.5 minutes/day respectively, p = 0.237).

**Conclusions:** In this study a trend is observed, children are more active in large playgrounds compared to medium and small playgrounds. No significant data were found probably due to the small sample, would be interesting to be tested in a larger sample.

**Keywords:** Playground size, Schools, Physical activity, Accelerometers, Children.

**Conflict of Interest Disclosure:** The source of funding for the research is the Coca-Cola Foundation. The authors declare that they have no competing interests. The funding source had no role in study design, data collection and analysis, decision to publish, or preparation of manuscripts.

**Further collaborators:**

On behalf of the MiniSALTEN Study Group.

144/2441

EFFECTIVENESS OF A PROGRAM INTERVENTION WITH REDUCED-IRON MNPS ON MORBIDITY, IRON STATUS AND CHILD GROWTH IN YOUNG CHILDREN IN ETHIOPIA

(1)Samuel, Aregash; (2)Osendarp, Saskia; (3)Adish, Abdul Aziz;

(4)Zarifopoulou, Aikaterina; (5)Kebebe, Amha; (2)Brouwer, Ingeborg.

(1)Msc. Nutritionist. Division of Human Nutrition. Wageningen University. The Netherlands. Ethiopian Public Health Institute. Ethiopia.; (2)PhD. Nutritionist. Division of Human Nutrition. Wageningen University. The Netherlands.; (3)Micronutrient Initiative. Addis Ababa. Ethiopia; (4)Division of Human Nutrition. Wageningen University. The Netherlands.; (5)Ethiopian Public Health Institute. Addis Ababa. Ethiopia.

**Background and objectives:** WHO recommends a daily micronutrient powder supplementation for all young children in populations with a prevalence of childhood anaemia. We assessed the effectiveness of an integrated program with low dose iron (6 mg) MNPs on morbidity, growth and iron status of children 6-23 months of age in Ethiopia.

**Methods:** In a quasi-experimental design, 2356 infants 6-11 months of age, from program and matched-controlled clusters were followed longitudinally for 8 months. All children in program clusters received 15 sachets/month of lower iron dose (6 mg/serving) MNPs (15 nutrients formulation), in addition to a supply of locally produced complementary food. Iron status (Hemoglobin, serum Ferritin, sTfR) was assessed at base- and endline in a subsample. Morbidity from infectious diseases ((bloody) diarrhoea, upper and lower respiratory infections, fever and hospitalizations) were assessed every two weeks by recall. Anthropometry and information on infant feeding practices were collected every quarter.
**Results:** Changes in Hemoglobin concentrations during intervention differed significantly (p = 0.054) in intervention (+0.25; SD 1.50 g/dL) compared to non-intervention (-0.08; SD 1.13 g/dL). An increase in height (+11.6; SD 2.9 cm and +10.7; SD 3.3 cm, p<0.000) and decrease in height-for-age z-scores (-0.96; SD 1.20 and -1.18: SD 1.30, p<0.000) were significantly different between intervention and non-intervention groups. The prevalence of anaemia increased (29%) in non-intervention children and reduced (24%) in intervention children. Stunting increased in both groups, but the increase in stunting was lower in the intervention children (from 12.2% to 22.1%) compared to the non-intervention children (from 17.8% to 42.2%). The longitudinal prevalence of diarrhea was 3.65% in the intervention group and 1.83% in the control group (p=0.000). The longitudinal prevalence of flu was also higher in the MNP group (5.75%) than in the control group (2.78%, p=0.000).

**Conclusions:** Providing low-dose iron MNPs every alternate day to 6-23 month old children for 8 months in the context of a program on local production of complementary foods, improved Hemoglobin concentrations and linear growth outcomes. However, MNPs also resulted in increased morbidity from infectious disease in the intervention compared to the non-intervention areas.

**Keywords:** low-dose iron MNPs; morbidity; iron; young children; Ethiopia

144/2443

EVALUATION OF THE PRIMARY OBESOGENIC MICROENVIRONMENT IN CHILDREN OF THE CITY DE CORRIENTES

Gorban de Lapertosa, Silvia; Chiapello, Jorge; Sotelo, Nancy; Delsin, Bernabé; Arias Tichij, Valeria.

Facultad de Medicina. UNNE. Argentina.

**Background and objectives:** Argentina is facing an epidemic of overweight / obesity, particularly in children of school age. To evaluate the frequency and preference of obesogenic foods, as well as, to rate the frequency and type of habitual physical activity and that which is performed during school hours.

**Methods:** In the course of 2014, by means of systematic random sampling, primary school students were selected with an age ranging from 6 to 14 years of age through a survey among tutors with demographic data. The survey included frequency and consumption of sodas, fast foods, fried foods and processed meat products. The survey inquired about food consumption outside home and its characteristics as well as the frequency of physical activity.

**Results:** We evaluated 1442 students; 45.63% (658) were female. Consumption of soft drinks was assessed in 449 surveys answered for this item, with 14.57% consuming soft drinks with a frequency of 3 or more times a day. From the total evaluated, 3.58% consumed fast foods, 26.14% fried foods, and 5.55% processed meat products. Of the total number of students, 333 (22.88%) answered for food preferences outside home, 23.14%

preferred hamburgers, 12.40% pizzas, 12.12% cookies, 7.16%, and a varied remaining percentages of low frequency. Physical activity of one hour a day is practiced between 3 to 4 days a week by 49.70% of the students. A 37.97% practice physical activity 2 days a week at school. These data present a relation between the different nutritional states including overweight-obesity (p = 0.02).

**Conclusions:** High consumption of different obesogenic food groups is observed, as well as, a high percentage of sedentarism; teachers and parents discussed strategies to overcome these habits, promoting healthy eating and increase physical activity in order to prevent this age group from engulfing the epidemic of non-communicable chronic diseases in the future.

**Keywords:** Obesogenic; Physical activity; School Feeding; Obesity; Overweight.

**Further collaborators:** Aylen Fernandéz

144/2445

NEEDS OF NUTRITIONAL LABELING IN PROCESSED FOODS OF COSTA RICA

(1)Montero Campos, Marielos de los Ángeles; (2)Heredia-Blonval, Katrina; (3)Vega Solano, Jaritza; (4)Benavides-Aguilar, Karla Francela; (5)Blanco-Metzler, Adriana.

(1)MSc.FoodTechnologist. Unit of Health and Nutrition/INCIENSA. Costa Rica.; (2)Lic. Nutritionist. Independent Researcher. Costa Rica.; (3)Lic. Nutritionist. Hiredby Project # 108167 of the International Development Research Centre. Costa Rica.; (4)Lic. Food Technologist. Hiredby Project # 108167 of the International Development Research Centre. Costa Rica.; (5)MSc. Food and Nutrition Scientist. Unit of Health and Nutrition. Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA). Costa Rica.

**Background and objectives:** Although in Costa Rica there has existed regulation on nutrition labeling since 1992, currently, according to the Technical Regulation of Central America (RTCA 67.01.60:10), the declaration of nutrients is not mandatory. In addition, there is no optimal government surveillance system. This has caused some inconsistency in the presentation of information to consumers, and possibly causing confusion in them.

To describe the main needs of the legislation on nutritional labeling in processed foods in Costa Rica.

**Methods:** Quantitative, consists of the analysis of the declaration of nutritional labeling of 5259 processed foods in the year 2013 and 7570 in the year 2015. For the collection and analysis of data was used the smartphone application "Data Collector" and the methodology developed By the George Institute for Global Health of Australia.

**Results:** The deficiencies found in nutritional labeling in both years were similar. These deficiencies are: A) 36% (2013) - 32% (2015) of products with nutritional labeling did not reported sodium; B) lack of report of portion sizes, C) inadequate contrast, size and type of writing, which make the information illegible; D) lack of nutritional labeling despite the presence of nutritional de-
scriptors; E) incorrect use of units of measurement; F) incorrect
translation of labels, among others.

**Conclusions:** In order to encourage a conscious selection of foods in the consumers and also to avoid confusions, it is necessary to establish as mandatory nutritional labeling of processed foods in Costa Rica and in Central America, through the update of RTCA 67.01.60: 10.

**Keywords:** Salt, sodium, nutritional labeling, food regulation, Costa Rica.

**Further collaborators:**

Acknowledgment: International Development Research Center projects # 106888 and # 108167

144/2454

NATIONAL ACTION PLAN TO REDUCE SALT,
SUGAR AND FAT CONSUMPTION 2017-2021

(1)Aguenaou, Hassan; (2)Alla, Amal; (3)Barkat, Amina; (2)Derouiche, Abdelfettah; (3)El Berri, Hicham; (2)Taboz, Youness; (2)Benkirane, Hasnae.

(1)PhD. Nutritionist. Joint Research Unit in Nutrition and Food, URAC 39 (Ibn Tofail University-CNESTEN) Regional Designated Center of Nutrition (AFRA/IAEA). Morocco,; (2)PhD; (3)Md. PhD.

**Background and objectives:** The amount of salt, sugar and / or fat (saturated and trans) consumed in Morocco is at least 50% higher than what is recommended by the World Health Organization (WHO). However, too much salt, sugar and / or fat (saturated and trans) is harmful for the health. This is why the Ministry of Health of Morocco is committed to reduce the consumption of salt, sugar and / or fat (saturated and trans). The target by 2021, is to gradually reduce salt consumption to 6 g / p / d, sugar to 60 g / p / d, reduce consumption of saturated fat and banish trans fatty acids.

**Methods:** Three studies were carried out, one on salt, another on sugar and the last on fat. Two reports were prepared, one on the status of the nutritional situation in Morocco, another on the action plan for the reduction of salt, sugar and fat consumption. The working methodology of this plan was based on the holding of several workshops and meetings with the different actors concerned directly or indirectly by the reduce of the consumption of salt and fat (saturated and trans).

**Results:** This plan aims to reduce gradually, in collaboration with the food industry, the salt, sugar and fat (saturated and trans) content in processed products. At the same time, the population should be sensitized and responsible. This action plan includes 5 strategic axes, 10 actions, 24 measures and 46 activities.

**Conclusions:** In the longer term, consumption of salt, sugar and fat in Morocco must meet the WHO recommendations of 5 g/p/d of salt and 50 g/p/d of sugar, eliminate all trans fats produced industrially and Significantly reduce the saturated fat content of the diet

**Keywords:** National action plan, salt, sugar, fat (satured and trans)

144/2457

SOCIALIZATION DURING MEALS AND ITS ASSOCIATION WITH UNIVERSITY STUDENTS' NUTRITIONAL STATUS

(1)Azevedo de Aquino, Luana; (2)Vieira Liberato, Juliana; (2)Alcântra, Solange Pires Leite de; (2)Gobetti, Clara Affonso; (3)Sena, Ana Beatriz Franco; (4)Assis, Bruno dos Santos de.

(1)PhD. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (2)BSc. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (3)PhD. Graduate Program in Collective Health. Fluminense Federal University. Brazil.; (4)MSc. Graduate Program in Collective Health. Fluminense Federal University. Brazil.

**Background and objectives:** Eating behaviour is an important factor influencing students' weight. Therefore, the purpose of this study was to evaluate the context of socialization during meals and its association with the nutritional status of university students.

**Methods:** Cross-sectional analysis of data derived from the baseline of the "Longitudinal Study of Nutrition and Health in University Students (NUTSAU)", conducted in second-semester students of Rio de Janeiro Federal University – Macaé Campus. The instrument used for data collection was a structured self-completion questionnaire. The anthropometric evaluation consisted of body mass and height measurements, and thus body mass index was calculated. Meal pattern was estimated based on six response options. Statistical analysis was performed using the SPSS program, version 19.0. The project was approved by the Research Ethics Committee of UFRJ-Macaé Campus.

**Results:** The sample consisted of 147 university students. Regarding the realization of the main meals, it was observed that among those who ate breakfast socializing with family (21.2%) and friends (16.8%), the minority was overweight (27.6% and 17.4%, respectively) (p = 0.43). A similar behavior was observed for those who had lunch socializing with friends (68.6%) with the minority identified as overweight (23.4%) (p = 0.16). Additionally, the habit of having dinner socializing with family members (34.4%) and friends (18.0%) was related to a lower frequency of overweight (27.3% and 30.4%, respectively) (p = 0.50).

**Conclusions:** We did not observe statistically significant associations between socialization during meals and nutritional status. However, our data indicate a clinical relevance of this habit as a protective factor against overweight.

**Keywords:** Dietary patterns. Nutritional status. University.
# EATING PLACES AND ITS ASSOCIATION WITH UNIVERSITY STUDENTS' OVERWEIGHT

(1)Azevedo de Aquino, Luana; (2)Gobetti, Clara Affonso; (2)Alcântra, Solange Pires Leite de; (2)Vieira Liberato, Juliana; (3)Sena, Ana Beatriz Franco; (4)Assis, Bruno dos Santos de.

(1)PhD. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (2)BSc. Department of Public Health Nutrition. Federal University of Rio de Janeiro State. Brazil.; (3)PhD. Graduate Program in Collective Health. Fluminense Federal University. Brazil.; (4)MSc. Graduate Program in Collective Health. Fluminense Federal University. Brazil.

**Background and objectives:** College or university is a critical period regarding unhealthy changes in eating behaviours in students. Therefore, the purpose of this study was to evaluate the context of eating places and its association with the nutritional status of university students.

**Methods:** Cross-sectional analysis of data derived from the baseline of the "Longitudinal Study of Nutrition and Health in University Students (NUTSAU)", conducted in second-semester students of Rio de Janeiro Federal University - Macaé Campus. The instrument used for data collection was a structured self-completion questionnaire. The anthropometric evaluation consisted of body mass and height measurements, and thus body mass index was calculated. Meal pattern was estimated based on six response options. Statistical analysis was performed using the SPSS program, version 19.0. The project was approved by the Research Ethics Committee of UFRJ-Macaé Campus.

