0.000). There was no endpoint group difference for hepcidin, IL-6 and B12 except folate which was higher in experimental group only compared to active control group (p=0.032).

**Conclusions:** Inclusion of Guava in regular SNP meal can be an effective strategy to improve iron status of ICDS preschool beneficiaries.

**Keywords:** Guava, Iron Status, Supplementary Nutrition Meal, ICDS, Preschoolers

## 144/862

### DEVELOPMENT OF A MULTI-SECTORAL SYSTEM TO ENFORCE A NATIONAL CODE ON MARKETING BREAST MILK SUBSTITUTES IN CAMBODIA

(1)Hou, Kroeun; (2)Prak, Sophonneary; (3)Aing, Hoksrun; (4)Green, Mackenzie; (5)Chai, Tze Lin; (6)Chum, Veasna.

(1)MPH. Deputy Country Director. Helen Keller International. Cambodia; (2)MD.MPH. Deputy Director. Maternal and Child Health Center. Ministry of Health. Cambodia; (3)Ph. Director. Department of Drugs and Food Safety. Ministry of Health. Cambodia; (4)Msc. ARCH Regional Coordinator. Helen Keller International; (5)Bsc. Research Specialist. Helen Hellen International. Cambodia; (6)Msc. ARCH National Coordinator. Helen Keller International. Cambodia.

**Background and objectives:** In 2005, Cambodia endorsed Sub-Decree 133 (SD133), a national code that regulates the marketing of breast milk substitutes (BMS). In 2014, research revealed that code violations were widespread and that there were no multi-sectoral mechanisms in place to enforce SD133. To monitor national code law, WHO recommends that the Ministries of Health set up an inter-ministerial monitoring team, composed of different ministries, agencies and departments that have a direct responsibility over the marketing, availability and promotion of relevant products.

**Methods:** Data on code violations and gaps in enforcement were used to advocate for an evidence-based plan to strengthen enforcement of SD133. Prior to August 2014, there was confusion over the roles of the four implementing ministries and no formal monitoring system, resulting in low reporting of code violations. Meetings and consultations were conducted with key stakeholders to discuss these issues. Policymakers including Officials from the Ministries of Health, Commerce, Information, and Industry and Handicraft, along with representatives from relevant UN Agencies and NGOs, collaborated to create a multi-sectoral supervisory mechanism to enforce the National Code regulating BMS in Cambodia.

**Results:** In August 2014, an Oversight Board (OB) was created to monitor and enforce SD133. This is co-led by the Ministry of Health and the Council for Agriculture and Rural Development; however, the four line Ministries are also represented by their Secretaries. The OB has two executive arms: (i) the Control Committee reviews marketing content regarding breast milk substitutes, and (ii) the Executive Working Group monitors and enforces compliance.

In 2015 the OB developed terms of reference and guidelines for the implementation of SD 133; which were adopted in December 2015. In 2016, the OB developed different monitoring checklists for the four line Ministries. Four provinces were selected to pilot test the system, develop implementation guidelines, and propose recommendations. Training included orientation on the national code and monitoring guidelines.

**Conclusions:** Cambodia's experience & lessons learned in establishing a multi-sectoral enforcement mechanism provide a valuable model for other countries wanting to establish similar systems to enforce code regulations.

**Keywords:** Breastfeeding, Policy, Multi-sectoral, Enforcement, Cambodia

## 144/864

### SIGNIFICANT IMPROVEMENT IN SUPPLEMENTATION OF MEGA DOSE OF VITAMIN A TO UNDER FIVE CHILDREN IN INDIA

Gupta, Aakriti.

PhD Scholar. Department of Food and Nutrition. Lady Irwin College. Delhi University. India.

**Background and objectives:** Vitamin A deficiency (VAD) is associated with increased risk of mortality and morbidity amongst under five children (U5). VAD continues to be an important public health problem in India. A survey conducted in 2011-2012 indicated that 2.5% of U5 had VAD. A recent cochrane review revealed that the Vitamin A supplementation (VAS) should be continued for reduction in morbidity in U5.

The Vitamin A Supplementation Programme was given low priority by the Government of India during 1990-2005 which was reflected in the National Family Health Survey (NFHS)-III data which found that only 16.5% of the children received VAS during 2005.

**Methods:** The NFHS is a large-scale, multi-round survey which undertakes systematic and stratified sampling techniques to ensure inclusion of villages with different socioeconomic characteristics. The NFHS sample covers 99 percent of India's population living in each state. The survey provides state and national level data for India on IYCF practices, maternal and child health, reproductive health, nutrition, anaemia and food supplementation practices using the standard indicators.

An analysis of secondary data available from National Family Health Survey (NFHS)-III (2005-2006) and NFHS-IV (2015-2016) was conducted on the coverage of VAS amongst U5 in different states of the country.

**Results:** The coverage of VAS was found to increase from 16.5% to 60.2% amongst U5 over a decade (2005-2016). The increase in the VAS coverage was observed in the range of 20-66% in different states of the country. The states with the highest increase in the coverage of VAS were Sikkim (18% to 84%), Karnataka (14% to 79%), Chhattisgarh (9% to 70%), Goa (31% to 90%) and Gujarat (13% to 71%). The improvement in coverage of VAS amongst U5
could be attributed to the close monitoring and supervision by the
government and development partners.

**Conclusions:** The present study revealed that the Govern-
ment of India and development partners have strengthened the
VAS Programme in the country. There is a need of continued and
sustained efforts for achieving full coverage of VAS to prevent the
mortality and morbidity amongst U5.

**Keywords:** Vitamin A supplementation, vitamin A deficiency, Mega dose of Vitamin A

(ORs) and 95% confidence intervals (CIs) for coal-burning fluo-
rosis in the top quartiles (vs. the lowest quartiles) were 0.52 (0.33,
0.83) for α-carotene, 0.48 (0.31, 0.76) for β-carotene, 0.33 (0.20,
0.53) for lutein/zeaxanthin, 0.40 (0.25, 0.67) for lycopene, 1.40
(0.88, 2.24) for β-cryptoxanthin, 0.42 (0.26, 0.67) for total carot-
enoids, respectively.

**Conclusions:** Higher intake of carotenoids is independently associated with lower prevalence of coal burning fluorosis. Increasing consumption of carotenoids food may benefit the prevention of coal burning fluorosis in Guizhou.

**Keywords:** Carotenoids, Coal-burning fluorosis, Cross-sectional study

ASSOCIATION BETWEEN DIETARY CA-
ROTENOIDS AND FLUOROSIS IN CHINESE
COAL-BURNING FLUOROSIS AREA: A CROSS
SECTIONAL STUDY

(1)Liu, Jun; (2)Yang, Sheng; (2)Luo, Mingjiang.

(1)Ph.D Associated professor. Department of Nutrition and Food Hygiene. School of Public Health. Zunyi Medical University. China; (2)Postgraduate. Department of Nutrition and Food Hygiene. School of Public Health. Zunyi Medical University. China.

**Background and objectives:** Carotenoids are a group of di-
et-derived phytochemicals with antioxidant and anti-inflamma-
tory properties that have attracted substantial interest because of
their capacity to reduce the risks of relevant diseases. Epidemi-
ology and experiments have demonstrated that excessive fluoride
could lead to oxidative damage and oxidative stress was an impor-
tant mechanism of fluorosis. However, there has no epidemiology
studies reported the association between carotenoids and the coal
burning fluorosis. Thus, we investigated the relation of carotenoid
intake, to the prevalence of coal-burning fluorosis.

**Methods:** Subjects were required to be country resident for at least 5 years, aged between 20-75 years in Zhijin county, which is the most severe coal-burning fluorosis area in Guizhou. Face-to-face interviews were conducted to assess habitual dietary intakes using a 75-item food frequency questionnaire and various covariates by structured questionnaires. Dietary consumption of carotenoids, energy and other nutrients will be calculated according to the database of the China Food Composition and United States Department Of Agriculture.

**Results:** A total of 899 participants were involved and the prev-
alence of coal burning fluorosis was estimated to be 72.9% in this
cross-sectional study. In the univariate logistic regression analysis
showed significantly dose-dependent inverse correlations between
the prevalence of coal burning fluorosis and the intake of α-caro-
tene, β-carotene, lutein/zeaxanthin, lycopene and total carotenids
in all of the subjects (all P-trend:<0.001). But there was no asso-
cicatoin of the prevalence of fluorosis with β-cryptoxanthin. After
adjustment for sociodemographic characteristics, dietary factors
and other potential confounders, the associations were slightly at-
tenuated but remained significant for all (P-trend: <0.001–0.008)
except for β-cryptoxanthin (p=0.553). The adjusted odd ratios

A CLUSTER RANDOMISED CONTROL TRIAL OF
AN INTEGRATED AGRICULTURE-NUTRITION
PACKAGE TO IMPROVE CHILDREN'S DIETS
THROUGH COMMUNITY BASED CHILDCARE
CENTRES IN MALAWI

(1)Gelli, Aulo; (2)Roschnik, Natalie.

(1)Ph.D. Nutrition epidemiologist. Poverty, Health and Nutrition Division. International Food Policy Research Institute (IFPRI);

(2)MSc. Senior Research and Impact Advisor. Programme Policy and Quality. Hunger and Livelihood team. Save the Children.

**Background and objectives:** The Nutrition Embedded Eval-
uation Program Impact Evaluation (NEEP-IE) study is a cluster
randomised controlled trial designed to evaluate the impact of a
childcare centre-based integrated nutrition and agriculture inter-
vention on the diets, nutrition and development of young children
in Malawi. The intervention includes activities to improve nutri-
tious food production and training/behaviour change communi-
cation to improve food intake, care and hygiene practices.

**Methods:** Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either 1) a control group with communities with Save the Children supported CBCCs and parenting education; or 2) an intervention group where additional nutrition and agricultural support activities were provided to help communities provide nutritious meals in the preschools all year round. Primary outcomes at child level include dietary intake of children aged 3-6y (measured through 24-hour recall) and infant and young child feeding (IYCF) practices for children aged 0-24m. At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agriculture and nutrition pathways were measured. During this trial, we followed a mixed methods approach combining child-, household-, CBCC- and market-level surveys and assessments with in-depth interviews and focus group discussions with project stakeholders.

**Results:** The integrated agriculture and nutrition intervention improved dietary intake and dietary diversity for pre-school children and their younger siblings. Positive effects were also observed
for household production and production diversity. These effects
were driven by increased consumption and production of nutri-
tious foods.

**Conclusions:** Assessing the simultaneous impact of pre-school meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine from a food systems perspective, the impact of a pre-school meals programme on dietary choices, alongside outcomes in nutrition, child development and agriculture domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes.

**Keywords:** Pre-school feeding, impact evaluation, nutrition, agriculture, diets.

**Further collaborators:** Amy Margolies, Johns Hopkins University, USA. Marco Santacroce, International Food Policy Research Institute (IFPRI). USA. Aisha Twalibu, Save the Children Malawi. Helen Moestue, Save the Children USA. Mangani Katundu, Chancellor College, University of Malawi, Malawi.

144/879

AFLATOXIN EXPOSURE IN CHILDREN IN MIR-PUR, DHAKA: DATA FROM A BIRTH COHORT

(1)Mahfuz, Mustafa; (2)Ashraful Alam, Mohammed; (3)Hossain, Muttaquina; (3)Amran Gazi, Mohammod; (4)Ahmed, Tahmeed.

(1)MBBS. MPH. Deputy Project Coordinator. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research. Bangladesh. Dhaka. Bangladesh; (2)MSc. Senior statistical officer. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research. Bangladesh.; (3)MBBS. MPH. Research Investigator. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research. Bangladesh.; (4)MBBS. PhD. Senior Director. Nutrition and Clinical Services Division. International Centre for Diarrhoeal Disease Research. Bangladesh.

**Background and objectives:** Dietary exposure to aflatoxin has been implicated in growth faltering in young children. Bangladesh has a hot and humid climate that is conducive to fungal growth and subsequent contamination of dietary staples. Given the high burden of childhood stunting, there has been no data on long-term exposure to aflatoxin measured by aflatoxin B1-lysine (AFB1-lys) adduct in plasma samples from children of urban Bangladesh. This study tried to explore the levels of aflatoxin exposure and its association with growth in a group of children followed longitudinally.

**Methods:** This study used data and biospecimens collected during 2010-2014 in MAL-ED birth cohort study in an urban slum of Mirpur, Dhaka where children were followed from birth to 36 months. AFB1-lys adduct concentrations were assessed by isotope dilution mass spectrometry from the plasma samples collected at 7, 15, 24 and 36 months. The limit of detection was 0.4 pg AFB1-lys/mg albumin. Aflatoxin exposures were compared to anthropometry, breastfeeding, dietary intake, and seasonal variation of sample collection.

**Results:** Number of Cohort children with available plasma samples tested at 7 months, 15 months, 24 months and 36 months were 208, 196, 173 and 167 respectively. For 744 tested plasma samples, geometric mean was 1.07 pg AFB1-lysine/mg albumin (range 0.04 - 123.5 pg/mg albumin). Percent of children demonstrated chronic aflatoxin exposure were 10.1%, 20.9%, 17.9%, and 61.7% for 7, 15, 24 and 36 months, respectively. Reduction in breastfeeding prevalence (80% at 24 months vs. 38% in 36 months) corresponds with high level detection of AFB1-lysine at 36 months. Consumption of grain significantly associated with aflatoxin exposure (OR 2.5, 95% CI 1.6-3.8, p= 0.0001). Seasonal variations detected as AFB1-lysine concentrations were highest at the end of rainy seasons. No association was detected between anthropometric indices and aflatoxin exposure.

**Conclusions:** Sixty two percent of children are chronically exposed to aflatoxin at the end of third year. This is the first reporting in children from Urban Bangladesh. Low mean concentration of detection could be responsible for lack of association with growth parameters. Nonetheless, more work is required to explore further the sources of aflatoxin from the dietary staples.

**Keywords:** Aflatoxin. MAL-ED. Bangladesh. AFB1-lys. children.

144/882

ISOFLAVONES, LIGNANS AND PROSTATE CANCER RISK: AN ANALYSIS OF INDIVIDUAL PARTICIPANT DATA FROM 5 PROSPECTIVE STUDIES

Perez-Cornago, Aurora.

PhD. Cancer Epidemiology Unit. Nuffield Department of population Health. University of Oxford. United Kingdom.

**Background and objectives:** The role of phytoestrogens in prostate cancer development is unclear. Previous studies have shown different results for isoflavones among Asian and non-Asian populations, and there are too few published prospective data to evaluate whether the associations differ by stage and grade of disease. The aim of this study was to determine the association between prediagnostic blood concentrations of isoflavones [genistein, daidzein, equol] and lignans [enterolactone and enterodiol]) and the risk of prostate cancer and to evaluate these associations by tumour stage and grade. Because of the large difference in circulating isoflavone concentrations between Asian and non-Asian populations, the isoflavone analyses were conducted separately for Asian and non-Asian studies.

**Methods:** A pooled analysis of individual participant data including up to 241 and 503 Asian cases and controls, and 1846 and 3929 non-Asian cases and controls from 5 prospective studies. Multivariable-adjusted conditional logistic regression was used to estimate the odds ratios (ORs) for prostate cancer based on the study-specific fourths of circulating concentrations of each phytoestrogen.

**Results:** Blood isoflavones were not associated with the risk of total prostate cancer in either Asian or non-Asian populations,
although in Asian populations there was a suggestion of an inverse association between blood equol and prostate cancer risk (multi-variable-adjusted OR for the highest versus lowest fourth = 0.61 [95% confidence interval [CI] =0.39-0.97] and OR per 75 percentile increase = 0.69, 95 CI = 0.46-1.05). No associations between lignans and prostate cancer risk were observed (OR per 75 percentile increase = 1.06, 95 CI = 0.90-1.25 for enterolactone and OR per 75 percentile increase = 0.99, 95 CI = 0.79-1.25 for enterodiol). These associations did not differ significantly by time-to-diagnosis or by tumour stage or grade.

**Conclusions:** There was no strong evidence that prediagnostic blood concentrations of isoflavones or lignans are associated with prostate cancer risk, although there are still relatively few published prospective data.