**Results:** The sample consisted of 147 university students. Regarding the consumption of the main meals, it was observed that among those who ate breakfast at home (85.5%) a minority was overweight (24.6%) (p = 0.43). A similar behavior was observed for those who had lunch at home, who prepared their own packed-lunches and who bought packed-lunches (34.8%, 37.0% and 8.7%, respectively) with the minority identified as overweight (20,8%, 31,4% e 41,7%, respectively). Among those who generally ate fast-food the majority was classified as overweight (66.7%) (p=0.04). Having dinner at home was also related to a lower frequency of overweight (23.9%) (p=0.41)

**Conclusions:** It was observed that the patterns of having lunch at home, taking home-made packed-lunches and of buying packed-lunches may be protective habits against overweight in university students.

**Keywords:** Dietary patterns. Nutritional status. University.

# IMPACT OF OBESITY ON THE WORKING CONDITIONS OF TEACHERS AND EMPLOYEES OF THE BRAZILIAN STATE SCHOOL NETWORK

(1)Silva, Elza Cristina; (2)Almeida Roediger, Manuela de; (3)Monteiro Goulart, Rita Maria; (4)Sanches, Ana Maria; (5)Matsura Shirassu, Mirian; (6)Waisberg, Jaques; (7)do Nascimento da Silva, Maria de Lourdes.

(1)Nutritionist. Master's Degree Program in Health Sciences by the Institute of Medical Assistance to the State Public Servant - HSPE / IAMSPE- SP. Brazil; (2)Posdoctoral student. Nutritionist. Program of Nutrition in Public Health. School of Public Health. University of São Paulo. Brazil.; (3)PhD. Nutritionist. Public Health from the Faculty of Public Health, University of São Paulo. Brazil; (4)Medical doctor at the Hospital of the Public Servant at PREVENIR - IAMSPE. Brazil; (5)Medical Center of the Promotion and Protection of Health of the Institute of Medical Assistance to the State Public Servant. Brazil; (6)Doctor. Professor and Coordinator of the Stricto Sensu Post-Graduation Program in Health Sciences of the Institute of Medical Assistance to the State Public Servant (IAMSPE). Brazil; (7)PhD. Nutritionist. Program of Nutrition in Public Health. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** The prevalence of obesity has increased in state school teachers. Studies show that the healthier the workers are in the work environment, the greater and more consistent the company's prospects for success. This study verified the prevalence of obesity and its association with working conditions of teachers and employees of state schools in São Paulo.

**Methods:** A retrospective cross-sectional study using data of civil servants of the state schools in the city of São Paulo, composed by adults and elderly people of both sexes (n = 23,273). The study variables were: obesity measured by body mass index (BMI; kg/m2) considering obese when BMI ≥ 30 kg/m2; and working conditions (factors at work that affect feeding habits, working hours and annual health leave in the last 12 months) measured by specific questionnaire. Multiple logistic regression was used to verify the association between variables using the Stata / SE 13.0 program.

**Results:** Of the 23,273 individuals analyzed, 83.5% are female, 63.2% of the 19- to 49-year-old age group. The prevalence of obesity was 29.0%, higher in women (83.5%) and in the age group of 50 years and over (57.0%). It was found that working conditions that affect feeding habits (RP = 1.55), a workload of 30 hours and more (RP = 1.98), and annual health leave (RP = 1.26) were associated obesity in teachers and employees of the state school network.

**Conclusions:** The obesity was associated with working conditions in teachers and employees of the state school network. These results show the importance of developing political policies, which are able of stabilizing and finally, reverse the epidemiological situation presented.

**Keywords:** Obesity, working conditions, teachers, employees.
# NEXUS OF WATER, SANITATION, HYGIENE, GENDER, AND NUTRITION: A CONCEPTUAL FRAMEWORK OF THE PATHWAYS OF INFLUENCE

(1)Caruso, Bethany; (2)Sinharoy, Sheela; (3)Trinies, Victoria; (4)Freeman, Matthew.

(1)PhD. Post Doctoral Fellow. Department of Environmental Health. Rollins School of Public Health. Emory University. USA.;

(2)MPH. PhD Candidate. Nutrition and Health Sciences Program. Emory University. USA.; (3)MPH. Public Health Program Associate. Rollins School of Public Health. Emory University. USA.; (4)PhD. Assistant Professor. Department of Environmental Health. Rollins School of Public Health. Emory University. USA.

**Background and objectives:** Globally, 2.5 billion people lack access to improved sanitation and 663 million people lack access to improved water for drinking. Of these, a disproportionate number are women and girls. We examined the adverse effects of gender-differentiated restricted access to water, sanitation, and hygiene facilities on women and girls' health and nutrition, and associated causal pathways.

**Methods:** We synthesized multidisciplinary literature on how gender-differential access to water, sanitation, and personal hygiene (WASH) impacts reproductive, maternal and child health and nutrition. We critically reviewed the evidence and developed a framework to articulate the direct and indirect pathways through which a lack of access to WASH resources and behaviors may affect the health and nutrition of women, adolescent girls, and young children.

**Results:** Underlying gendered norms and practices around WASH, as well as sex-based biological differences, result in differential impact on women and girls' health and nutrition through a number of causal pathways. These include women and girls' roles as WASH duty-bearers, which can require significant time commitment and caloric expenditure; gender-based constraints on freedom of movement, which pose barriers to necessary WASH resources and behaviors; and the sex-specific need for WASH resources and hygienic facilities for childbirth and menstrual hygiene management. These factors can increase women and girls' vulnerability to undernutrition, anemia, infectious disease, and adverse birth outcomes through multiple pathways. A lack of access to WASH resources and behaviors also increases women's time poverty and risk of depression, which can influence care practices, infant and young child feeding behaviors, and the nutritional status of children. Our review concludes with recommendations for policy, advocacy, and future research.

**Conclusions:** Women and girls bear a disproportionate burden of responsibilities and health and nutrition impacts related to WASH. Integrated programming that addresses the WASH needs of women and girls is necessary to achieve further gains in health and nutrition. Our framework provides a conceptual basis for future interdisciplinary research into the biological and behavioral pathways by which WASH may affect nutrition and growth.

**Keywords:** WASH, gender, anemia, undernutrition, women's nutrition

# IMPROVING ACCESS TO FRESH FRUIT AND VEGETABLES AMONG LOW INCOME FAMILIES IN THE USA: THE NEAT TRIAL

(1)Segura-Pérez, Sofía; (2)Damio, Grace; (3)Perez-Escamilla, Rafael.

(1)M.S., R.D. Hispanic Health Council. US; (2)M.S. Nutritionist. Hispanic Health Council. USA; (3)PhD. Professor of Epidemiology and Public Health. Yale School of Public Health. USA.

**Background and objectives:** Eating a variety of fruit and vegetables has been shown to reduce the risk of chronic diseases. Thus, The Nutrition Education, Access and Texting (NEAT) trial sought to assess the impact of distribution of incentive coupons along with a texting-based marketing campaign promoting usage of a Mobile Market (MM), on increasing access, purchase, and intake of fruit and vegetables among SNAP-Ed participants.

**Methods:** NEAT was a randomized trial with low-income participants with children under 5 years old. Participants had unlimited texting plans and were willing to receive daily texting for a 4-week period. They completed a ½ hour baseline survey collecting demographic, and fruit and vegetables data. Participants were then assigned to the experimental group (n=100) receiving four $5 coupons for use at the MM during the next 6 weeks plus a month of daily text messages informing them about MM stop locations, tips on preparing/eating more fruit and vegetables, and reminders to use their coupons or the control group (n=93) that only received text messages about free family community events. Participants from both groups completed a 6-week follow-up phone interview.

**Results:** Both groups had similar baseline characteristics, mean age of 32±8.81 years, 79% were Hispanic, mostly female (96%), and receiving SNAP benefits (80%) (N=193). At follow-up (n=169) intervention group participants spent significantly more on fruits than those in the control group ($42 vs. $30, p=0.027), and were also more likely to buying their produce at the MM (46% vs. 23%, p=0.002). There was a also a significant increase in fruit intake in the intervention group only (p=0.001). Participants accessing the MM were very satisfied with the produce sold as well as the customer service.

**Conclusions:** NEAT was successfully implemented and led to higher use of MM, and increased spending and intake of fruits.

**Keywords:** food access, food security, fruit and vegetables, mobile market
## QUALITY OF LIFE AMONG ECUATORIAN ADOLESCENTS WITH FOOD ALLERGY DETERMINED BY SKIN TEST REACTIVITY AND SERUM IGE LEVELS

**Background and objectives:** Food allergy (FA) can affect the quality of life of people. FA determined by skin test reactivity and serum IgE levels increase the precision of the diagnosis. Therefore, the objectives of this study are to determine the prevalence of food allergy (determined by skin prick reactivity and serum immunoglobulin E (IgE) levels) and its affectation on quality of life among Ecuadorian adolescents.

**Methods:** A cross-sectional study was conducted among 462 Ecuadorian adolescents from Santa Isabel between July 2014 and February 2016. Skin prick test (SPT) was applied in adolescents to identify allergic sensitization (wheat size > 3 mm that negative control) using 20 commercial food allergens. Adolescents with allergic sensitization were examined by a Immunologist to identify: i) history of food-associated allergic symptoms, ii) positive IgE specific serum using ImmunoCAP technique and iii) affectation in the quality of life applying a questionnaire. Positive IgE to a specific food was defined with serum levels ≥ 0.35 IU. FA was identified when the participants reported history of food-associated allergic symptoms and had a positive SPT or positive IgE specific levels. Affection of quality of life evaluated three items: dietary restrictions, emotional impact and risk from accidental exposure.

**Results:** FA by SPT was prevalent among 4.33% of the adolescents. FA by SPT and serum IgE levels was prevalent in 1.73% of the participants. Shrimp and peanuts were the main allergens. FA by SPT and serum IgE levels affects the quality of life of adolescents an average of 0.05 / 6, SD ± 0.94.

**Conclusions:** FA is prevalent in adolescents from Santa Isabel. The use of specific IgE in combination with SPT increased the diagnostic accuracy. Adolescents with FA did not present significant affectation in their quality of life, contrarily to other studies that observe notable affectation. This opposite result can be explained by the lack of knowledge about their condition.

**Keywords:** adolescent, Ecuadorian, food allergen, IgE, quality of life.

## ACCEPTABILITY OF MULTI-MICRONUTRIENT POWDERS (MNP) IN YOUNG CHILDREN: FACTORS AFFECTING CAREGIVERS' DECISIONS - BY FAMILY, HEALTH PERSONNEL AND COMMUNITY ACTORS IN THREE REGIONS OF PERU

**Background and objectives:** Prevalence of anemia remains high in infants and young children in Peru. This study explored the experiences and practices, of families, health personnel and other community actors from government-funded social programs regarding MNP supplementation in children 6 to 36 months, leading to an understanding of the issues related to their acceptability and consumption by families and young children.

**Methods:** The qualitative study took place in three regions of Peru: Piura, Ucayali, Huancavelica, served by two Government-funded social programs (Day care centres and Family accompanying program of the Ministry of Development and Social Inclusion, MIDIS). Data was collected using semi-structured in-depth interviews, focus groups, exit interviews from primary health care services, and semi-participative observations during counseling sessions in health services, mealtimes at child care centers and in households, as well as during household visits carried out by the social programs. Data was transcribed, coded and analyzed to identify sub-themes and their relationship to the consumption and acceptability of MNPs.

**Results:** Caregivers give MNPs until they encounter a negative occurrence (diarrhea, illness) or lack of acceptability from the child. Health personnel and community actors are committed to the delivery of MNP with high perceptions of their value but there were weaknesses in training and counseling, which translated into inappropriate preparation practices and inadequate support networks when caregivers experience difficulties. Quality of monitoring data collected could be improved and further used to feedback into processes and practices.

**Conclusions:** Qualitative data provides a rich context to the processes surrounding supplementation with MNPs in these 3 regions to improve programs. Improved training, counseling and better support systems could enhance acceptability and consumption of MNP by caregivers.

**Keywords:** Multimicronutrients; acceptability; infants and young children; social programs; support networks

**Further collaborators:**

This study was conducted in coordination with MIDIS, funded by the contract BIRF N° 8222-PE. F-006-0-8222 to MIDIS.

<footnote>(1)Morillo Argudo, Diana Alexandra; (2)Calle Chalco, Ximena Elena;</footnote>

<footnote>(2)Sacoto Macías, Rosa Angélica; (3)Andrade Tenesaca, Dolores Susana;</footnote>

<footnote>(4)Rodas Espinoza, Claudia Rosana; (5)Córdova Jimbo, Diana Paola;</footnote>

<footnote>(6)Zúñiga Carpio, Gabriela Alexandra; (7)García García, Ana Angélica;</footnote>

<footnote>(8)Ochoa Avilés, Angelica.</footnote>

<footnote>(1)MD. Department of Biosciences. Cuenca University. Cuenca.</footnote>

<footnote>Ecuador.; (2)BSc. Cuenca University. Cuenca. Ecuador.; (3)Eng. MD, PhD. Department of Biosciences. Faculty of Chemistry Sciences.</footnote>

<footnote>Cuenca University. Cuenca. Ecuador.; (4)MD, Immunologist. Faculty of Medicine. Azuay University. Cuenca. Ecuador;</footnote>

<footnote>(5)BSc. Department of Biosciences. Cuenca University. Cuenca.</footnote>

<footnote>Ecuador.; (6)Nutritionist. MSc. Department of Biosciences. Cuenca University. Cuenca. Ecuador.; (7)Eng. Department of Biosciences.</footnote>

<footnote>Cuenca University. Cuenca. Ecuador.; (8)MD, PhD. Department of Biosciences. Faculty of Chemistry Sciences. Cuenca University.</footnote>

<footnote>Cuenca. Ecuador.</footnote>

<footnote>(1)Creed-Kanashiro, Hilary; (2)Bartolini, Rosario; (2)Goya, Cecilia;</footnote>

<footnote>(3)Jimenez, Michelle.</footnote>

<footnote>(1)MPhil. Nutritionist. Instituto de Investigación Nutricional. Lima. Peru; (2)BA. Anthropologist. Instituto de Investigación Nutricional. Lima. Peru; (3)MSc. Nutritionist. Instituto de Investigación Nutricional. Lima. Peru.</footnote>
REASONS ALLEGED BY PUERPERAL WOMEN TO SEEK CARE IN A HUMAN MILK BANK OF A UNIVERSITY HOSPITAL

(1)Thais Resende Teixeira, Karla; (2)Accioly, Elizabeth; (3)de Oliveira Lopes, Fernanda; (4)Azevedo dos Santos, Talita; (1)de Souza Gouveia Moreira, Laís.