**Keywords:** Pooled analysis, nested case-control study, prostate cancer, isoflavones, lignans

**Further collaborators:**

The Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group (EHNBPCCG)

ral products, with less processing and less food additives. This term may refer to a food product with flavors that remind consumers of the homemade product; with an artisanal appearance; and is normally considered healthier and tastier. Food products with the term traditional were similar to the term homemade. Nonetheless, they can also refer to food products with variations, or old brands, or to food products whose flavors or ingredients have been kept since the first formulation. Food products that present the term original also refer to more natural products, to products whose production mode is traditional. Participants reported feeling confused or deceived by the use of non-standardized terms.

**Conclusions:** Therefore, it is necessary to improve the inspection on the use of these terms in food products. The study reinforces the need for assuring consumers' rights to adequate and concise information. Thereby, with the information available in food labels, consumers may choose their food products in a conscious way.

**Keywords:** Food labeling; Consumer behavior; Industrialized food product; Nutrition.

144/885

PERCEPTION OF BRAZILIAN CONSUMERS IN RELATION TO THE TERMS HOMEMADE, TRADITIONAL AND ORIGINAL IN LABELS OF PACKAGED FOODS

(1)Uggioni, Paula; (2)Muller, Jessica.

(1)PhD. Assistente Professor. Dept. of Nutrition. Nutrition Postgraduate Programme of Federal University of Santa Catarina. Brazil; (2)MSc. Nutritionist. Nutrition Postgraduate Programme of Federal University of Santa Catarina. Brazil.

**Background and objectives:** Terms such as homemade or traditional are present in labels of food products commercialized in Brazil. According to the Brazilian legislation, food labeling should not have terms that cannot be demonstrated, since they may induce the consumer to error in relation to its nature or composition. The study aimed at investigating the perception of Brazilian consumers from Florianópolis/Brazil, in relation to industrialized food products with the terms homemade, traditional and original.

**Methods:** Nine focal groups, with three to eight participants each, were conducted (October/December 2015). The group meetings were guided by a semistructured interview script with questions related to terms found in the frontal panels of industrialized products that were identified in a survey carried out in one of the ten biggest supermarket chains in Brazil. In addition, food packages were used to instigate the discussion about the meanings of each term. As criteria for inclusion: participants had to be adult; to buy food products; and, they could not have a degree in Nutrition.

**Results:** Forty-four subjects aged 20-58 participated in the focal groups (24 female). According to the participants, food products that present the term homemade generally refer to more natu-

144/892

SOCIAL DIFFERENTIALS AND NUTRITIONAL STATUS OF CHILDREN POPULATION IN THE NORTHWEST AND PAMPEANA REGIONS IN ARGENTINA

(1)Rodríguez Junyent, Constanza; (2)Román, María Dolores; (3)Pou, Sonia Alejandra.

(1)PhD. Student Nutricionist. Carrera de Nutrición Facultad de Medicina. Universidad Católica de Córdoba. Argentina; (2)PhD. Nutritionist. Instituto de Investigaciones en Ciencias de la Salud (UNC-CONICET). Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.; (3)PhD. Nutritionist. Instituto de Investigaciones en Ciencias de la Salud (INICSA). Universidad Nacional de Córdoba. CONICET. Facultad de Ciencias Médicas. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Argentina.

**Background and objectives:** Childhood nutritional status is influenced by biological, environmental and psychosocial determinants. Until the first National Survey of Nutrition and Health (ENNyS) performed in 2005, Argentina possessed few epidemiological studies about child nutrition and health. To study social "inequities" in health (avoidable and unfair social differences) in two regions with heterogeneous socio-economic realities, allows to know some characteristics that may explain, in part, differences in health and nutrition during childhood.

**Objectives:** a) To describe the socio-economic context in which children (2-5 years) reside in Pampeana and Northwest regions of Argentina, according to ENNyS (2005). b) To analyze the association between potential social determinants and children's nutritional condition in both regions.

**Methods:** observational cross-sectional study. Social determinants were defined according to available indicators correspond-
ing to the study sample of ENNYS (n=981 children in NOA and n=898 in and Pampeana region. We examined difference in ratios of social indicators between regions. The association of the previously defined factors was analyzed with the nutritional status (reference WHO 2006) in each region using a Chi-squared and Fisher test

**Results:** The ratio of families with female head of household was higher (p<0.0001) in NOA (64.91% vs 35.09% in Pampeana region). Significant differences were observed in the ratio of families with unsatisfied basic needs and poverty (according to poverty line and indigence line) between both regions, as well as access to potable water, electricity and in-house bathrooms. The NOA was determined as being the most disadvantaged region (p<0.0001). The children's low height was significantly associated with poverty (yes/no) in NOA (p=0.0003) and in Pampeana region (p=0.0147), and was associated with anemia in NOA (p≤0.0001). In NOA region, both underweight (p=0.028) and overweight/obesity (p=0.016), were associated with unsatisfied basic needs.

**Conclusions:** the two regions studied present differential socio-economic contexts. Nutritional status in children aged 2 to 5 years old is linked to conditions of poverty of their environment, especially in the NOA region. The identification of social determinants in childhood health and nutrition contributes to the definition of policies aimed at reducing the social inequities in health, and the design of future editions of the ENNyS.

**Keywords:** social differentials, nutritional status, childhood, Argentina.

144/899

RETHINKING FOOD SYSTEMS AND FOOD CHOICES THROUGH COMMUNITY GARDEN PARTICIPATION: LESSONS FROM A UNIVERSITY SETTING IN BRAZIL

**Background and objectives:** Community gardens promote health and wellbeing by influencing nutritional and social environments, as well as health-related behaviors. Our objective is to describe the experience of developing a community garden in a university as a context to promote healthy eating.

**Methods:** Participatory community-based methodologies were adopted to develop collectively an urban garden at the Federal University of Sao Paulo, Santos City, Brazil. An iterative planning was conducted over a ten-month period, beginning with an initial assessment of local resources and community engagement

efforts, succeeded by interdisciplinary activities – besides gardening activities – focusing primarily on food systems and other environmental influences on food choices (i.e., workshops, cooking sessions, educational movies, debates, and social media). Direct observation was used to evaluate each activity in terms of individual responses and participation.

**Results:** Activities sizes ranged from 9-45 participants, and provided an opportunity for dialogue and sharing of knowledge and perceptions about current food, physical and social environmental changes, lifestyle modifications, and impacts on healthy eating. The meetings appeared to enhance engagement and critical consciousness, intentions to change behavior, and empowerment to modify the environments towards health (e.g. skills acquired were applied creating home gardens and cooking for the family using unprocessed foods). Also, the community garden showed social benefits, such as social interaction, cultural diversity, community cohesion and revitalization of the spaces.

**Conclusions:** This experience demonstrates the potential of community gardens as a facility to enhance local environmental changes and health-conscious food choices. It provides a basis for interventions to improve community capacity and to support social development.

**Keywords:** Community garden, community development, community-based participatory research, healthy food system, nutritional environment

**Further collaborators:** This work was financially supported by the Pro-rectory of Extension and Culture of Federal University of Sao Paulo (Pró-reitoria de Extensão e Cultura – PROEC/UNIFESP) and receives a scholarship from the Pro-rectory of Student Affairs (Pró-reitoria de Assuntos Estudantis – PRAE/UNIFESP). We are thankful to all staff and students involved in the Project. We are thankful to PRAE/UNIFESP and PROEC/UNIFESP for the scholarship to the undergraduate students Renata Reis, Debra Alves Andrada and Giovanna Taltassori.

144/917

ASSOCIATION BETWEEN USUAL FREE SUGAR INTAKE AND BMI Z-SCORE OF AUSTRALIAN CHILDREN AND ADOLESCENTS

**Background and objectives:** Previous studies suggested dietary sugar consumption to be the main contributing factor in obesity, yet the findings were inconsistent. Moreover, evidence regarding the consumption of free sugar, which was defined as sugar added during manufacturing processes as well as some specific sweet foods, causing obesity was limited. In particular, free sugar from liquid and solid food was found to have different effects on obesity measures. The current analysis aimed to assess the effects

<footnote>(1)Milhassi Vedovato, Gabriela; (2)Helena Pereira Nunes, Heloise;</footnote>

<footnote>(3)Gobetti Leonardi, Fabricio; (4)Manchini Cardoso, Renata.</footnote>

<footnote>(1)MS, PhD. Nutritionist. Institute of Health and Society. Baixada Santista Campus. Federal University of Sao Paulo. Brazil.; (2)Social Work. Institute of Health and Society. Baixada Santista Campus. Federal University of Sao Paulo. Brazil.; (3)MS. Social Work. Institute of Health and Society. Baixada Santista Campus. Federal University of Sao Paulo. Brazil.; (4)Nutritionist. Institute of Health and Society. Baixada Santista Campus. Federal University of Sao Paulo. Brazil.</footnote>

<footnote>(1)Wong, Hon Ting; (2)Louie, Jimmy Chun Yu.</footnote>

<footnote>(1)MNutrDiet. School of Biological Sciences. Faculty of Science. University of Hong Kong. Hong Kong Special Administrative Region. China; (2)PhD. School of Biological Sciences. Faculty of Science. University of Hong Kong. Hong Kong Special Administrative Region. China.</footnote>
of consuming free sugar from solid and liquid food on the BMI z-score of Australian children and adolescents.

**Methods:** In this cross-sectional analysis, the data from the 2007 Australian National Children's Nutrition and Physical Activity Survey were used. Participants' dietary intake was collected using two separate multiple-pass 24-hour recalls, and free sugar intake was estimated using a previously established methodology. Usual intake of free sugar was estimated using Multiple Source Method. Structural equation modeling was used to determine the association between usual free sugar intake and age-and-sex-specific BMI z-score, and its indirect effect on BMI z-score moderated via energy over-consumption. Confounding variables such as physical activity level, saturated fat and fiber intake, and socioeconomic statuses were also included in the model.

**Results:** The association between total free sugar consumption and BMI z-score was weak and statistically non-significant (standardized $\beta$ = 0.009, $P$ = 0.672). Similar results were obtained when the predictor variable was changed to free sugar from solid food (standardized $\beta$ = 0.26, $P$ = 0.236) and liquid food (standardized $\beta$ < 0.001, $P$ = 0.991). The effect of usual free sugar intake on BMI z-score mediated via energy over-consumption was minimal (standardized indirect effects = -0.035-0.16).

**Conclusions:** Usual free sugar intake was not associated, either directly or via energy over-consumption, with BMI z-score in this dataset. This possibly reflected the complex relationship between free sugar intake and obesity. However, limitations of this study, such as underreporting and bias in the sampling period, may also have contributed to the findings. Further research effort is needed to further elucidate the roles played by free sugar consumption in causing obesity in children and adolescents.

**Keywords:** free sugar, structural equation modeling, children, obesity, Australia

To determine whether the traditional lower fat, higher carbohydrate diet is more effective than the higher fat, lower carbohydrate diet at preventing obesity among a non-obese healthy population in China.

**Methods:** Six-month randomized controlled-feeding trial conducted at Zhejiang University in Southern China, and Chinese PLA General Hospital in Northern China. Healthy young adults (aged 18-35 years, body mass index < 28) who lived on the university campus or in the hospital dormitory. (1) A lower fat, higher carbohydrate diet (fat 20%, carbohydrate 66% energy)); (2) a moderate fat, moderate carbohydrate diet (fat 30%, carbohydrate 56% energy); (3) a higher fat, lower carbohydrate diet (fat 40%, carbohydrate 46% energy). Protein provided 14% energy in all diets. Spectrum of fat intake was achieved by replacing a proportion of energy derived from carbohydrates (white rice and wheat flour) with fats (soybean oil).

**Results:** Reduction in body weight was significantly greater in the lower fat, higher carbohydrate group throughout the intervention ($P < .001$ for the interaction between diet group and time). Weight change at 6 months was -1.6 kg (95% CI: -1.8, -1.4) for the lower fat, higher carbohydrate group, -1.0 kg (95% CI: -1.2, -0.8) for the moderate fat, moderate carbohydrate group, and -0.8 kg (95% CI: -1.1, -0.5) for the higher fat, lower carbohydrate group. Reductions in waist circumference, total cholesterol, lower-density lipoprotein cholesterol, non-higher-density lipoprotein cholesterol and apolipoprotein B on the lower fat, higher carbohydrate group were greater than those observed on the other two diets groups.

**Conclusions:** Among healthy non-obese Chinese, a lower fat, higher carbohydrate diet is more effective than higher fat, lower carbohydrate diet at preventing obesity and improving cardiometabolic risk profile. (ClinicalTrials.gov NCT02355795.)

**Keywords:** Fat, carbohydrate, intervention, cardiometabolic risk, body weigh

144/919

EFFECTS OF MACRONUTRIENT DISTRIBUTION ON WEIGHT CHANGE AND RELATED CARDIO-METABOLIC PROFILES IN HEALTHY NON-OBESE CHINESE: A RANDOMIZED, CLINICAL TRIAL

**Background and objectives:** In the past 30 years, obesity rates in China have increased rapidly in parallel with a transition from the traditional lower fat, higher carbohydrate diet to a diet relatively higher in fat and reduced in carbohydrate.

144/924

PARENT'S KNOWLEDGE, ATTITUDES, AND PRACTICES ABOUT SALT/SODIUM INTAKE IN CHILDREN

**Background and objectives:** PAHO promotes implementation of a knowledge, attitudes and practices (KAP) questionnaire as an element to support strategies to reduce blood pressure (BP) and cardiovascular diseases risk throughout reducing sodium intake.

<footnote>(1)Li, Duo; (2)Wan, Yi; (2)Wang, Fenglei; (3)Yuang, Jihong; (3)Li, Jie;</footnote>

<footnote>(3)Jiang, Dandan; (4)Zheng, Jusheng; (5)Huang, Tao; (6)Mann, Jim.</footnote>

<footnote>(1)PhD. Institute of Nutrition & Health. Qingdao University.</footnote>

<footnote>China; (2)Department of Food Science and Nutrition.</footnote>

<footnote>Zhejiang University. Hangzhou. China; (3)No. 1 Department of Nutrition. Chinese PLA General Hospital. Beijing. China; (4)MRC Epidemiology Unit. University of Cambridge. Cambridge. UK;</footnote>

<footnote>(5)Saw Swee Hock School of Public Health. National University of Singapore. Singapore; (6)Departments of Human Nutrition and Medicine. University of Otago. Dunedin. New Zealand.</footnote>

<footnote>(1)Gaitan-Charry, Diego; (2)Arboleda, Juan; (3)Marroquin, Juan; (4)Lozano, Gustavo; (5)Cadavid Castro, Martha Alicia; (6)Arboleda, Luz Marina.</footnote>

<footnote>(1)Md, Phd. Assistant Professor. Nutrition And Dietetics School.</footnote>

<footnote>University Of Antioquia. Colombia; (2)Bsc. Faculty Of Medicine.</footnote>

<footnote>University Of Antioquia. Colombia; (3)Bsc. School Of Nutrition And Dietetics. University Of Antioquia. Colombia; (4)Msc.</footnote>

<footnote>Professor. School Of Nutrition And Dietetics. University Of Antioquia. Colombia; (5)Msc. Assitant Professor. School Of Nutrition And Dietetics. University Of Antioquia. Colombia;</footnote>

<footnote>(6)Phd. Faculty. School Of Nutrition And Dietetics. University Of Antioquia. Colombia.</footnote>
take. PAHO´s KAP is targeted to adult population, however, a reduction of sodium intake also reduces BP in children. Considering that a family environment and parent´s decisions may influence children salt/sodium intakes, our propose was to identify parent´s KAP related to salt/sodium intake of children.

**Methods:** PAHO´s KAP questionnaire was adapted to evaluated salt/sodium variables focusing in Children. The adapted questionnaire was applying to parents and caregivers of children beneficiaries of a food complementary program in Antioquia – Colombia.