(1)Nutritionist of Antonio Pedro University Hospital / Fluminense Federal University. Niterói/ RJ. Brazil.; (2)Dra. Nutricionist. Federal University of Rio de Janeiro. Department of nutrition and dietetics. Rio de Janeiro / RJ. Brazil.; (3)MSc. Nutritionist. Antonio Pedro University Hospital / Fluminense Federal University. Niterói/ RJ. Brazil; (4)Nutritionist. Federal University of the State of Rio de Janeiro. Rio de Janeiro / RJ. Brazil.

**Background and objectives:** There are many reasons that make breastfeeding difficult. Within this context, it becomes relevant to know the reasons that lead women to seek help in human milk banks (BLH). The objective of the study was to describe the main reasons of women seeking care at the Human Milk Bank of a University Hospital in the city of Niterói, Rio de Janeiro state, also describing the characteristics of these women and their babies.

**Methods:** This is a retrospective study, based on data from service forms, in the year 2015. The data were extracted from the institution's BLH service forms, applied to women who sought care in that sector, in the year 2015.

To assess the profile of the women were collected socio-demographic, gestational, lifestyle, type of Childbirth, history of current breastfeeding, use of artificial nipples, breast exams, the reason for the demand for the milk bank and the main complaint of these women and the conduct adopted by the Multiprofessional team of the human milk bank.

Data were also collected from the newborn. For the evaluation of weight and gestational age at birth, the cutoff points of the Brazilian Society of Pediatrics and the World Health Organization were used.

**Results:** The majority of the study participants corresponded to adults, residents of the city of Niterói. Difficulty in breast-feeding was the motive most alleged by women who sought BLH, followed by breastfeeding pain. The majority started prenatal care in the first trimester (78.4%), but it was observed a low frequency of guidelines on breastfeeding during that period. The most prevalent type of delivery was the surgical one (81.1%), 38.5% offered artificial formulas for their babies, and of these 72% reported difficulties in relation to breastfeeding.

**Conclusions:** The main reasons that motivated the search for BLH were related to difficulties with breastfeeding, which could be avoided or at least minimized, with guidelines to support and promote breastfeeding even during prenatal care and in the Which emphasizes the role of the multiprofessional health team in the attention to women in the pregnancy-puerperal cycle.

**Keywords:** Human milk bank; Breastfeeding; women seeking care

EVIDENCE-BASED INTEGRATION OF NUTRITION INTO MULTI-SECTOR BRAC PROGRAMS IN BANGLADESH

(1)Jalal, Chowdhury Jalal; (2)Habicht, Jean-Pierre; (3)Lee, James;

(3)Bhuiyan, Muhammad Mahbub; (2)Pelto, Gretel.

(1)Micronutrient Initiative. Ottawa. Canada; (2)PhD. Professor Emeritus. Cornell University. USA; (3)Independent Consultant.

**Background and objectives:** Integrated multisector nutrition-specific and nutrition-sensitive interventions are a recognized and widely endorsed strategy to ensure sustainable improvements in the nutrition of women, adolescents and children. Despite broad agreement about the nature of barriers to effective integration in recent literature, there remains insufficient evidence of the actions which can eliminate those barriers. The Micronutrient Initiative has been conducting a research to identify these barriers particularly related to adolescent nutrition and inform designing integration of actionable nutrition packages through multisector programs of BRAC - an NGO known for its largest national-level programs in the world. The purpose of this research was to generate evidence on how to integrate nutrition into multiple-sector programs and preliminarily recommended evidence-based integration of actionable nutrition packages through multiple-sector programs

**Methods:** We conducted a review of nutrition gaps in Bangladesh; prepared Program Impact Pathways (PIP) to understand how BRAC programs operate; and explored nutrition activities carried out by other agencies. A step-wise focused ethnographic studies (FES) was used to understand the barriers and opportunities relevant to adolescent nutrition at individual-, household-, and community-levels. FES also informed existing gaps in delivery of services. The steps in FES provided opportunities for gradually strengthening the research protocols and pinpoint critical gaps that needed to be filled by different programs. Plotting of FES results on the PIPs identified components of different programs through which BCI and other nutrition services may be provided.

**Results:** Preliminary analysis suggested non-existence of any interventions BRAC or other agencies dedicated specifically to improving adolescent nutrition. Behaviour Change Intervention (BCI) material should be tailored to include different strategies for in- and out-of-school adolescents. Provision of weekly Iron and folic acid (WIFA) supplementation will need to be ensured. BRAC's Village Theatres, Adolescent Clubs, contacts by health volunteers, Nutri-garden, etc. are potential candidates to deliver nutrition services but have been so far neglected.

**Conclusions:** Preliminary results show opportunities to deliver nutrition interventions through multiple nutrition and non-nutrition sectors and to maximize the demand for services. The research is still in progress and the October IUNS presentation will further include how the evidence-generated interventions will have been operationalized into BRAC programs.

**Keywords:** Nutrition integration, multi-sectoral, adolescents
# COMPARISON OF "OUT OF HOUSEHOLD PURCHASED FOODS" (OHF) IN LATIN AMERICAN COUNTRIES BASIC FOOD BASKETS (BFB)

(1)Monroy Valle, Michele; (2)Graciano, Beatriz Andrea.

(1)Nutritionist, Masters in Epidemiology. Instituto de Investigaciones Químicas y Biológicas, Universidad de San Carlos de Guatemala; (2)Nutritionist. Escuela de Nutrición. Universidad de Buenos Aires. Buenos Aires. Argentina.

**Background and objectives:** Basic Food Basket (BFB), used in Latin American countries as official poverty measure methodology, gives information about the most commonly purchased foods by the country population. Eating out for leisure is a habit among the 4th and 5th income quintile, but a need for most population during the working week. The expenditure that household allocates to purchase foods outside the household is necessary and more than half urban households had reported to purchase breakfast and/or lunch five to six days a week. The objective was to compare the inclusion and characteristics of OHF in Latin American Countries BFB.

**Methods:** We check in the official list of foods from 19 countries urban BFB, those that identify OHFs (breakfasts, lunches or dinners) as part of the structure of the average minimum diet. It was excluded from the analysis that the OHF were in the consumer's price index, because it is not used to measure poverty directly as the BFB. Information was collected online from official sources as National Statistics Institutes or similar responsible for BFB monthly price publication in the following countries: Guatemala, El Salvador, Honduras, Nicaragua, Belize, Brazil, Costa Rica, Dominican Republic, Panama, Mexico, Ecuador, Colombia, Venezuela, Peru, Bolivia, Paraguay, Argentina, Chile, Uruguay.

**Results:** here are countries where BFB composition is not available. Only 6 include out of household purchase: Ecuador, Bolivia, Uruguay, Chile, Mexico and Paraguay. Ecuador, Bolivia, Paraguay have a food group named "Foods and Beverages consumed out of household" which includes various foods and complete meals such as lunches or dinners. Uruguay measure is more complex with Meals outside the household, prepared meals, expenses in restaurants, bars and hotels. Chile and Mexico reports individually lunch menu of other plates. For all countries, OHF represented more than 15% of household expenses.

**Conclusions:** Countries must make efforts to update the BFB and include out of household purchase to calculate the real cost of actual diets. Nutritionist must do research on OHF composition, nutrition value and the distribution into the family.

**Keywords:** Basic Food Basket, out of household purchased foods, Latin America

# EFFECT ON ONE UN PROGRAMME ON NUTRITION SECURITY IN RUTSIRO AND NYAMAGABE DISTRICTS

(1)Ouma, Cyprian; (2)Tanimoune, Mahamadou.

(1)BSC Nutritionist. WFP. Kenya; (2)PHN. Nutritionist. WFP. Rwanda.

**Background and objectives:** Food consumption score(FCS) is a measure of dietary diversity, food frequency and the relative nutritional importance of the food consumed. With evaluation of Food and Nutrition security status of households as a major One UN project objective, we aimed to study the effect of the various components of the One UN interventions on Food Consumption Score.

**Methods:** A cross-sectional survey was conducted to collect data on the targeted population in the two districts between August and September 2016. Sampled children were 3700. Two stage sample stratification by district and wealth category was done. Final sample size was 3700 children aged 6-59 months.

**Results:** Households with children enrolled in the Micro nutrient programme had a slightly higher percentage (39%) of children with acceptable food consumption score as compared to those not enrolled (36%). Households with children that consumed MNP before the survey were more food secure than those not enrolled and those enrolled and did not consume the MNP the day before the survey. Children who consumed CSB++ the day before the survey had slightly better consumption score as compared to those who did not consume CSB++ (39.7% vs. 37.6%).

**Conclusions:** The improvement of Food security situation after the One UN Project intervention highlights the need for incorporating such interventions in future nutrition programs.

**Keywords:** Micro nutrient, food consumption score
ASSESSMENT OF PLASMA CONCENTRATION OF VITAMIN A, VITAMIN B12 AND IRON AMONG TUBERCULOSIS PATIENTS WITH AND WITHOUT HIV INFECTION: A COHORT STUDY

(1)Gebremicael, Gebremedhin; (2)Alemayehu, Mihret; (3)Sileshi, Meron;

(3)Gebrezgeaxier, Atsebeha; (3)Ashenafi, Nigat; (3)Tefera, Hulumtaye;

(4)Weldie, Mistre; (5)Kassa, Desta.

(1)MSc. Infectious Diseases. Ethiopian Public Health Institute. Ethiopia; (2)MSc. Department of Medical Laboratory Sciences of Addis Ababa University. Ethiopia; (3)MSc. Ethiopian Public Health Institute (EPHI). Ethiopia; (4)PhD. Department of Medical Laboratory Sciences of Addis Ababa University. Ethiopia; (5)PhD. Immunologist. Ethiopian Public Health Institute (EPHI). Ethiopia.

**Background and objectives:** The impact of micronutrients concentration in the body on TB development diseases progression and TB treatment outcome on micronutrients concentration level in the body is not fully understood. In this study, we determined the level of Plasma Vitamin A, Vitamin B12 and Iron in TB patients with and without HIV Infection before and after TB treatment,

**Methods:** A total of 262 study participants which composed of 144 active TB patients [57 HIV co-infected (HIV+TB+) and 87 HIV negative (HIV-TB+)], 71 HIV+ and Tuberculin Skin test negative (HIV+TST-), 22 HIV-TST+, and 25 controls (HIV-TST-) were recruited. Vitamin A concentration was measured using high performance liquid chromatography (HPLC), whereas Iron and vitamin B12 concentrations were measured using cobas® 6000 analyzer at baseline and after six months of anti-TB treatment (ATT)

**Results:** HIV-TB+ patients had low plasma concentrations of vitamin A (0.07µmol/L) and Iron (0.25µg/dl) and high level of concentration of vitamin B12 (626pg/ml) compared to HIV-TST+ (0.15µmol/L, 0.86µg/dl and 354.5pg/ml respectively) and to HIV-TST- (0.15µmol/L, 0.90µg/dl and 360.4pg/ml respectively). Similarly, the concentration of Iron was significantly lower in HIV+TST- patients (0.58µg/dl) compared to HIV-TST+ and HIV-TST- study participants. After ATT, HIV-TB+ patients had high concentrations of vitamin A (0.15µmol/L) and Iron (0.85µg/dl) and low level of concentration of vitamin B12 (388.6pg/ml) compared to the baseline concentration levels (p<0.05); but not significantly different compared to that of HIV-TST+ concentration and HIV-TST-.

**Conclusions:** The low concentrations of vitamin A and Iron, and high concentration of vitamin B12 in HIV-TB+ patients which can be due to the preceding deficiencies that enhanced susceptibility to TB diseases, suggests the need of micronutrient supplementation for TB patients. In addition, the changes in plasma vitamin A, vitamin B12 and Iron following anti-TB treatment indicates the value of these parameters used to monitor TB treatment responses.

**Keywords:** Tuberculosis, anti-TB treatment, Vitamin B 12, Retinol, Iron

EFFECT OF HIGH PROTEIN INTAKE AND NUTRITIONAL ADVICE ON BODY WEIGHT MAINTAIN-ANCE AMONG OVERWEIGHT AND OBESE POST-PARTUM WOMEN

(1)Castro, Maria Beatriz Trindade de; (2)Araujo, Marina C.; (3)Barbosa Cunha, Diana; (4)Bezerra, Ilana Nogueira; (5)Adegboye, Amanda Rodrigues Amorim; (6)Kac, Gilberto; (7)Sichieri, Rosely.

(1)PhD. 1Nutritional Epidemiology Observatory. Department of Social and Applied Nutrition. Institute of Nutrition Josue de Castro (INJC). Federal University of Rio de Janeiro. Posgraduate Program of Nutrition. Brazil; (2)PhD. Sergio Arouca National School of Public Health. Oswaldo Cruz Foundation/Ministry of Health. Brazil; (3)PhD. Department of Epidemiology. Social Medicine Institute. State University of Rio de Janeiro. Rio de Janeiro. Brazil; (4)PhD. Ceará State University. Mater in Nutrition and Health Course. Brazil; (5)PhD. Department of Life Sciences. University of Westminster. London. UK; (6)1Nutritional Epidemiology Observatory. Department of Social and Applied Nutrition. Institute of Nutrition Josue de Castro. Federal University of Rio de Janeiro. Posgraduate Program of Nutrition. Brazil; (7)3Department of Epidemiology. Social Medicine Institute. State University of Rio de Janeiro. Rio de Janeiro. Brazil.

**Background and objectives:** Failure to return to pre-pregnancy weight after childbirth may contribute to obesity. There is evidence that high protein and low carbohydrate intake in the general population helps to maintain boby weight. However, there is limitted evidence of the effect of high protien intake among postpartum women. To evaluate the effect of high protein intake and nutritional advice on body weight loss during first six months of postpartum.

**Methods:** Randomized controlled trial with ninety four overweight or obese postpartum womenfrom two public maternity ward situated in Rio de Janeiro state, Brazil. Postpartum women were randomized to intervention (IG) and control group (CG). The IG received protein foods sardine supplementation (130 g / one can per week) to increase dietary protein content combined with instructions to restrict the consumption of carbohydrates. The control group (CG) received nutritional advice to follow that national nutrition guideline with standart quantities of carbohydrate, protein and fat. To guarantee the trial adherence CG received 2 kg of pasta per month. Linear mixed-effects model was applied to test the effect of high protein intake on body weight loss during postpartum. Then, the interaction between IG (high protein intake) and intake of macronutrients (CH and Fat) were also investigated.

**Results:** The CG gained more weight over time (β=0.824; SE=0.393; p= 0.037) than women in the IG (β=0.013; SE=0.402; p= 0.975). Intake of (g/kg) of protein (β=-0.88; p<0.001), lipids (β=-1.76; p<0.001) and carbohydrate (β= -0.39; p<0.001) over time were idenpendently associated with weight loss. There was a significant interaction between IG and lipdid intake (g/kg) (β=-13.9; p= 0.012)

**Conclusions:** High protein intake and dietetic advice were associated with the maintenance of body weight during postpartum period.
**Background and objectives:** HIV sensitive programming such as safety nets requires strong targeting process in order assist most affected PLHIV. To design appropriate intervention, WFP and Rwandan Biomedical Centre /HIV, STIs and OBBI Division conducted a national survey on the nutrition status, food security status, and vulnerability among PLHIV.

**Methods:** Two-stage cluster sampling, with cluster defined as district and the primary sampling unit (PSU) was the Hhealth facility (HF). The probability-proportional-to-size (PPS) sampling was applied with pre-stratification by program (Pre-ART and ART). A total of 2,386 PLHIV have been surveyed all category combined in 60 HFs selected countrywide, two by district.

**Results:** High overweight prevalence among adult PLHIV 17.5 % (BMI≥ 25.00) compared to underweight 13.7 % (BMI <20.00). The majority (79.5 %) was classified as pre-obese (BMI 25.00-29.99) and 20.5 % as obese (BMI ≥ 30.00). Of the 13.7 % underweight prevalence, 68.3 % were classified as mild (BMI between17-18.99), 18.7 % as moderate (BMI 16-16.99) and 13 % as severe (BMI <16). Clients with a higher viral load (greater than or equal to 1000 copies/ml) were found to be overweight/obese (23.1 %) compared to the category of clients with lower viral load category (<400 copies/ml) (18 %). The prevalence of overweight was also higher among women (22.1 %) than men (10.3 %) and in Kigali city (30.1 %). The highest prevalence of overweight/obesity was among clients who had at least completed secondary school (47.3 %), monthly salaried employees (39 %), those earning a monthly income above 50.000 RWF (37.6 %).

**Conclusions:** Overweight and obesity coexist with undernutrition among PLHIV in Rwanda. Overweight affects more women, urban, highly educated, client with higher viral load and the better off wealth category. However these findings hide critical vulnerability among lower socioeconomic category where undernutrition, food insecurity and poor copying strategy is high. Additional investigation is required to clearly understand the double burden of malnutrition among PLHIV for better targeting.

**Keywords:** Obesity, co existence

**Background and objectives:** Obesity in the adolescent age presents great challenges for health and nutrition services, because if it is not corrected in time, it will be the gateway for the early onset of chronic noncommunicable diseases. Objective: To determine the prevalence of cardiovascular risk factors in adolescents enrolled for the 2016 school year in educational institutions in the city of Asuncion

**Methods:** The study was observational, descriptive, transversal with analytical component. Sociodemographic, clinical, anthropometric and lifestyle variables were evaluated

**Results:** A total of 250 students were selected from 5 schools, 55% female, the mean age of the total was 13.6 ± 1.7 years, most of them belong to the third cycle of Basic School Education. All of them had a family history, the most frequent being hypertension, diabetes and obesity. The mean body weight was 51.9 ± 9.5 kg, BMI 20.7 ± 3.9 kg / m2, systolic blood pressure (SBP) 99.6 ± 8.7 mmHg, and diastolic blood pressure (DBP) 65.7 ± 5.7 mmHg. 65% presented adequate weight, 23% malnutrition by excess and the rest risk of malnutrition. 5% had high waist circumference and 2% had high blood pressure. 92% affirm to carry out sports, the women, walk and the men play soccer. One student reported smoking, she does it every day. 3% consume alcoholic beverages on certain occasions. The major risk factor for cardiovascular disease was excess malnutrition. There was no significant relationship between increased waist circumference, BMI and mean blood pressure.

**Conclusions:** The main risks for cardiovascular disease found in the sample were overweight and obesity

**Keywords:** Adolescents, Cardiovascular Risk, Nutritional Status, Blood Pressure

**Further collaborators:**
Luz Delgado Cena
**Background and objectives:** Maternal metabolic status before and during pregnancy exerts an important influence on neurodevelopment and behavior in the offspring. Maternal characteristics may be a significant predictor of behavioral problems in childhood and mental health problems during adulthood. The aim of the present study was to analyse the effect of maternal obesity or gestational diabetes (GD) conditions on adaptive behavior and social-emotional development in their offspring at 6 and 18 months of life.

**Methods:** From a total of 331 pregnant women participating in the PREOBE study, 215 pregnant women and their offspring were evaluated. The mothers were divided into 4 groups according to their pre-gestational body mass index or the development of GD: overweight (n:44), obese (n:32), GD (n:58), and healthy normal weight (n:81). Adaptive behavior and social-emotional development was assessed using the Adaptive Behavior Assessment System-Second Edition (ABAS-II) and Bayley's III Social-Emotional scale. Differences in scores were analysed by ANOVA, MANCOVA and Chi-Square Test, using SPSS version 22.0.

**Results:** At 6 months of life, those children born to obese mothers showed lower scores in social-emotional (p=0.005) and self-direction (p=0.035) skills, compared to those born to normal weight-healthy mothers. At 18 months of age, children born to overweight/obese mothers presented lower scores in self-direction (p=0.028), leisure (p=0.037) and self-care (p=0.024) than those born to normal weight-healthy mothers. However, in adjusted analysis by maternal age and cultural level, these results disappeared. Additionally, children born to normal weight-healthy and GD mothers showed higher scores in conceptual skills (communication, functional pre-academics and self direction) (p=0.001) than children born to obese/overweight mothers.

**Conclusions:** Obesity or Overweight during pregnancy are associated to poorer child's social-emotional and adaptive behavior development at 6 and 18 months of life. Problems in early life to adapt to the natural and social demands of environment can be predictors of learning disorders or attention deficits. These results couldn't help to understand the underlying aetiology of cognitive and behaviors problems in preschool children.

**Keywords:** Pregnancy, Obese, Gestational Diabetes, Adaptive Behaviour, Social-Emotional

**Conflict of Interest Disclosure:** Study funded by Spanish Ministry of Innovation and Science. Junta de Andalucía: Excellence Project (P06-CTS-02341); Spanish Ministry of Education (Grant no. SB2010-0025); Spanish Ministry of Economy and Competitiveness (BFU2012-40254-C03-01).

**Further collaborators:** Partial support was received by Abbott Laboratories, Granada, Spain.

**Background and objectives:** One of the major health problems in children is overweight and obesity. At the age of preschool, children are still being looked after by an adult. In low-income families, the biological mother is the one who takes this role, which is why it is important to analyze the mother's perceptions of healthy eating, her aspirations, and challenges. The present study aimed to comprehend the challenges faced by low-income mothers when feeding their children in a district of Lima.

**Methods:** Using qualitative methods, we conducted 4 focus groups and 11 in-depth interviews in Spanish with a total of 30 volunteer mothers of preschool-aged children from low-income households in Virgen de la Candelaria, district of Villa Maria del Triunfo, Lima, Peru. The method was grounded theory. We analyzed verbatim transcripts using an inductive method of open coding, and themes were established by consensus among authors, the information was summarized creating a thematic framework.

**Results:** Children to reach a good nutritional status. The mother's mean age was of 30 years old; 87% were from different departments of Peru; 56% had a high school education or less, and all of them lived with 20 soles a day. The following themes regarding perceptions, aspirations, and challenges emerged: the ways of preparing food for preschool children showed a positive attitude towards the preparation methods and addressed the child's behavior at mealtime. The themes that emerged on the aspirations of the mothers were in relation to health and eating well. The challenges were to get to fulfill their aspirations were one of the major concerns faced was how to get them.

**Conclusions:** This finding increased our understanding of the perceptions, aspirations, and challenges faced by the mothers of preschoolers, and can help to inform more cultural aspects for effective nutrition interventions.

**Keywords:** Preschool, perceptions, aspirations, challenges, feeding.

<footnote>(1) Nieto Ruiz, Ana; (2) Torres-Espínola, Francisco José; (3) Arias, Miriam;</footnote>

<footnote>(4) Rueda, Ricardo; (5) Campoy, Cristina.</footnote>

<footnote>(1)cPhD. Psychologist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (2)PhD. Psychologist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (3)Nutritionist. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.; (4)PhD. MD. R&D Department. Abbott Nutrition. Granada. Spain.; (5)PhD. MD. Prof. EURISTIKOS Excellence Centre for Paediatric Research. University of Granada. Spain.</footnote>

<footnote>(1) Delgado Pérez, Doris; (2) Liria Domínguez, María Reyna.</footnote>

<footnote>(1) PhD. Nutritionist. Centro de Investigación en Bioquímica y Nutrición. Universidad Nacional Mayor de San Marcos. Peru;</footnote>

<footnote>(2) PhD. Nutritionist. Instituto Investigación Nutricional. Peru.</footnote>
# THE ASSOCIATION BETWEEN FOOD AND NUTRITION LITERACY AND DIETARY INTAKE IN ELEMENTARY SCHOOL CHILDREN

(1)Doustmohammadian, Aazam; (2)Omidvar, Nasrin; (3)Keshavarz Mohammadi, Nastaran; (4)Amini, Maryam; (5)Eini-Zinab, Hassan; (6)Amirhamidi, Zeinab; (6)esfandiari, Saeed; (7)Abdollahi, Morteza.

(1)Ph.D Candidate in Nutrition. Department of Community Nutrition. National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (2)PhD.Nutritionist. Department of Community Nutrition. National Nutrition and Food Technology Research Institute; and Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (3)PhD. Health Education and Health Promotion. School of Public Health. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (4)PhD. Nutritionist. Department of Nutrition Research. National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (5)PhD. Sociologist. Department of Community Nutrition. National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (6)MSc in Nutrition. Department of Community Nutrition. National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.; (7)PhD. Department of Nutrition Research. National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology. Shahid Beheshti University of Medical Sciences. Tehran. Iran.

**Background and objectives:** Food and nutrition literacy may be the underlying factor that protects nutritional quality during transitions. This study evaluates the association between Food and Nutrition Literacy (FNLIT) and dietary intake of elementary school children in Iran.

**Methods:** This cross-sectional study was undertaken on 803 students (419 boys and 384 girls) aged 10–12 years from 44 elementary schools in Tehran city, Iran. Demographic characteristics, socio-economic status, as well as three 24-hour dietary recalls (two week-days and one weekend) were collected through interviewing the students and their mothers and/or other caregivers. Food and nutrition literacy was measured by a locally designed and validated questionnaire consisted of 46 items in 7 subscales. Food group consumption was compared with recommendations. Dietary diversity score (DDS) was calculated as part of the pyramid serving database that was categorized into 23 broad food groups.

**Results:** Adjusted binary regression logistic showed that students with low food and nutrition knowledge were less likely to meet recommended portion of vegetable (OR=2.83, 95% CI=1.12-7.17) and meat (OR=2.37, 95% CI=1.01-5.55) groups. Those with low functional food nutrition literacy were less likely to meet recommended daily intake of fruits (OR=2.42, 95% CI=1.38-4.25).

Mean diet diversity score (DDS) was significantly higher in children with high functional food and nutrition literacy and food label literacy (p=0.001 and p=0.04 respectively).

**Conclusions:** The findings suggest that improving food and nutrition literacy in children can serve as an appropriate mean to facilitate healthy dietary patterns of children.

**Keywords:** Food and nutrition literacy, elementary school children, dietary intake, Iran

# PREDICTORS OF POOR NUTRITIONAL STATUS AMONG CHILDREN AGED 6–24 MONTHS IN AGRICULTURAL REGIONS OF MALI

(1)Makamto Sobgui, Caroline; (2)Makamto Sobgui, Caroline;

(3)Kamedjie Fezeu, Leopold; (4)Diawara, Fatou; (5)Diarra, Honafing;

(5)Afari-Sefa, Victor.

(1)Public Health Nutrition Specialist. World Vegetable Centre. Bamako. Mali; (2)World Vegetable Center. West and Central Africa. PO Box 320. Bamako. Mali; (3)Université Paris 13 UFR de Sante médecine et biologie humaine. 74 rue marcel Cachin 93000 Bobigny. France; (4)Agence National de Sécurité Alimentaire. Bamako. Mali.; (5)World Vegetable Center. West and Central Africa. PO Box 320. Bamako. Mali.

**Background and objectives:** Inadequate nutrition during the first two years of life has tremendous consequences on the health and growth of children. Understanding the magnitude and determinants of nutritional status can help to avert this problem. This study aimed to assess the prevalence and potential causes of undernutrition in children aged 6 - 24 months in poor rural regions of Mali.

**Methods:** A community based cross-sectional study was conducted in villages in Sikasso and Mopti regions from January to March 2016. A structured questionnaire was used to collect data and characteristics of 959 boys, 856 girls, and their mothers, living in 1764 households. Anthropometric measurements such as weight, height, and mid upper arm circumference (MUAC) were performed using standardized methods. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with nutritional status of the children.

**Results:** The prevalence of underweight, stunting and wasting was 23.9%, 28.4% and 13.9% respectively. MUAC also indicated that 16.5% of children were undernourished. Chronic malnutrition was significantly associated with the presence of diarrhea in the past two weeks (p<0.001), higher child age (p<0.001), male sex (p<0.001), households with lowest household amenity score (p<0.002) or fewest dietary diversity score (p<001). Likewise, acute malnutrition was associated with preterm birth (p<0.03), lower child age (0.001), high number of siblings (p<0.03) and living in a household with higher months of inadequate food provisioning (p<0.03). These factors should be considered for any intervention aiming to reduce undernutrition among children in this age group living in Sikasso and Mopti in Mali.
**Conclusions:** Future efforts should be directed at examining how families in very poor and food-insecure areas can be empowered to feed their children a more diverse diet. These interventions must increase the availability and sustainability of household food provisioning as well as take into account potential illnesses.