**Results:** Questionnaires were obtained from 2997 parents and caregivers; 37.5 (SD±10.9) years old, 94.3% female, and 65% from rural areas. Related with knowledge, 15.6% of respondents declare that they know difference between salt and sodium, 11.4% always know the amount of sodium ingested by children, 15.4% declare that always labeling of children´s food has information about sodium content, 63.5% agree that sodium affects children's health and 62.1% consider that the amount of sodium ingested by their children is adequate. About attitudes, 57.4% and 29.2% of respondent try their children reduce salt and sodium intake, respectively. About practices, 81.7% of respondent declared some action to reduce children's salt/sodium, among them: 22% read food labeling related with sodium, 19.6% choose to buy low sodium content foods, and 68.9% avoid children's addition of salt on the table.

**Conclusions:** Parents and caregivers recognize that sodium intake has a negative effect on children's health. However, they lack knowledge about what is sodium, furthermore, they think that sodium intake is adequate in children. Parents try to reduce children sodium intake, nevertheless, their actions generally aimed to decrease salt addition, rather than avoid foods source of sodium. It is important to implement educational strategies to sensitize parents and caregivers about a possible excessive intake of sodium in children and identification of food sources of the mineral.

**Keywords:** Sodium, knowledge, attitudes, practices, parents, children

**Further collaborators:** Acknowledgments: Gobernación de Antioquia

high-income settings, including greater risks for undernutrition, overweight/obesity, and micronutrient deficiencies. Considering the dramatic shift from communicable to non-communicable diseases (NCDs) in LMICs, the recognition of poor diet as a key risk factor for NCD is also becoming increasingly important. Additionally, adolescent pregnancy is three times higher in LMICs, highlighting the dual burden of poor nutrition and increased pregnancy rates for adolescents in these contexts. It is well established that malnutrition in pregnancy, particularly for adolescents, can lead to poor maternal and infant birth outcomes and sustained intergenerational effects.

Adolescence represents a key entry point for nutrition interventions that will underlie good health and practices in adulthood, especially considering the psychosocial growth and increasing autonomy that occurs during this period. However, before establishing appropriate interventions, we must first understand current trends in intake. As such, the objectives of this review are to describe the dietary intake and practices of adolescent girls in LMICs.

**Methods:** Using an adapted version of the UNICEF framework for child undernutrition as a logic model, we will systematically evaluate existing literature on the dietary intake and practices of adolescent girls in LMICs. Types of studies and documents to be reviewed will include observational studies, surveys, qualitative research studies, program evaluations, and other descriptive program documents. Participants must include adolescent girls (10-19 years). Primary outcomes assessed will include: types of food consumed, food composition, place consumed, and frequency of consumption. Secondary outcomes will be data dependent and will include height, weight, BMI, and micronutrient deficiencies. Studies conducted in high-income settings and those published prior to 2000 will be excluded.

**Results:** Pending.

**Conclusions:** Understanding adolescent girls' dietary intake and practices is critical for identifying causes of malnutrition in order to offer strategic recommendations for improvement through programming, advocacy, and future research. This study will not only synthesize existing evidence across several contexts, but it will translate knowledge into useable action points for country officials.

**Keywords:** Adolescent, LMIC, diet, eating practices, nutrition transition

<footnote>(1)Keats, Emily; (2)Carducci, Bianca; (3)Gaffey, Michelle; (4)Bhutta, Zulfiqar.</footnote>

<footnote>(1)PhD. MPH. Centre for Global Child Health. The Hospital for Sick Children. Toronto. Canada.; (2)MSc. Centre for Global Child Health. The Hospital for Sick Children. Toronto. Canada.; (3)MA. MSc. Centre for Global Child Health. The Hospital for Sick Children. Toronto. Canada.; (4)Phd. MBBS. FRCPCH. FAAP. Centre for Global Child Health. The Hospital for Sick Children. Toronto. Canada.</footnote>
POLYCYCLIC AROMATIC HYDROCARBONS BIO-
MARKER AMONG NON-OCCUPATIONALLY EX-
POSED INDIVIDUALS IN SILESIA

(1)Zając, Joanna; (2)Kolarzyk, Emilia; (3)Szot, Wojciech; (4)Potocki, Artur; (5)Koperny, Magdalena.

(1)MSc. Nutritionist. Biologist. Department of Hygiene and Dietetics. Jagiellonian University. Medical College. Krakow. Poland.; (2)Prof. Biologist. Department of Hygiene and Dietetics. Jagiellonian University. Medical College. Krakow. Poland.; (3)PhD. MD. Department of Hygiene and Dietetics. Jagiellonian University. Medical College. Krakow. Poland.; (4)MSc. Chemist. Department of Hygiene and Dietetics. Jagiellonian University. Medical College in Krakow. Poland.; (5)MSc. Public health practitioner. Systematic Reviews Unit - Polish Cochrane Branch. Jagiellonian University. Medical College. Krakow. Poland.

**Background and objectives:** Polycyclic aromatic hydrocarbons (PAH) constitute a composition of different molecules, ubiquitously present in the environment. Typically are connected with cigarette smoke and heavy industry, while those compounds can be present in food as a result of heat processing, such as: grilling, smoking or frying. The aim of presented study was measurement of PAHs' biomarker: 1-hydroxypyrene, among non-occupationally exposed individuals.

**Methods:** 206 individuals from region of Silesia in Poland were analyzed with respect to 1-hydroxypyrene urine concentration. High performance liquid chromatography with solid phase extraction and fluorescent detection was used for measurement. Biomarker concentration was normalized for creatinine. Questionnaires for all participants focusing on smoking status and knowledge about PAH sources were obtained.

**Results:** Mean concentration of biomarker was 0,74 µg/g (SD: 0,39; max: 1,94 µg/g; min:0,06 µg/g). 15% of participants were no-smokers. Smokers obtained higher values comparing to non-smokers (0,82 µg/g; CI: 0,76 to 0,87 vs. 0,73 µg/g; CI: 0,67 to 0,78). Participants were not aware about food sources of PAHs.

**Conclusions:** Results measured for non-smoking individuals are higher than guidelines described as guidance value for non-smokers, not exposed at work (0,46 µg/g). The basic knowledge about presence of PAHs in food and practical ways how such exposure can be lowered is especially important as for general population diet remains substantial PAHs' source.

**Keywords:** biomarker, 1-hydroxypyrene, polycyclic aromatic hydrocarbons

FOOD ENVIRONMENTS OF SCHOOL-AGED
CHILDREN AND ADOLESCENTS IN LOW- AND
MIDDLE- INCOME COUNTRIES: INVESTIGATING
A PROPOSED CONCEPTUAL FRAMEWORK

(1)Carducci, Bianca; (2)Keats, Emily; (3)Gaffey, Michelle; (4)De-Regil, Luz Maria; (5)Roth, Daniel; (6)Bhutta, Zulfiqar.

(1)MSc. Centre for Global Child Health. The Hospital for Sick Children. Canada.; (2)PhD. MPH. Centre for Global Child Health. The Hospital for Sick Children. Canada.; (3)MA. MSc. PhD candidate. Centre for Global Child Health. The Hospital for Sick Children. Canada.; (4)DSc. MSc. Micronutrient Initiative. Canada.; (5)MD. PhD. Department of Paediatrics and Centre for Global Child Health. The Hospital for Sick Children and University of Toronto. Canada.; (6)PhD. MBBS. FRCPCH. FAAP. Centre for Global Child Health. The Hospital for Sick Children. Canada.

**Background and objectives:** Adequate nutrition during school-age and adolescence is important for both current and future health, and these periods are key windows of opportunity for the catch-up growth needed to prevent persistent intergenerational effects of malnourishment (Black et al., 2013; PAHO, 2011). While there have been efforts to determine the burden of malnutrition (undernutrition, overweight/obesity and micronutrient deficiencies) among school-aged children (SAC) and adolescents in LMICs, little is known about the influence of the food environment, particularly in low- and middle-income country (LMIC) settings. Food environments are defined as the collective physical, economic, policy and socio-cultural surroundings, opportunities and conditions that influence people's food and beverage choices and nutritional status (Swinburn et al., 2014). The objective of this study is to synthesize available evidence on the characteristics of the food environment of SAC and adolescents in LMICs in order to substantiate a proposed conceptual framework.