**Keywords:** Stunting, Wasting, underweight, children, Mali

**Further collaborators:**

Abdou Tenkouano. West and Central Africa Council for Agricultural Research and Development, 7 Avenue Bourguiba, PO Box 48, Dakar, Senegal. Email: a.tenkouano@coraf.org

144/2559

## URINARY PESTICIDE EXPOSURE IN FRENCH ADULTS WITH LOW AND HIGH ORGANIC FOOD CONSUMPTION FROM THE GENERAL POPULATION-BASED NUTRINET-SANTÉ

(1)PhD. Nutrition Epidemiologist. EREN. Université Paris 13. Inserm (U1153). Inra (U1125). Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. Cnam. COMUE Sorbonne-Paris-Cité. F-93017 Bobigny. France; (2)PhD. Toxicologist. Toxalim. Université de Toulouse. INRA. ENVT. INP-Purpan. UPS. F-31027 Toulouse. France.; (3)PhD. Operational coordinator. EREN. Université Paris 13. Inserm (U1153). Inra (U1125). Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. Cnam. COMUE Sorbonne-Paris-Cité. F-93017 Bobigny. France.; (4)PhD. MD. Director. EREN. Université Paris 13. Inserm (U1153). Inra (U1125). Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. Cnam. COMUE Sorbonne-Paris-Cité. F-93017 Bobigny. France.; (5)Prof. Lab Director. EREN. Université Paris 13. Inserm (U1153). Inra (U1125). Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. Cnam. COMUE Sorbonne-Paris-Cité. F-93017 Bobigny. France.; (6)PhD. Nutritionist. Nutrition. Obésité et Risque Thrombotique (NORT). Aix-Marseille Université. INRA. INSERM. 13005. Marseille. France.; (7)PhD. Nutrition Epidemiologist. EREN. Université Paris 13. Inserm (U1153). Inra (U1125). Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. Cnam. COMUE Sorbonne-Paris-Cité. F-93017 Bobigny. France.

**Background and objectives:** Food consumption is the primary route of exposure to pesticide residues in general population. Due to its strict regulation, organic farming may contribute to reduce dietary exposure to pesticides but findings based on observational data are scant. In a nested case-control study from the NutriNet-Santé study, we aimed to compare urinary pesticide residues between “organic” and “conventional” consumers.

**Methods:** Based on self-reported organic food consumption assessed through a food frequency questionnaire, 150 low and 150 high organic food consumers were selected with <10% or >50% of organic food in the diet respectively (expressed as the proportion

of organic food in the whole diet in g/d). Participants were matched using the propensity score method including sociodemographic, food intakes and health characteristics.

Urinary pesticide residues and metabolites (organophosphorus, pyrethroid and azole compounds) were assessed. The molar sum of diethyl (total DEPs), dimethyl (total DMPs) and total dialkylphosphates (total DAPs) were computed. Differences in distributions across groups were tested using Wilcoxon signed-rank test for matched data. Median concentrations (MD), expressed in µg/g creatinine, were provided.

**Results:** Mean age was 58.5y and 70% of participants were women. Significantly lower (p <0.05) urinary levels of DETP (MD: 0.196 versus 0.297), DMTP (MD: 0.620 versus 1.382), total DAPs (0.12 versus 0.16) and free 3-PBA (0.017 versus 0.021) were observed among organic consumers compared to conventional consumers.

**Conclusions:** Our findings suggest that dietary pesticide exposure in adults may be lowered by switching from conventional foods to organic foods. This is particularly of high interest among consumers of conventional fruits and vegetables, as their exposition may be the highest.

**Keywords:** organophosphates; organic diet; pesticides; observational study

**Further collaborators:**

Rodolphe Vidal. Institut Technique de l'Agriculture Biologique (ITAB), F-75595 Paris. France.

Bruno Taupier-Letage. Institut Technique de l'Agriculture Biologique (ITAB), F-75595 Paris. France.

Gaël Durand. LABOCEA, F-29280 Plouzané. France.

Gwendolina Limon. LABOCEA, F-29280 Plouzané. France.

144/2567

## NUTRITIONAL STATUS AT BIRTH AND BLOOD PRESSURE IN CHILEAN YOUNG ADULTS: TWO COHORTS, 15 YEARS APART

**Background and objectives:** Hypertension is one of the main determinants of cardiovascular disease, so is important to identify risk factors of this condition. Birth weight (BW) has been mentioned as one of these factors especially in developed countries. The objective of this study was to assess the association between BW and blood pressure in a follow up of two cohorts in young adults from Valparaiso Region of Chile.

**Methods:** Two retrospective random samples born between 1974-1978 (cohort 1, n=999) and between 1988-1992 (cohort 2, n=741), were assessed in 2000-2002 and 2014-2016, at 24-28 years. BW was obtained from newborn records while blood pressure

<footnote>(1)Baudry, Julia; (2)Debrauwer, Laurent; (2)Delcambre, Adéline;</footnote>

<footnote>(3)Druesne-Pecollo, Nathalie; (4)Galan, Pilar; (5)Hercberg, Serge;</footnote>

<footnote>(6)Lairon, Denis; (2)Cravedi, Jean-Pierre; (7)Kesse-Guyot, Emmanuelle.</footnote>

<footnote>(1)Bustos, Patricia; (2)Amigo, Hugo; (3)Vasquez, Ximena.</footnote>

<footnote>(1)MD. Nutrition Department. Faculty of Medicine. University of Chile. Chile; (2)PhD. Nutrition Department. Faculty of Medicine. University of Chile. Chile; (3)MSc.MD. Nutrition Department. Faculty of Medicine. University of Chile. Chile.</footnote>
sure was ascertained concurrently. Multiple linear regressions
were built, adjusted by sex and BMI.

**Results:** In the cohort 1 the mean of BW was 3.17 Kg (±504), BMI was 25.8 (± 4.45), Systolic blood pressure (SBP) was 114.6 (±13.5) and DBP: 72.4 (±8.79). In cohort 2, BW was 3.33 (±488), BMI: 27.4 (±5.6), SBP 119.7 (±14.1) and DBP 72.5 (±9.8). There were significant differences in these means (cohort 2 versus 1) except in DBP.

In the cohort 1, for each Kg of BW increase, SBP decrease in 2.42 ( 95% CI=-3.74 to -1.10, p< 0.0001). In cohort 2, this figure was β -0.22 (95%=-2.18 to 1.72 p=0.82). For each Kg of BW increase, DBP decrease in -1.29 (95% CI= -2.26 to -0.33, p< 0.009) in the cohort 1 and β -0.49 (95% CI= -1.95 to 0.95, p=0.51) in cohort 2. These results are similar using BMI at birth instead of BW.

**Conclusions:** In the first cohort, born in the 1970's, an inverse association between BW and SBP and DBP were found. Fifteen years later, when low birth weight was lower and obesity is public health problem, we couldn't verify these associations. The possible explanation for these results are that better conditions at birth may reflect that there are no major fetal injury that have repercussions in adult life and that the risk of chronic diseases are determined later in life.

**Keywords:** Birth weight, blood pressure, adults

**Conflict of Interest Disclosure:** None

Funded by Chilean National Fund for Scientific and Techno-
logic Development (Fondecyt, n°1140453)

144/2568

EVALUATION OF THE INTENTION OF CONSUMP-
TION OF FRUITS, AND VEGETABLES OF THE EM-
PLOYEES OF AN EVENT SPACE IN THE CITY OF
SÃO PAULO

(1)Toscano Ferreira, Rosana; (1)Korukian Freiberg, Clara; (2) Araujo de Assis Rocha, Amanda.

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

**Background and objectives:** Fruits and vegetables are essen-
tial components of a healthy diet. They have low energetic density,
high fiber content, antioxidant components, besides being sourc-
es of micronutrients. The World Health Organization advocates
consumption of at least 400 g / day. Studies indicate that fruit and
vegetable consumption (FLV) is below recommended levels and
is among the top ten factors in determining the global burden of
disease in the last decade. The main objetive of this study was to
evaluate the intention of FLV consumption of employees of a space
of events.

**Methods:** This is a cross-sectional, non-directional, quantitative, descriptive and analytical study. We collected quantities of servings served by the employees, in four days of October / 2014 characterizing the consumption intention. It was stipulated as adequate consumption when the total amount of FLV / day was great-

er than or equal to 120 g. An average of sixty clients was evaluated,
totaling an analysis of 240 meals.

**Results:** In the menu we observed the incidence of two types of salads daily, besides the presence of fruit in 75% of the days. The presence of tubers (mandioquinha and potato ball) was observed as salads in 50% of the days. 20.4% of the meals did not have any type of salad and the prevalence occurred in the male gender. In 41.8% of the meals people used only one of the salads. In relation to the intention of consumption of the two types of salads was observed 38.3%. Meals that had a salad and fruit, or two salads and fruit were around 14% each. In 4.4% of the meals no type of salad was chosen, only fruit. In 54.6% the fruit was not chosen. Meals without salad and without fruit totaled 12.2%. The quantities of FLV considering the presence or absence of tubers showed that the percentage of adequate consumption decreased from 44.6% to 34.2%. Thus, the proportion of underweight increased from 55.4% to 65.8%.

**Conclusions:** According to the literature, FLV consumption was low. The female gender had greater consumption than the male. The presentation of the meals, when attractive, can generate increase of the consumption.

**Keywords:** FLV consumption. Eating habits. Food behavior. Collective feeding.

144/2570

INFLUENCE OF INCOME ON THE HOUSEHOLD
AVAILABILITY OF FRUITS AND VEGETABLES IN
BRAZIL

(1)Vieira Cunha Lima, Severina Carla; (2)de Oliveira Silva, David Franciole; (2)Araújo da Silva, Ana Paula; (3)Lima Torres, Neidjany Patricia; (2)de Lima Motta, Virginia Williane; (2)Bastos Pimentel, Jessica; (4)Oliveira Souza, Thatyane; (4)de Sales Souza, Angélica Luiz; (5)Maurício de Sena Evangelista, Karine Cavalcanti; (5)de Oliveira Lyra, Clélia.

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

**Background and objectives:** The household availability of food is influenced by several factors, such as eating habits, beliefs and income. Investigating the influence of income on the purchase of fruits and vegetables can contribute to the identification of the household availability of these foods according to income classes and provide subsidies for a better targeting of public policies aimed at encouraging the purchase and consumption of fruits and vegetables. The objective of this study is to evaluate the association between household monetary availability (HMA) per capita of fruits and vegetables (FV) and the classes of monthly family income (MFI) in Brazil, in the years of 1987, 1995, 2002 and 2008.
**Methods:** Were used the microdata from Household Budget Survey (HBS) carried out in the years 1987-1988, 1995-1996, 2002-2003 and 2008-2009, conducted by the Brazilian Institute of Geography and Statistics. The data of the HMA per capita of each food were obtained through the Collective Acquisition Booklet (POF), registered daily, during the period of seven consecutive days. The MFI was evaluated using the Work and Individual Income Questionnaire and classified in MFI classes, according to the minimum wage amount.

**Results:** The annual HMA per capita of FV, considering all income classes, in the years 1987, 1995, 2002 and 2008 was 93.5, 74.8, 56.8 and 61.4 Kg, respectively. When the income classes are analyzed separately, an increase in annual HMA per capita of FV was verified in all classes of income analyzed, so that from the lowest (<2 minimum wages) to the highest (> 30 minimum wages) the difference was greater than 100 kg in 1987 (50,2 Kg [137,6 g/day] x 162,4 Kg [444,9 g/day] and 2008 (37.7 kg [103.3 g/day] X 146.1 kg [400.3 g / day]).

**Conclusions:** Income can influence the household availability of FV in Brazil, so that families with higher purchasing power acquire approximately three times more than those with lower purchasing power.

**Keywords:** Household availability, Income, Fruits, Vegetables, Brazil.

(n=45) improved significantly from 0.301 (0.258-0.378) to 0.392 (0.372-0.417), (P<0.001) yet remained the lowest ranking group. South-East Asian LMIC (n=11) also improved significantly from 0.456 (0.408-0.522) to 0.564 (0.515-0.598), (P<0.001). The GNI for American LMIC (n=26) and European LMIC (n=20) increased from 1990-2005, but then dropped over the next ten years (both P<0.05). American LMIC, 0.459 (0.419-0.479) to 0.469 (0.444-0.490) to 0.457 (0.432-0.485); European LMIC, 0.571 (0.517-0.602) to 0.582 (0.526-0.606) to 0.575 (0.523-0.608) – values for 1990, 2005 and 2015, respectively, – showing no overall improvement. Eastern Mediterranean LMIC (n=16) 0.484 (0.414-0.525) to 0.483 (0.386-0.498) and Western Pacific LMIC (n=16) 0.433 (0.356-0.538) to 0.494 (0.262-0.604) remained stable across the MDG timespan (P>0.500). In nearly all 7 country groups, there was a decrease in PEM and MID (in high-income countries only PEM decreased), together with increased obesity. The different GNI trends among country groups were caused by the dynamic changes in these two opposing factors—decreased deficits and increased excess.

**Conclusions:** From 1990 to 2015, under-nutrition decreased, whereas over-nutrition increased steadily to become a major cause of malnutrition worldwide. The next Sustainable Development Goals should include alongside zero hunger – reduce obesity.

**Keywords:** global nutrition index, obesity, protein-energy malnutrition, micronutrient deficiency, Millennium Development Goal time trend (1990-2015)

144/2575

## GLOBAL NUTRITION IN THE MDG ERA (1990-2015): A SHRINKING HUNGRY, AND EXPANDING FAT WORLD (REVISED 144/298)

(1) Berry, Elliot; (2) Peng, Wen.

(1) MD. FRCP. Braun School of Public Health. Hebrew University-Hadassah. Jerusalem. Israel.; (2) MD. MPH. School of Medicine. Qinghai University. China. Research Center. The Amity Foundation. China.

**Background and objectives:** Following its publication in 2008, the global nutritional index (GNI) has been updated for the Millennium Development Goal (MDG) years (1990-2015), to show world trends in malnutrition, as it alone penalizes a country for over-nutrition.

**Methods:** We have re-calculated the GNI according to the methodology of the human development index, using geometric means, based on three indicators of nutritional status: macronutrient deficiency (DALY rates due to protein-energy malnutrition (PEM)), micronutrient deficiency (MID, DALY rates due to iron, vitamin A and iodine deficiency) and excess (prevalence of female obesity). The GNI (range 0-1) was calculated for 186 countries classified into seven groups according to the World Bank and WHO.

**Results:** The collective world GNI increased progressively from 0.433 for 1990 to 0.473 for 2015. Although high-income countries (n=52) remained the leading country group, their GNI worsened significantly from 0.657 (0.551-0.723) to 0.611 (0.536-0.675) (P<0.001). African low- and middle-income countries (LMIC)

144/2581

## CHANGES IN COMPLEMENTARY FEEDING PRACTICES RESULTING FROM A COMMUNITY-BASED BEHAVIOR CHANGE COMMUNICATION PROGRAM IN VIETNAM: A REPEATED CROSS-SECTIONAL STUDY

(1) Takanashi, Kumiko; (2) Phi, Quyen; (3) Dao To, Quyen; (4) Nguyen, Lan;

(5) Le Danh, Tuyen.

(1) Registered Dietitian. PhD. International Life Sciences Institute Japan Center for Health Promotion. Japan.; (2) MSc. Scientific Research Management Section. National Institute of Nutrition. Vietnam.; (3) Pharmacist. MSc. International Life Sciences Institute Japan Center for Health Promotion. Japan.; (4) MD. PhD. Scientific Research Management Section. National Institute of Nutrition. Vietnam.; (5) MD, PhD. National Institute of Nutrition. Vietnam.

**Background and objectives:** Nutritionally balanced and safe complementary food greatly contributes to children's growth in the first two years of life. Community-based behavior change communication (BCC) programs are an effective strategy to improve complementary feeding practices, but little is known about the effects of BCC programs on entire communities. This study aimed to examine the changes of mothers' complementary feeding practices and hand hygiene practices before and after the implementation of a community-based BCC program.

**Methods:** This is a repeated cross-sectional study which involved 329 mother and child (6-23 months) - pairs in the 2015
factors that could potentially affect nutritional status and health in
preconception women

**Methods:** This study aims to identify relation between Jamu consumption (traditional herbs) and food restriction (taboo) against hemoglobin (Hb) value in preconception women in Banggai Regency in the year 2016-2017. This study used cross sectional design with saturated sampling technique. The population in this study were 53 preconceptional women that meet the inclusion and exclusion criteria to judge the several factors that affect the value of Hb. Bivariate analysis using unpaired t test.

**Results:** The result show that stated hemoglobin levels average is 12.76 g / dL and the mean value 13.0 g / dL with the lowest hemoglobin value of 7.3 g / dL and hemoglobin highest value 15.9 g / dL. The test results of bivariate showed no significant difference in mean hemoglobin values among women whose consume herbs and women who did not (p = 0.751), there was no significant difference in mean hemoglobin values between groups of women with certain food restriction (taboo) and those who do not have restriction on certain foods (p = 0.231), there are no significant differences in mean hemoglobin values among women who do not consume herbs and those who consume herbs (p = 0753)

**Conclusions:** It is important to be aware of the pharmacological content of the medication particularly when it is systemically administered. Food taboos influence the amount, frequency and quality of nutrients as contributing factor against hemoglobin level and nutritional status of women before pregnancy. Hence, we need integrated and comprehensive approaches, with interventions to improve the overall health of the preconception women in this specific cultural context.

**Keywords:** Preconception, traditional herbs, taboo, hemoglobin

**Further collaborators:** Adi Tube, Researcher. Banggai District Health Office

144/2606

GROWTH CHANGES FROM INFANCY TO CHILD-
HOOD AND GLUCOSE TOLERANCE IN LATE AD-
OLESCENCE: EVIDENCE FROM HONG KONG'S
"CHILDREN OF 1997" BIRTH COHORT

(1)Cheng, Tuck Seng; (2)Leung, Gabriel M.; (3)Schooling, C. Mary.

(1)BSc. MPhil student. School of Public Health. Li Ka Shing Faculty of Medicine. The University of Hong Kong. Hong Kong SAR. People's Republic of China.; (2)MD. School of Public Health. Li Ka Shing Faculty of Medicine. The University of Hong Kong. Hong Kong SAR. People's Republic of China.; (3)PhD. School of Public Health. Li Ka Shing Faculty of Medicine. The University of Hong Kong. Hong Kong SAR. People's Republic of China.

**Background and objectives:** Previous studies on the association of growth with glucose metabolism have yielded inconsistent findings. Also, the role of growth at different phases remain unclear. We investigated the associations of growth changes from infancy to childhood with glucose tolerance in late adolescence.

**Methods:** Singletons born in Hong Kong from April to May 1997 were recruited into a prospective population-based "Chil-

dren of 1997" birth cohort (n=3276). Growth changes (weight-for-age z score (WAZ), length/height-for-age z score (LAZ) and body-mass-index-for-age z score (BAZ) based on the WHO growth charts) at different time intervals from infancy to late childhood were estimated using a spline model. Fasting plasma glucose (FPG) and glycated hemoglobin (HbA1C) concentrations at 16 to 18 years old were measured. Impaired glucose tolerance (IGT) was defined as FPG≥5.7 mmol/L or HbA1C≥5.6%. The multivariable linear and logistic regression models were adjusted for maternal characteristics (passive and active smoking status, migrant status, education, age, parity), infant characteristics (breastfeeding status, gestational age, WAZ at birth or LAZ or BAZ at 3 months), family history of diabetes and household income, while the second models were additionally adjusted for previous growth.

**Results:** Higher LAZ gain from 3 to 36 months (β=0.016mmol/L,95% confidence interval (CI)=0.001,0.030), WAZ gain from 36 to 108 months (β=0.032mmol/L,95% CI=0.019,0.044), LAZ (β=0.028mmol/L,95% CI=0.007,0.048) and BAZ (β=0.024mmol/L,95% CI=0.007,0.041) gains from 132 to 180 months were associated with higher FPG, while higher BAZ gain from 108 to 132 months was associated with lower HbA1C (β=-0.017mmol/L,95% CI=-0.017,0.000) and odds ratio (OR) of IGT (OR=0.68, 95% CI=0.54,0.86). The positive associations of BAZ from 36 to 108 months with FPG (β=0.013mmol/L,95% CI=0.002,0.025), WAZ gain from 36 to 108 months with HbA1C (β=0.009mmol/L,95% CI=0.000,0.019) and WAZ (OR=1.13,95% CI=1.00,1.27) and BAZ (OR=1.14,95% CI=1.03,1.25) gains from 36 to 108 months with IGT and the negative association of LAZ gain from 108 to 132 months with IGT (OR=0.73,95% CI=0.54,0.98) were more evident after additional adjustment for previous growth.

**Conclusions:** Our study demonstrated that there may be independent associations of growth across life stages with glucose metabolism. Further studies are warranted to improve understandings on the underlying mechanisms at different growth phases.

**Keywords:** growth, infancy, childhood, adolescence, glucose metabolism

144/2607

DIETARY CHANGES NEEDED TO IMPROVE DIET
SUSTAINABILITY: ARE THEY SIMILAR ACROSS
EUROPE?

(1)Vieux, Florent; (2)Perignon, Marlène; (3)Gazan, Rozenn; (2)Darmon, Nicole.

(1)PhD. MS-Nutrition. France; (2)PhD. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (3)MSc. MS-Nutrition. France.

**Background and objectives:** It is not known whether the dietary changes needed to achieve nutritional adequacy while reducing diet-related greenhouse gas emissions (GHGE) are similar across Europe when cultural and gender specificities are taken into account.
**Methods:** Starting from each mean observed diet in five European countries (France, UK, Italy, Finland and Sweden) and for each gender, nutritionally-adequate diets departing the least from observed diet were designed with linear programming by applying stepwise 10% GHGE reductions. Other models directly minimized GHGE.

**Results:** For most countries and whatever the gender, achieving nutritional adequacy implied substituting sugared and fatty products by fruit, vegetables and starchy foods, but increased GHGE. Within-food-groups substitutions were reinforced when imposing a stepwise GHGE reductions while meeting nutritional adequacy. Changes in consumption of animal-based products occurred but differed according to country and gender, particularly for fish, poultry and non-liquid milk dairy. The maximal GHGE reductions achievable ranged from 62% to 78% but they induced large departures from observed diets (at least 2.8 kg/day) by modifying the quantity of at least 99% of food items.

**Conclusions:** Setting nutritional goals with no consideration for the environment may increase GHGE. However, diet sustainability can be improved by substituting sugared and fatty food products by fruit, vegetables and starches, which involves country-specific changes in consumption of animal-based products. Standardized surveys and individual diet modeling are promising tools for further exploring ways to achieve sustainable diets in Europe.

**Keywords:** Sustainability. Diet modelling. Europe. Greenhouse gas emissions. Nutrition.

144/2612

SPATIAL CORRELATION BETWEEN DIABETES MELLITUS AND FOOD INTAKE IN BRAZIL, 2013

(1)Freire Pequeno, Nila Patrícia; (2)Vale, Diógo; (3)Silva Bezerra, Mariana; (2)de Araujo Cabral, Natalia Louise; (4)Pereira Santos, Camila Dayze; (2)Silva de Lima, Marcos Felipe; (2)Freitas da Silva Pereira, Ingrid; (5)de Sousa, Bruno Jonatan; (6)Roncalli da Costa Oliveira, Ângelo Giuseppe; (7)de Oliveira Lyra, Clélia.

(1)Msc. Registered Dietitian Nutritionist. Professor. Departament of Nutrition. Federal University of Rio Grande do Norte. Brazil.; (2)Msc. Registered Dietitian Nutritionist. Public Health Graduate Program. Federal University of Rio Grande do Norte. Natal. Brazil.; (3)BSc. Registered Dietitian Nutritionist. Nutrition Graduate Program. Federal University of Rio Grande do Norte. Natal. Brazil.; (4)BSc. Registered Dietitian Nutritionist. Public Health Graduate Program. Federal University of Rio Grande do Norte. Natal. Brazil.; (5)BSc. University Center of Rio Grande do Norte. Natal. Brazil.; (6)PhD. Dentist. Professor. Departament of Dentistry. Public Health Graduate Program. Federal University of Rio Grande do Norte. Natal. Brazil.; (7)PhD. Registered Dietitian Nutrition. Professor. Departament of Nutrition. Nutrition Graduate Program. Public Health Graduate Program. Federal University of Rio Grande do Norte. Natal. Brazil.

**Background and objectives:** The National Health Research (PNS, in Portuguese) conducted in Brazil in 2013, identified that 6.2% of the adult population (9 million people) had diabetes. Eating habits and life style may be related to this prevalence. Therefore, this study aimed to analyze the spatial correlation between diabetes and food intake in the Brazil adult population in 2013.

**Methods:** Ecologic study of spatial analysis, using data from the PNS, by the Brazilian Institute of Geography and Statistics, representing the 27 federative units (UF) of Brazil, in 2013. The dependent variable was diabetes prevalence in adults. The independent variables were the regular intake of vegetables, fruits and fruit juice (minimum of 5 servings/day); Soft drinks (> 5 days/week); Sweets (> 5 days/week); Replacement of meals by sandwiches, savory pastries or pizzas (> 5 days/week). Spatial analysis was conducted to verify the univariate and bivariate spatial correlations using the GeoDa software, through which thematic maps were built and the Local Moran's I (LMI) was calculated. This index presents results exclusively for significant spatial statistic correlations.

**Results:** It was found a significant and positive spatial correlation (p < 0.05) between diabetes prevalence and the consumption of sweets (LMI = 0.5878); soft drinks (LMI = 0.2056); vegetables, fruits and fruit juice (LMI = 0.1082); and, replacement of meals (LMI = 0.4561). High/High Clusters were identified between diabetes prevalence and all the independent variables in the Southeast, South and Midwest states. Low/Low Clusters between diabetes and consumption of sweets in states of the North, and for vegetables, fruits and fruit juice in states of the Northeast. These findings suggest spatial coexistence of a higher diabetes prevalence in UF where the adult populations have a higher intake of ultra-processed foods, such as in South Central Brazil.

**Conclusions:** The results demonstrate that the ingestion of ultra-processed foods and diabetes prevalence are correlated and are different in Brazil's territory. The habitants of different UF have different eating habits that favors diabetes prevalence, possibly related to the development of those places. Health actions and the prevention of this NCD, considering eating habits and nutrition, should be strengthened in Brazil.

**Keywords:** Spatial analysis; Chronic Disease; Noncommunicable diseases; Food habits; Food consumption.

**Further collaborators:**

Maria do Socorro Costa Feitosa Alves.

PhD. Dentist. Professor. Departament of Dentistry. Public Health Graduate Program. Federal University of Rio Grande do Norte. Natal. Brazil.
## WHICH DIETARY CHANGES TO MOVE TOWARDS NUTRITIONALLY ADEQUATE DIETS WITHOUT INCREASING THEIR IMPACT ON BIODIVERSITY, WATER AND LAND-USE? THE CASE OF TUNISIA

(1)Perignon, Marlène; (2)El Ati, Jalila; (3)Sinfort, Carole; (4)Drogue, Sophie; (5)Darmon, Nicole; (6)Amiot-Carlin, Marie Josephpe; (7)Group, MEDINA-Study.

(1)PhD. Nutritionist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (2)PhD. Nutritionist. Institut National de Nutrition et de Technologie Alimentaire. Tunisia.; (3)PhD. Environmental Physician. Unité Mixte de Recherche Information, Technologies, Analyse environnementale, Procédés agricoles (UMR ITAP). Montpellier SupAgro. France; (4)PhD. Economist. Unité Mixte de Recherche 1110 Markets, Organizations, Institutions and Stakeholders Strategies (UMR MOISA). INRA, CIRAD CIHEAM and Montpellier SupAgro. France.; (5)INRA.