**Methods:** We comprehensively searched for and evaluated studies and reports published since 2000 in the peer-reviewed and grey literature that describe or assess characteristics of the food environment including product (food availability, assistance and supply), proximity (accessibility), promotion (advertising), prominence (shelf-space), purchasing (sales analysis), price (affordability), preference (choice, desirability and acceptability) and policy (legislation and regulation) among school-aged children (5-9 years) and adolescents (10-19 years) across LMICs. We included observational and experimental study designs, national and sub-national policy, program and strategy documents, while excluding animal studies and systematic reviews. Electronic databases (Medline, Embase, CAB abstracts, PsycINFO, Web of Science, The Cochrane Library, CINAHL) were searched using a combination of appropriate keywords, MeSH, and free text terms.

**Results:** Pending – synthesis is ongoing.

**Conclusions:** From this synthesis, we will substantiate a proposed conceptual framework of the food environment of SAC and adolescents. Understanding characteristics of the food environment is critical for identifying associations to diet-related health
outcomes and possible indicators of the food environment of SAC and adolescents.

**Keywords:** Food Environment, Nutrition, Diet, School-age Children, Adolescents

(¹)Boni, Lucia; (²)Crespo, Lucia; (³)Rodríguez Junyent, Constanza;

(⁴)Scuzzi, Graciela.

(¹)BSc Nutritionist. Carrera de Nutricion. Universidad Catolica de Cordoba; (²)BSc Nutritionist. Carrera de Nutricion. Universidad Catolica de Cordoba. Argentina; (³)PhD Student. Carrera de Nutricion. Universidad Catolica de Cordoba. Argentina; (⁴)MPh. Escuela de Nutrición. Universidad Nacional de Córdoba y Universidad Católica de Córdoba. Argentina.

**Background and objectives:** Introduction: Human rights approach allows you to define the obligations of States against major human rights; the concept of health has evolved, is now recognized as a fundamental right determined by a set of personal, social, economic, political and environmental conditions; proper nutrition is necessary but not enough to be healthy.

Objective. Investigate the nutritional condition of children in a kindergarten and social representations of the right to health of caregivers.

**Methods:** This research was carried out from two perspectives. In a first stage it was approached from the quantitative perspective, determining the nutritional condition of 89 children attending the kindergarten. In a second stage, from the qualitative perspective, a study on the representations of the right to health of caregivers was done through purposive sampling. They were conducted seven interviews, also participant observation. The analysis of qualitative data was performed using the constant comparative method and inter-method triangulation.

**Results:** 9% of children were stunted, and 35% overweight or obese. No sex or age differences were found. As for the performances all mothers considered health as absence of disease and parents as primarily responsible for the health of children, malnutrition was not visualized as a health problem; while teachers and health professionals, had a more comprehensive view, they recognize the health situation of children and incorporate the state as guarantor. Violence, drug and alcohol, and pollution were the main problems represented by the interviewees.

**Conclusions:** It requires a paradigm shift in terms of concepts of health, rights, citizenship, and empower citizens to recognize and exercise their rights, highlighting the State's obligation to adopt measures to guarantee and fulfill the right to health in this community.

**Keywords:** social representations, rights, health, childhood, nutritional condition.

(¹)Mackay, Sally; (²)Lee, Amanda; (³)Vandevijvere, Stefanie;

(⁴)Swinburn, Boyd.

(¹)MSc. Registered Nutritionist. School of Population Health. University of Auckland. New Zealand.; (²)PhD. The Australian Prevention Partnership Centre. Sax Institute. Australia;

(³)PhD. School of Population Health. University of Auckland. New Zealand.; (⁴)MD. School of Population Health. University of Auckland. New Zealand World. Health Organization

Collaborating Centre for Obesity Prevention. Deakin University. Australia.

**Background and objectives:** Price and affordability of diets are important determinants of food choice and therefore health. A standardized method to determine the relative price and affordability of healthy diets compared to current diets was developed and tested in New Zealand.

**Methods:** A healthy diet meeting food and nutrition guidelines, nutrient reference values, and energy requirements for a healthy BMI, and a current (unhealthy) diet based on eating patterns identified from national nutrition surveys and energy requirements for the current population BMI were developed. Food prices were collected from three supermarkets, fresh produce stores and takeaway outlets. Affordability of the diets was assessed using three income scenarios for a household of four. Only the current diet contained alcohol, takeaways or discretionary foods (energy dense, high in saturated fat, sugar, sodium). A range of scenarios assessed the cost of diets after changing different metrics such as the type of price (e.g. usual, discounted), diet composition or energy adjustments.

**Results:** The healthy and current diets were similar in cost at NZ$566 per fortnight. If households were receiving welfare assistance, the healthy and current diets would require 45% of household income and, if receiving the median household income, 18% of household income. If GST were removed from healthy foods, the healthy diet would become 6% cheaper than the current diet. The relative differences between diets changed when scenarios were modeled for inclusion of foods in the healthy diet (healthier takeaways, discretionary foods at 6% of energy, moderate amount of alcohol), which price to use (discounts, brand choice), and whether the diets were isocaloric.

**Conclusions:** The relative price and affordability of a healthy and current New Zealand diet was similar, however changing some aspects of price or diet changed the price differential. It is essential when comparing diet costs over time or between locations to use the same principles and methodology.

**Keywords:** Food affordability, Diet cost
THE PATIENTS WITH GESTATIONAL DIABETES AND OBESITY MOSTLY REQUIRE INSULIN AS A TREATMENT AUTHORS

(1)Saurral, Ruben; (2)Manià, Silvana; (3)Fernandez, Daniela; (3)Rafael, Rodnay; (3)Sanchez, Nelson; (3)Avendaño, Ariel; (3)Pool, Ramiro.

(1)MD. Departamento de Diabetes y Embarazo. Maternidad Municipal Maria Eva Duarte de Peron. Buenos Aires. Argentina;

(2)Nutritionist. Departamento de Diabetes y Embarazo. Maternidad Maria Eva Duarte de Peron. Buenos Aires. Argentina;
(3)MD. Departamento de Diabetes y Embarazo. Maternidad Maria Eva Duarte de Peron. Buenos Aires. Argentina.

**Background and objectives:** Determining nutritional status, diagnostic method and treatment in patients with gestational diabetes.

**Methods:** Descriptive, retrospective, observational study of the pregnant population attending the Diabetes and Pregnancy clinic of the Maternity Municipality of Malvinas Argentinas, Buenos Aires, between January and December 2014. Information was gathered from clinical records.

The diagnosis method of fasting plasma glucose and Oral glucose tolerance test according to the latin american association of diabetes (ALAD) criteria, insulin treatment or dietary plan only, the mean of BMI and age. The data was processed with the EPI INFO7 statistical program.

**Results:** 227 cases of GDM were confirmed in relation to the 3975 registered births. The nutritional status based on the BMI: obesity 35%, overweight 27%, normal 36%, underweight 2%.

The average age was 29 years, the mean BMI was 28. It was detected with OGTT: 81%, and with FPG: 19%.

From the group of patients diagnosed with gestational diabetes through OGTT: 34% required only food plan, his average age was 28 years and the BMI 25; 37% required insulin with an average age of 30 years and BMI of 30; 29% failed to evaluate treatment for concurrent treatment with full term.

From the group of patients diagnosed with gestational diabetes through FPG: 22% required only food plan, his average age was 25 years and BMI 27.5; 64% required insulin with an average age of 28 and a mean BMI of 31.5; 14% failed to evaluate treatment for concurrent treatment with full term.

**Conclusions:** In our population with GDM, 35% presented obesity and 27% were overweight; The patients who required an insulin treatment the average presented obesity, regardless of the diagnostic method, which shows the need to act on modifiable risk factors.

**Keywords:** Diabetes, pregnant, obesity, overweight, nutritional

DETERMINING THE PREVALENCE OF EATING DISORDERS AMONG DIETETIC STUDENTS IN SOUTH AFRICA

(1)Barnard, Jandri; (2)Veldman, Frederick; (3)Kassier, Suna.

(1)MSc. Dietetics. College of Agriculture Earth and Environmental Sciences. University of KwaZulu Natal. South Africa; (2)Head of Department and Professor. School of Health Care Sciences. Sefako Makgatho University. Pretoria. South Africa; (3)PhD. Nutrition and Dietetics. Dietetics and Human Nutrition Department. University of KwaZulu Natal. South Africa.