**Background and objectives:** As several Mediterranean countries, Tunisia has experienced an epidemiological and nutritional transition resulting in an increase in overweight, obesity and co-morbidities. In the last decades, food consumption departed from traditional diets towards higher consumption of animal-based and sweet products. Tunisia also faces environmental issues such as water scarcity, soil erosion and biodiversity loss. This growing concern for health issues and climate change has emphasized the need to promote sustainable diets, i.e. nutritionally adequate, affordable, culturally acceptable, and with low environmental impact. The objective was to identify dietary changes needed to move towards nutritionally adequate diets without increasing their environmental impact.

**Methods:** Nutrient intakes were estimated using dietary data from the nationally representative Tunisian study on food consumption (n=7209, 35-70y), and food composition from a Tunisian database and the Food Processor software. Environmental impact of diets was assessed through 6 indicators - water scarcity, biodiversity, and 4 indicators for land-use (erosion resistance, mechanical filtration, groundwater replenishment, biotic production) - estimated for 161 foods. For each gender, two optimized diets respecting all nutritional recommendations from WHO and with minimized departure from the mean observed diet were designed with linear programming under 2 scenarios to fulfill: i) all nutritional constraints (NUTRI) and ii) all nutritional constraints without exceeding observed levels for the 6 environmental indicators (NUTRIENV).

**Results:** Calcium, copper, iron (for women), magnesium and potassium intakes were below their recommendations in the mean observed diets, while sodium and fats exceeded them. Under the NUTRI scenario, i.e. reaching nutritional adequacy without controlling for the environmental impacts, the main dietary changes were the increases of vegetables, starchy foods, fish and dairy products, and decreases of fats and sweet products. All the environmental indicators were impaired, except erosion resistance and biotic

production. Under the NUTRIENV scenario, i.e. when environmental indicators were limited to their observed levels, changes in dairy and starchy products quantities were lower than in the NUTRI scenario. In addition, fruits increased and meat decreased.

**Conclusions:** Environmental impacts should be assessed when identifying food consumption changes to reach nutritional adequacy. Dietary changes identified to move towards more sustainable diets in Tunisia will be translated into action proposals.

**Keywords:** Sustainable diet; Nutritional adequacy; Environmental impact; Tunisia; Diet modeling

**Further collaborators:**

The MEDINA Study Group: MJ Amiot (INRA), N Achir (CIRAD), L Alouane (INNTA) J El Ati (INNTA), S Bellagha (INAT), PM Bosc (CIRAD), M Broin (Agropolis), N Darmon (INRA), C Dhuique-Meyer (CIRAD), MC Dop (IRD), S Drogué (INRA), S Dury (CIRAD), A Ferchoui (INRA), C Gaillard (CIRAD), Z Ghraibi (INAT), F Jacquet (INRA), Y Kameli (IRD), F Kefi (CIHEAM), E Kesse-Guyot (INRA), D Lairon (INSERM), Y Martin-Prevel (IRD), C Méjean (INRA), C Mouquet (IRD), S Njoumi (INAT), M Padilla (CIHEAM), M Perignon (INRA), C Sinfort (SupAgro), P Traissac (IRD), E Verger (IRD).

## ANALYSIS OF THE USAGE AND CHARACTERISTICS OF DIETARY SUPPLEMENT CONSUMERS OF URBAN COSTA RICAN POPULATION

(1)Guerrero Calderon, Fabiola; (2)Pacheco Arteaga, Maria Amalia;

(3)Gómez Salas, Georgina.

(1)Bch. Nutritionist. School of Nutrition. University of Costa Rica. Costa Rica; (2)Bch. Nutritionist. School of Nutrition. University of Costa Rica. Costa Rica; (3)MSc. Nutritionist. Department of Biochemistry. School of Medicine. University of Costa Rica. Costa Rica.

**Background and objectives:** Previous studies reveal that dietary supplement (DS) consumption has increased in the Western world in all ages groups and is influenced by gender, age, educational level, socioeconomic status and other factors. In Costa Rica there is no information regarding DS use in the general population. The present study was focused on assessing the prevalence of use and determining the socio-demographic, anthropometric and nutritional characteristics of urban Costa Rican DS consumers, and to explore the reasons for their consumption.

**Methods:** Data were obtained from Latin American Nutrition and Health Study (ELANS), a cross-sectional study including a representative sample of urban population from eight LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela). In Costa Rica 798 participants were asked about DS use, and six months after the first contact a second questionnaire was applied by telephone to subjects who had previously reported DS use, in order to delve on the characteristics and perceptions involved in DS consumption. Chi-square test was used to compare observed and expected frequencies
**Results:** Approximately 6% (n=48) of the population surveyed reported the use of DS, mainly in the form of multivitamins. No significant differences for sex, age, socioeconomic status (SES), educational level and body mass index (BMI) were found for DS intake. DS consumers reflected significantly higher intakes of dietary calcium in both sexes, and dietary vitamins C and vitamin E in women, compared to nonusers. Reasons for consumption of DS focused on health benefits, prevention of illness, improved immunity, and energy boost. Although perceived as beneficial for 58% of the cases, the use was discontinued after six months.

**Conclusions:** The prevalence of DS usage was lower than reported by other studies in the field. A pattern similar to that described in the literature (BMI <25 kg/m2, physically active, healthy lifestyles and favorable socio-demographic backgrounds) was not found in this study.

**Keywords:** dietary supplements; consumers; perceptions, Costa Rica

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

**Further collaborators:** On behalf of ELANS Study Group

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## SELF-REPORTED ADVERSE EVENTS DURING LONG-TERM VITAMIN D SUPPLEMENTATION: DATA FROM A RANDOMIZED CONTROLLED TRIAL (VITAMIN D ASSESSMENT STUDY)

(1)Malihi, Zarintaj; (2)Lawes, Carlene M.M; (3)Waayer, Debbie; (4)Toop, Les; (5)Khaw, Kay-Tee; (6)Camargo Jr., Carlos A.; (7)Scragg, Robert.

(1)Msc. PhD student. Department of Epidemiology and Biostatistics. School of Population Health. Faculty of Medical and Health Sciences. University of Auckland. New Zealand;

(2)MBChB. PhD.School of Population Health.The University of Auckland. Auckland. New Zealand; (3)MEd. School of Population Health.The University of Auckland. Auckland. New Zealand;

(4)MBChB. MD.Department of Public Health & General Practice. The University of Otago. Christchurch. New Zealand; (5)MBBChir. MSc.Department of Public Health. University of Cambridge. Cambridge. England; (6)MD.DrPH. Department of Emergency Medicine. Massachusetts General Hospital. Harvard Medical School. Boston. USA; (7)MBBS.PhD. School of Population Health. The University of Auckland. Auckland. New Zealand.

**Background and objectives:** Many randomized controlled trials (RCTs) are examining the health effects of long-term vitamin D supplementation. To date, there are limited data on long-term

adverse events (AEs); recently published RCTs briefly reported on AEs, without undertaking a detailed assessment. Many earlier studies of vitamin D supplementation had small sample sizes and/or short follow-up periods. The main purpose of this study was to assess self-reported non-serious AEs during long-term monthly 100,000 IU vitamin D3 supplementation in 2558 participants in the vitamin D arm, compared to 2550 participants in the placebo arm.

**Methods:** We analysed data from the vitamin D assessment study (ViDA) trial's monthly-to-4monthly questionnaire over four years of follow-up to assess the incidence rate of the first reported AE, and first event in each category of the AE, including pain, respiratory illnesses and infection, gastrointestinal problems, tiredness, dizziness, skin-related symptoms and complications related to other health conditions. SAS package 9.4 was used for data analysis.

**Results:** There was no significant difference between the treatment arms for the first reported AE. 358 (14.0%) participants from vitamin D arm versus 337 (13.2%) participants from the placebo arm said they had AEs after taking the assigned capsule. Including repeated events by the same individuals, there were a total of 1153 AEs (627 and 526 in the vitamin D and placebo arms, respectively). However, only 559 participants (288 in the vitamin D and 271 in the placebo arm) explained the type of event. The incidence rate of any first event in participants of vitamin D arm was 5.1 versus 4.9 in the placebo arm with an attributable risk of 0.23 (P=0.56). Further regression analysis showed that being from minority ethnic groups (Māori, Pacific, South Asian; p<0.0001), a non-drinker or monthly drinker (p=0.011), or being a non- or ex-smoker (0.004) were associated with more AE reporting.

**Conclusions:** Monthly supplementation of 100,000 IU vitamin D3 did not increase participants' self-reported AEs in the ViDA study.

**Keywords:** Vitamin D3, supplementation, RCTs, adverse-events

**Conflict of Interest Disclosure:** The main study (ViDA) was supported with a New Zealand Health Research Grant (10/400) and by the accident corporation compensation of New Zealand (R.S., C.A.C., A.W.S., L.T., C.M.M.L., K,-T.K.) Funders had no role in the design, conduct, and analysis, interpretation of data or the preparation of this abstract. ZM is funded by a University of Auckland doctoral scholarship.
# THE IMPORTANCE OF THE EVALUATION OF COMPETENCES OF A COOK OF A FOOD AND NUTRITION UNIT OF A CANCER HOSPITAL

(1)Sandoval, Ana Paula; (2)Cardenas, Thais de Campos; (3)Araujo do Nascimento, Ivanice; (4)Toscano Ferreira, Rosana.

(1)Nutrition'Student. Nutrition of Department. São Camilo University Center. São Paulo. Brazil.; (2)MSc. Nutritionist. Nutrition of Department. Brazilian Cancer Control Institute - IBCC. São Paulo. Brazil.; (3)Nutritionist. Nutrition of Department. Brazilian Cancer Control Institute - IBCC. São Paulo. Brazil.; (4)MSc. Nutritionist. Nutrition of Department. São Camilo University Center. São Paulo. Brazil.

**Background and objectives:** The hospital is an organization specialized in prevention, recovery and maintenance of the health of the community. Understanding hospital activity as a business and balancing with its mission requires business management. The food service indirectly constructs and maintains the positive or negative image of the hospital, becoming the indicator of the service provided. Given this, food workers are required not only to prepare quality meals, but to develop their cognitive potential and the fundamental role of communication, participation and leadership in order to achieve the proposed objectives, increase productivity, minimize Efforts and costs. It is fundamental that the cook for the exercise of his activities present competences according to the requirements of the position. To evaluate the competences of the cook within a Food and Nutrition Unit of a cancer hospital.

**Methods:** This is a cross-sectional observational descriptive study with primary data collection. It was performed in March 2017 in a hospital UAN, administered by self-management located in the eastern region of the city of São Paulo. The study was carried out with a collaborator, the cook, who was responsible for the meals of the patients, and the data collection took place during three days from the observation of the daily routine by means of a check list elaborated on the basis of the literature and the internal rules of the hospital Containing 26 competencies required for that position. An unstructured interview was conducted in order to contribute to the data collection.

**Results:** The cook presented a 70% adequacy, being a responsible and attentive professional with the team and the patients, but was verified 30% of inadequacy, mainly in relation to the leadership, demonstrating difficulty in conducting the team in an efficient and satisfactory way.

**Conclusions:** The employee does not present all the competencies required for the position, mainly in relation to the leadership in relation to the team, being necessary to implement training program in order to promote the development and potentialization of its leadership spirit, contributing to personal and professional growth And therefore improvement in interpersonal relationships, with positive results for the UAN hospital and for the patients attended.

**Keywords:** Competencies. UAN Hospitalar. Cook.

# AN EXPLORATION OF CHINESE CONSUMERS' UNDERSTANDING OF EARLY AGE NUTRITION

(1)Conroy, Denise; (2)Smith, Sandy.

(1)PhD. Marketing. Consumer Behaviourist. University of Auckland Business School. New Zealand; (2)PhD. Marrketing. University of Auckland. New Zealand.

**Background and objectives:** China is potentially a large export market for New Zealand, particularly for milk products, yet little is understood about the Chinese consumer's understanding of nutrition. Most insight to date has been gained by taking a product focused perspective, but such research has yielded many failures and few successes for New Zealand companies trying to gain traction in the Chinese market. Consequently, this research has a different aim. It focuses on exploring the consumers' understanding, knowledge, attitudes, emotions and cognitive reactions regarding a general category, and the nutritional benefits sought from this category, rather than a specific product. Importantly, the research also includes an exploration of the environment, culture and political scape in which consumer understanding is derived and purchase decisions are made. The category for this project is supplementary infant and toddler foods. By supplementary foods we mean foods which are fed to a child either to support breast milk or instead of breast milk, weaning foods, and foods given to a child in addition to regular, shared family foods.

**Methods:** 14 in-home interviews were conducted in Shanghai, China. Participants were parents of infants between 2 months and 12 months of age. The interviews were conducted in Mandarin and an instantaneous translator was present to translate. 4 focus groups were also undertaken with mothers of toddlers ranging from 2 years to 5 years. A thematic analysis was undertaken utilising NVivo and a complimentary corpus analysis was also conducted.

**Results:** Emergent themes revealed a serious lack of basic understanding of nutrition, together with enormous trust in overseas milk powders and weaning food, and a total lack of trust in any Chinese products.

**Conclusions:** Policy makers in China have significant work to do to engage the trust of citizens and protect their dairy industry.

For NZ exporters insight into trust of foreign brands and the need for simple, clear labeling will be of benefit, together with insight into promotion

**Keywords:** Chinese consumers, early age nutrition

**Further collaborators:**

Funded by NZ Government project High Value Nutrition
# STRUCTURE AND NUTRITIONAL QUALITY OF FRENCH ADULT DIETS ACCORDING TO THEIR GREENHOUSE GAS EMISSIONS - FINDINGS FROM THE BIONUTRINET PROJECT

(1)Seconda, Louise; (2)Baudry, Julia; (3)Allès, Benjamin; (4)Galan, Pilar;

(5)Hercberg, Serge; (6)Langevin, Brigitte; (7)Lairon, Denis; (8)Poitereau, Philippe; (2)Kesse-Guyot, Emmanuelle.

(1)MSc. Epidemiologist. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France
ADEME Angers. France; (2)PhD. Epidemiologist. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France; (3)Equipe de Recherche en Epidémiologie Nutritionnelle. Centre de Recherche en Epidémiologie et Statistiques. Inserm (U1153). Inra (U1125). Cnam. Université Paris 13. COMUE Sorbonne Paris Cité. Bobigny. France.; (4)PhD. MD. Assistant director. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France;

(5)Pr. Director. Université Paris 13. EREN. Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité. France Département de Santé Publique. Hôpital Avicenne. Bobigny. France;

(6)PhD. Environmental scientist. Solagro. Toulouse. France;

(7)PhD. Epidemiologist. NORT (Nutrition Obésité et Risque Thrombotique). Aix Marseille Université. INRA. INSERM 13005. Marseille. France; (8)MSc. Environmental scientist. Solagro. Toulouse. France.

**Background and objectives:** Substantial climate change mitigation will not happen without a drastic reduction of greenhouse gas emissions (GHGEs). This involves important shifts in dietary patterns by a large proportion of the world's population.

The aim of this observational study was to compare and characterize diets with various levels of GHGEs from participants of the French NutriNet-Santé study.

**Methods:** Food consumption of 34,193 French adults included in the NutriNet-Santé cohort was assessed using an organic food frequency questionnaire. Dietary GHGEs (expressed in kg-CO2eq/year) of participants were computed, taking into account farming practices (organic or conventional production). Adjusted means of contribution of food groups to the diet (in percentage), percentage of organic food as well as compliance with the nutritional guidelines (reflected by the modified Programme National Nutrition Santé Guidelines Score, mPNNSGS) were compared between weighted quintiles of GHGEs, using ANCOVA models.

**Results:** Dietary GHGEs ranged from 677 kgCO2eq/year (Q1) to 2954 kgCO2eq/year (Q5), after adjustment for sex, age and energy intake. Contribution of meat to the diet increased along GHGEs (ranging from 2.6% (Q1) to 11.5% (Q5)) while an inverse trend was observed for fruit and vegetables. Concerning dairy products, the lowest contribution was found in the most climate-friendly diet (Q1).

After adjustment for age and sex, daily energy intake significantly increased along GHGEs (Q1: 1580 kcal/d (95%CI=1569-1592) versus Q5: 2647 kcal/d (95%CI=2633-2662), (p-trend<0.0001)). Percentage of organic food in the diet decreased along with GHGEs

(from Q1: 43.4% (95%CI=42.8-44.0) to Q5: 15.4% (95%CI=14.6-16.2)), as well as the adherence to the nutritional recommendations (mPNNSGS ranged from 8.34/13.5 (95%CI=8.30-8.38) in Q1 versus 7.95/13.5 (95%CI=7.90-7.80) in Q5).

**Conclusions:** Based on observational data, our study provides new arguments concerning the potential of actual healthy and alternative diets, with low environmental impact. Participants with low GHGEs diets have the highest contribution of fruit and vegetables, and the lowest contribution of animal's origin products. Their diets are more organic, provide fewer calories, and their compliance with French guidelines are better.

Our results highlight the importance of promoting holistic changes in dietary patterns to meet future environmental challenges, including the mitigation of global warming.

**Keywords:** Climate change, Dietary pattern, greenhouse gas emissions

# COMBINED HEALTHY LIFESTYLES AND RISK OF DEPRESSIVE SYMPTOMS IN THE NUTRI-NET-SANTÉ COHORT

(1)Adjibade, Moufidath; (2)Assmann, Karen E.; (2)Andreeva, Valentina.;

(3)Galan, Pilar; (4)Hercberg, Serge; (2)Baudry, Julia; (2)Kesse-Guyot, Emmanuelle.

(1)MSc. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.; (2)PhD. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.; (3)Md Phd. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.; (4)Prof Md Phd. Lab director. Nutrition Epidemiologist. Nutritional Epidemiology Research Team (EREN). Epidemiology and Statistics Research Center. U1153 INSERM. U1125 INRA. CNAM. Sorbonne Paris Cité. Paris 13 University. France.

**Background and objectives:** It is known that several modifiable lifestyle indicators, including diet quality, smoking status, alcohol consumption, weight and physical activity are independently associated with depression; however, their combined effects on depression risk is less studied. This study aimed to develop a Healthy Lifestyle Index (HLI) score composed of all of the above indicators and to investigate their association with the risk of incident depressive symptoms in a large French cohort.

**Methods:** The study sample consisted of 25,837 middle aged participants from the NutriNet-Santé study, initially free of depressive symptoms. The HLI was computed by assigning 1 point for each healthy behavior related to diet quality (measured by the modified French Programme National Nutrition Santé-Guideline
Score), smoking status, alcohol consumption, body mass index and physical activity. Incident cases of depressive symptoms were defined by a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥17 for men and ≥23 for women at least once during the follow-up. Hazard Ratios (HR) and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards models and population attributable risk (PAR) was calculated for each individual lifestyle indicator.

**Results:** A total of 2,112 first cases of incident depressive symptoms were identified over a mean follow-up of 6 years. In the adjusted models, compared with participants with a low score (0-2 healthy behaviors), participants with high and medium scores (4-5 and 3 healthy behaviors respectively) had a significantly lower risk of incident depressive symptoms (HR=0.75; 95% CI: 0.67-0.83) and (HR=0.84; 95% CI: 0.75-0.94) respectively, P-trend<0.0001. The estimated PAR representing the proportion of depressive symptoms cases in the population that are attributable to non-adherence to specific healthy lifestyle indicators were 8%, 5% and 5% for healthy diet, healthy weight and non-smoking respectively. The PAR was not estimated for physical activity and limited alcohol consumption because the estimated HR for these individual indicators was not statistically significant in multivariable models.

**Conclusions:** In this study, the combined healthy lifestyle behaviors were associated with a lower risk of incident depressive symptoms, indicating that modifying unhealthy lifestyles is of major interest in a context of prevention of depressive symptoms.

**Keywords:** Depressive symptoms; Lifestyle indicators; Population attributable risk

child nutrition through food production, and nutrition, health and hygiene behavior change communication (NHH-BCC). In Tanzania, HKI also used the EHFP platform to promote utilization of multiple micronutrient powders (MNP) for young children.

We assessed the effectiveness of HKI's EHFP platform for increasing MNP knowledge and utilization and reducing anemia compared to a non-EHFP beneficiary group that received MNP at home.

**Methods:** We used a cluster-randomized, longitudinal design. We randomly allocated 30 wards to EHFP or the comparison group (n=~1,150 children aged 6-12 months at baseline/group), and followed-up after 3, 12, and 18-months. At baseline and 12-months, both groups received a 2-month supply of MNP at home with MNP-relevant BCC. Village-level MNP sensitization was conducted before the 12-month delivery. In addition, the EHFP group received agricultural training and inputs, NHH-BCC and monthly MNP-specific interpersonal counselling (MNP-IPC) between 12- and 18-months. We assessed program exposure and impacts on maternal knowledge of MNP benefits, MNP utilization, and child anemia. We used intent-to-treat, cluster-adjusted OLS regression and linear mixed models to identify differences between time points (p-change<0.05) and study groups (p-group<0.05).

**Results:** MNP-IPC was higher (by design) in the EHFP compared to the comparison group (64% versus 5%, p-group<0.001); attendance at the MNP community sensitization was also higher (64% versus 29%, p-group<0.001). Between 3- and 18-months, knowledge of MNP benefits increased more in the EHFP group (+16pp versus +6pp, p-group=0.006); however, adequate MNP preparation increased in both groups (+20-21pp/group, p-change<0.001) and daily MNP consumption remained high in both groups (+8-11pp/group, p-change>0.05), with no group-wise differences. Similarly, anemia decreased between baseline and 3-months (-9-10pp/group, p-change<0.001) and between 12- and 18-months (-8pp/group, p-change<0.02) in both groups, with no differential decline between groups.

**Conclusions:** Promotion of MNP through EHFP increased exposure to MNP sensitization and MNP knowledge, but not utilization or effectiveness. However, given the effectiveness of EHFP in mobilizing communities for MNP sensitization events, community intervention platforms such as these may be a more viable delivery channel for distribution and promotion of MNP and other nutrition-specific interventions than possibly more costly and logistically challenging individual approaches.

**Keywords:** Community intervention platform; Anemia; Delivery; Micronutrient powder; Promotion

**Further collaborators:** This study was funded by Global Affairs Canada

**Background and objectives:** HKI's enhanced homestead food production (EHFP) model aims at improving maternal and

<footnote>(1)Becquey, Elodie; (2)Olney, Deanna; (3)Golan, Jenna; (4)Praygod, George; (5)Veryser, Stephen; (6)Smith, Erin; (7)Kitilya, Brenda; (8)Kidola, Jeremiah; (2)Ruel, Marie; (1)Rawat, Rahul.</footnote>

<footnote>(1)PhD. Poverty, Health and Nutrition Division. International Food Policy Research Institute. Senegal.; (2)PhD. Poverty, Health and Nutrition Division. International Food Policy Research Institute. United States.; (3)MSc, MPH. Poverty, Health and Nutrition Division. International Food Policy Research Institute. United States.; (4)MD, PhD. Clinical Research Programme. National Institute for Medical Research-Mwanza. Tanzania.; (5)MSc. Helen Keller International. Tanzania.; (6)MPH. Helen Keller International. Tanzania.; (7)MPH. Clinical Research Programme. National Institute for Medical Research-Mwanza. Tanzania.</footnote>
COMPARISON OF TWO PREGNANCY NUTRITIONAL EVALUATION STANDARDS IN ADOLESCENT CHILEAN PREGNANT WOMEN

**Background and objectives:** There are no curves to assess nutritional status and weight gain during pregnancy for adolescent women. We aimed to compare the diagnostic ability of the so-called Rosso-Mardones (RM) and Atalah et al (AEA) curves to detect newborns at risk in pregnant adolescents.

**Methods:** A sample of 5554 adolescent pregnant women was selected. The mothers had their deliveries at the Sótero del Río Hospital in Santiago, Chile, between 2001 and 2004. They were nutritionally classified with both evaluation patterns at the beginning of gestation. The distribution of newborns at risk for each maternal nutritional status according to both curves was calculated for the following categories: birth weight < 3000 g, birth weight > 4250 g, and birth length < 50 cm. Sensitivity and specificity values of the RM and AEA charts were calculated to determine newborns at risk in both obese and underweight women.

**Results:** A higher proportion of obese and underweight women were diagnosed with the RM curve. Proportions of at risk newborns were similar for each maternal nutritional category according to both curves. However, absolute numbers for those live births were much higher in women classified by RM. This led to a greater sensitivity of the RM curve.

**Conclusions:** The higher RM sensitivity could support its use to improve preventive actions for pregnant women younger than 20 years of age.

**Keywords:** birth weight and length, body mass index, adolescent pregnancy.

**Further collaborators:** Health personnel from the public services

THE EFFECT OF GENDER ON NUTRITION FACTS LABEL USAGE OF CERTAIN FOOD PRODUCTS

**Background and objectives:** Gender is an important socio-demographic factor that might determine the nutrition facts label usage. This study aimed to describe the prevalence of nutrition facts label use on certain food products by gender.

**Methods:** The study sample comprised of 647 (67.5%) female and 311 (32.5%) male participants. The mean age of participants was 21.5±1.86 years. In order to determine participants' nutrition facts label usage about certain food products including dairy and dairy products, meat and meat products, egg, legumes, bread, grains, pastry products, cereals, snacks, packed vegetables and fruits, cans and olives, oils, breakfast food products, sauces, salt and spices, beverages, ready to serve foods, instant soups, ready to serve desserts, frozen foods and diet products for special occasions were asked to participants by nutritionists. The responses are measured on a 3-Likert scale ranging from 1 (never) to 3 (always). The questionnaires were analysed with the statistical programme SPSS 22.

**Results:** While 501 (77.4%) of women participants read the nutrition facts label, 170 (54.7%) of men participants read the nutrition facts label (p<0.05). The frequency of female participants who always read the nutrition facts label of meat and meat products (71.9%), egg (72.5%), bread (70.3%), pastry products (%75.1), cereals (78.0%), snacks (77.1%), canned products and olives (75.2%), oils (73.9%), breakfast food products (75.8%), sauces (73.6%), salts and spices (76.2%), beverages (73.5%), ready to eat foods (73.7%), instant soups (74.0%), ready to eat desserts (75.9%), frozen foods (73.9%) and diet products for special occasions (77.8%) were higher than men participants (p<0.05). In the case of dairy and dairy products, legumes, grains, packed vegetables and fruits, there was no difference related to reading the nutrition facts panel among gender (p>0.05).

**Conclusions:** Understanding of nutrition facts label might be an important strategy for nutrition education. This study showed that men should be focused to improve their usage of nutrition facts labels by increasing their awareness about food labels.

**Keywords:** nutrition facts label, gender, certain food groups

<footnote>(1)Villalobos Restovic, Andrea; (1)Mardones, Francisco; (2)Rosso, Pedro;</footnote>

<footnote>(3)Farias, Marcelo; (4)Villarroel, Luis; (5)Bacallao, Jorge; (6)Rojas, Ivan.</footnote>

<footnote>(1)MD. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.; (2)MD. Department of Pediatrics. Pontificia Universidad Católica de Chile. Chile.; (3)MD. PhD. Department of Obstetrics and Gynecology. Pontificia Universidad Católica de Chile. Chile.; (4)PhD. Department of Public Health. Pontificia Universidad Católica de Chile. Chile.</footnote>

<footnote>(5)PhD. Universidad de Ciencias Médicas. Cuba.; (6)MD. Head of the Maternity Service at the Santa Maria Clinic of Santiago. Chile.</footnote>

<footnote>(1)Inan-Eroglu, Elif; (2)Dedebayraktar, Damla; (1)Ayaz, Aylin;</footnote>

<footnote>(1)Buyuktuncer, Zehra.</footnote>

<footnote>(1)PhD. Dietitian. Hacettepe University Faculty of Health Sciences, Nutrition and Dietetics Department. Turkey; (2)MSc. Dietitian. Hacettepe University Faculty of Health Sciences, Nutrition and Dietetics Department. Turkey.</footnote>