**Background and objectives:** It is expected that eating disorders (EDs) are more prevalent among first year dietetic students, but results contra-indicate that it is higher in first year non-dietetic students. Eating behaviour and eating attitude of students also vary among study majors, as well as subsequent years of dietetic study. To determine and compare the i)BMI (body mass index), ii)eating behaviour and iii)eating attitude of a sample of 62 first-, third- and fourth year dietetic- versus 83 first year non-dietetic students.

**Methods:** A cross-sectional descriptive survey was conducted by using the 'Sick, Control, One stone, Fat, Food' (SCOFF)- and Eating Attitude Test-26 (EAT-26) questionnaire (eating behaviour) and Three Factor Eating Questionnaire (TFEQ) (eating attitude) to compare a convenience sample of female undergraduate students (N = 145). It was compared for first- (n = 24), third and fourth year (n = 38) dietetic students and first year non-dietetic students (n = 83).

**Results:** First year non-dietetic students had a higher prevalence for Bulimia Nervosa (SCOFF1 - 11%), binge eating (SCOFF2 - 53.7% and EAT A - 22.9%), weight loss (SCOFF3 - 20.7%) and believing themselves to be fat (SCOFF4 - 50%). While first year dietetic students had a higher indication for food dominating their lives (SCOFF5 - 41.7%), Bulimia Nervosa (EAT B - 4.2%), using diet pills for weight loss (EAT C - 16.7%) and being previously treated for an ED (EAT D -8.3%). But the mean BMI of first year dietetic students (23.2±4.3 kg/m2) was lower than first year non-dietetic students (24.2±5.3 kg/m2).

**Conclusions:** A standardized screening tool could be used to select prospective dietetic students at Universities, in order to determine if they suffer from an existing or undiagnosed ED, as it should be emphasised that the core business of the dietitian is to help others with their eating habits. Thus firstly be in a position to address their own eating habits and behaviours. During selection the proposed screening tool 'ED questionnaire' (shortened version of the SCOFF questionnaire and behavioural questions of the EAT-26 questionnaire) was developed. They can then receive timeous intervention regarding existing eating habits and food-related behaviours.

**Keywords:** Eating behaviour. Eating attitude. Dietetic students. Eating Disorder Questionnaire.
ASSOCIATION BETWEEN DIETARY PATTERNS
AND SLEEP APNEA SYNDROME SEVERITY

(1)Lopes, Tássia; (2)Eduardo de Souza Borba, Matheus; (3)Tadashi Hattori, Wallisen; (4)do Vale Cardoso Lopes, Raíssa; (5)Mara Fisberg, Regina; (6)Shivappa, Nitin; (7)Zalcman Zimberg, Ioná; (8)Aparecida Crispim, Cibele.

(1)PhD candidate. Nutritionist. Health Sciences Post-graduation Program. Federal University of Uberlândia; (2)Nutrition Student. Federal University of Uberlandia. Brazil; (3)PhD. Biologist. Professor. Faculty of Medicine. Federal University of Uberlandia. Brazil; (4)MSc.Nutritionist.Department of Nutrition. University of Sao Paulo. Brazil; (5)PhD. Nutritionist. Professor. Department of Nutrition. University of Sao Paulo. Brazil; (6)PhD. Researcher. Arnold School of Public Health. Cancer Prevention and Control Program. University of South Carolina. United States; (7)PhD. Nutritionist. Researcher. Monash University. Australia; (8)PhD. Nutritionist. Professor. Faculty of Medicine. Federal University of Uberlandia. Brazil.

**Background and objectives:** Studies have shown a strong positive association between obstructive sleep apnea syndrome (OSAS), body mass index (BMI) and obesity. Some studies have shown that an increased intake of some nutrients intake - such as fat - can aggravate OSAS; however, studies evaluating the dietary pattern of individuals with OSAS are still scarce. Therefore, the objective of this study was to evaluate the association of dietary intake and OSAS severity.

**Methods:** A total of 305 OSAS patients were evaluated in a private clinic in Uberlândia city, Minas Gerais State, Brazil. Dietary intake was evaluated using a food frequency questionnaire (FFQ), and Dietary Inflammatory Index (DII) scores were computed. Higher DII scores indicate a more pro-inflammatory diet and lower scores indicate a more anti-inflammatory. Association between macronutrients, alcohol intake and DII data and apnea severity (mild, moderate and severe) was evaluated in different multinomial logistic regressions, using the mild degree of apnea severity as a reference. Analyses were adjusted for age, BMI and sex.

**Results:** It was observed that saturated fat intake (Beta=0.072, p=0.012,CI95% 1.016-1.136) showed a positive association with moderate degree of OSAS; alcohol showed a positive association with moderate (Beta=0.058,p=0.004, CI95% 1.019-1.102) and severe degree of OSAS (Beta=0.057, p=0.004, CI95% 1.019-1.099). Carbohydrate (Beta=-0.112, p=0.040, CI95% 0.986-1) and fiber (Beta=-0.064, p=0.014,CI95% 0.891-0.987) intake presented an inverse association with OSAS. There was no significant association between DII, energy, fat, protein and cholesterol intake and OSAS severity.

**Conclusions:** In conclusion, dietary patterns had an association with degrees of apnea severity, with more impact on moderate than severe apnea.

**Keywords:** Diet, sleep apnea, inflammatory, dietary surveys

**Further collaborators:**

Vinicius Vasconcelos Teodoro,
Samantha Lemos Paim

HIGHER SERUM CAROTENOIDS ASSOCIATED
WITH IMPROVED CARDIOMETABOLIC PRO-
FILES IN MIDDLE-AGED AND ELDERLY ADULTS:
A 6-YEAR PROSPECTIVE STUDY

(1)Chen, Yuming; (2)Wang, Cheng; (3)Zeng, Fang fang; (2)Cao, Wen-
ting; (2)Chen, Geng-dong; (4)Cao, Yi; (5)Liu, Jun; (4)Qiu, Rui; (4)Xiao,
Mian-li.

(1)Sun Yat-sen University; (2)PhD student. Department of Medical statistics and Epidemiology. Sun Yat-sen University. China.;
(3)PhD. Research fellow. Department of Medical statistics and Epidemiology. Sun Yat-sen University. China.; (4)MSc student. Department of Medical statistics and Epidemiology. Sun Yat-sen University. China.; (5)PhD. Associate professor. Department of Medical statistics and Epidemiology. Sun Yat-sen University. China.

**Background and objectives:** Previous studies suggested greater levels of carotenoids in diet or blood might be associated with cardiovascular risk factors, but scare data are available from prospective studies. This prospective study examined the associations of serum concentrations of carotenoids with cardiometabolic profiles (body fat, metabolic syndrome [MS], carotid intima-media thickness [cIMT], and non-alcoholic fatty liver disease [NAFLD]) in a community-based Chinese population.

**Methods:** A total of 4066 participants (40-75 years, 68% women) were recruited in urban Guangzhou (South China) at baseline, 79.3% and 73.0% of them were followed-up at the 3rd and 6th years. We collected general information, lifestyle factors and other covariates using Face-to-face interviews at each visit. Serum levels of carotenoids (α-, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin) were examined by HPLC at baseline. MS-related indices and cIMT (by ultrasonography) were determined at each visits. Body fat (by dual-energy X-ray absorptiometry) and NAFLD (by abdominal ultrasonography and serum triglycerides and transaminases) were measured at the first and second follow-ups. Serum inflammatory biomarkers (CRP and RBP4) were also tested.

**Results:** After adjustment for multiple covariates, HRs (95% CIs) of incident MS for the highest (vs. lowest) quartile (Q) were 0.39 (0.31-0.51) for lycopene, 0.42 (0.32-0.54) for α-carotene, 0.45 (0.34-0.56) for β-carotene, 0.72(0.57-0.90) for lutein/zeaxanthin, and 0.47(0.37-0.61) for total carotenoids (all P-trends <0.05). Greater total carotenoids in serum were associated significantly lower %fat mass (4.0%-7.8%, Q4 vs. Q1, p-trends<0.001) and lower changes in trunk fat and waist circumference (p-trends <0.05). cIMTs of common artery tended to be less increased in the higher group of some serum carotenoids (p-trends<0.05). The percentage mean difference in serum carotenoids in the improved (vs. progressed) NAFLD group were 9.1% for alpha-carotene, 22.0% for beta-carotene, 14.6% for beta-cryptoxanthin, 4.3% for lutein/zeaxanthin and 12.1% for total carotenoids in total subjects (all p<0.05) after adjusting for potential covariates. Path analyses showed that CRP and RBP4 played a significant intermediation role between carotenoids and MS and NAFLD.
**Conclusions:** Higher blood concentrations of carotenoids are associated with low risk of MS, favorable progress in body fat, cIMT and NAFLD mediated by inflammatory biomarkers in middle-aged and elderly Chinese adults.

**Keywords:** blood carotenoids; metabolic syndrome; carotid intima-media thickness; non-alcoholic fatty liver disease; body fat

**Conflict of Interest Disclosure:** This study was jointly supported by the National Natural Science Foundation of China (No. 81273049, 81472965, 81130052, 81072299) and the 5010 Program for Clinical Researches (No. 2007032) by the Sun Yat-sen University. The sponsor had no role in the design, analysis or writing of this article. We would thank the other team members for their contributions in data collection.

**Further collaborators:**

Prof. Wen-hua Ling, Xiao-wei Dai, Zhe-qing Zhang, Yan-hua Liu, Li-ping He, Li-li Sun, Wen-qi Shi, Ke Guan, Ying-ying Zhu, Xiao-wei Dong, Hui-yuan Tian, Juan He, etc.

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EFFECT OF POLICY REFORMS ON FOOD AND NUTRITION TRENDS IN VIETNAM AND MYANMAR FROM 1960 TO 2015

(1)Nguyen, Tuan; (2)Lapping, Karin; (3)Mathisen, Roger; (4)Itzkowitz, Laura; (5)Cashin, Jennifer; (6)Frongillo, Edward.

(1)MD, MS, PhD. Technical specialist. Alive & Thrive Southeast Asia. FHI 360. Vietnam.; (2)MPH, PhD. Project Director. Alive & Thrive. FHI 360. USA.; (3)MPH. Program Director. Alive & Thrive Southeast Asia. FHI 360. Vietnam.; (4)MPH. Consultant. Alive & Thrive Southeast Asia. FHI 360. Vietnam.; (5)MPH. Consultant. Alive & Thrive Southeast Asia. FHI 360. Myanmar.; (6)PhD. Professor. Arnold School of Public Health. University of South Carolina. USA.

**Background and objectives:** Global and national policy changes and events can affect food and nutrition trends. We conducted this study to examine the ecological association between policy changes and events and trends in food- and nutrition-related measures in Vietnam and Myanmar from 1960 to 2015.

**Methods:** We used an interrupted time-series design at the country level for this study. We identified relevant policies and events from 1960 to 2015 in Vietnam and Myanmar from WHO's Nutrition Landscape Information System and other available sources. We examined national trends in economy, agriculture, nutrition, and health measures gathered from World Bank, FAO, WHO, and UNICEF databases in relationship to policy changes and events in the two countries.

**Results:** In the last 50 years, both Vietnam and Myanmar had increased urban populations, increased life expectancy at birth, and decreased mortality rates for neonates, infants, young children, and mothers. Both countries had overall growth in gross domestic product, contributed to initially by increased agriculture production and then by trade, manufacturing, industry, and services. The two countries changed toward market economies, joining and getting support from Association of Southeast Asian Nations (ASEAN), lifting of economic sanctions, and implementing trade agreements. There were periods when the economies were negatively impacted by wars and conflicts (e.g., Sino-Vietnamese war and prolonged civil war and political unrest in Myanmar) or failed policies (e.g., "price, salary, and money" reform in Vietnam). In Vietnam, the implementation of policies, including National Nutrition Strategies, was associated consistently with economic, agricultural, and nutritional measures. In contrast, during Myanmar's 2011-2015 political, economic, and administrative changes, growth in gross domestic product slowed. Reduction in prevalence of stunting and underweight was negligible after the Myanmar's National Plan of Action for Food and Nutrition in 1994, but greater after the National Plan of Action in 2011.

**Conclusions:** Policy changes toward becoming a market economy and National Nutrition Strategies contributed to economic growth, agricultural production, and improved nutritional status in Vietnam and Myanmar. In addition, political stability was critical for these improvements.

**Keywords:** Food and nutrition dynamics, market economy, Myanmar, policy reforms, Vietnam

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SYSTEMATIC ASSESSMENT OF POLICY SPACE IN NEW ZEALAND FOR PRIORITY FOOD ENVIRONMENT POLICIES FOR OBESITY/NCD PREVENTION IN RELATION TO INTERNATIONAL TRADE AND INVESTMENT AGREEMENTS

(1)Garton, Kelly; (2)Thow, Anne Marie; (3)Vandevijvere, Stefanie;

(4)Swinburn, Boyd.

(1)MSc. PhD candidate. School of Population Health. University of Auckland. New Zealand.; (2)PhD. Senior Lecturer. Menzies Centre for Health Policy. University of Sydney. Australia.; (3)PhD. Senior Research Fellow. School of Population Health. University of Auckland. New Zealand.; (4)MD. Professor. School of Population Health. University of Auckland. New Zealand.

**Background and objectives:** Confronting the growing global burden of non-communicable diseases requires policy actions to improve food environments. There are, however, real and perceived barriers to policy development and implementation due to binding commitments under existing international trade and investment agreements (TIAs), which may contribute to regulatory chill. The monitoring of policy space for food environment interventions is thus an important public health priority. This study aims to systematically identify the areas of conflict and coherence between existing trade commitments and priority food environment policies at a national level in New Zealand, to determine where such policies may or may not face real or perceived legal challenges.

**Methods:** Using the trade and investment law implications of tobacco control policy as a framework, a realist review was carried out to determine the relevance of trade and investment agreement
provisions for public health nutrition. A set of 10 priority policy actions previously identified by public health experts in New Zealand were then cross-referenced with the terms and provisions of 9 international, regional and bilateral TIAs that New Zealand has signed and/or ratified in the last 10 years. These policies were then ranked by order of probability of legal risk.

**Results:** The results to be presented demonstrate the potential legal implications of national food environment policy priorities for New Zealand, including labeling measures, food composition standards, public procurement, marketing restrictions, and fiscal policy. Their estimated legal risk ranges from high certainty of no conflict (as is the case for introduction of a non-discriminatory excise tax on sugar-sweetened beverages) to high certainty of conflict under certain circumstances (as is the case for some mandatory labeling measures). Primary areas of concern for the selected policies include lack of scientific proof and/or measures not being the least trade restrictive to achieve objectives, interference with usage of trademarks, inconsistent product specifications, and indirect expropriation of investment.

**Conclusions:** Some priority food environment policy interventions may be pursued with minimal concern of legal challenges under international trade and investment regulations. Others require further analysis to determine under what conditions they could be challenged.

**Keywords:** trade, policy space, food environment, obesity, INFORMAS

## DOES LOVE MAKE MOTHERS BLIND? A TRANS-CONTINENTAL LARGE PAN STUDY ON MOTHERS' UNDERESTIMATION OF THEIR OVERWEIGHT/OBESE CHILDREN'S WEIGHT

**Background and objectives:** Assessing factors that affect the likelihood to change weight is crucial to develop effective public health strategies fighting the concerning obesity epidemic occurring worldwide. Recently, it has been suggested that parents' misperception of their children body size may affect children's likelihood of losing weight. The present study aimed at assessing

maternal misperception rates (in terms of perception as normal of an overweight/obese child), and the role played by misperception in affecting the chance of implementing actions changing kids' weight in Latin American children.

**Methods:** Large multicenter cross-sectional study enrolling children from five Latin American countries: Chile, Argentina, Brazil, and Mexico. Kids' eating habits, lifestyles, and families' characteristics were evaluated through a cultural specific validated tool, and mother's perception of children weight status was assessed using a projective test. Children underwent anthropometric assessment, and their Body Mass Index (BMI) was classified in underweight, normal weight and overweight/obese (OWO) according to CDC standards. For the purpose of the analysis, we considered only OWO children.

**Results:** Six hundred eighty children were enrolled, of these 235 (35%) were OWO. Most of mothers (164, 70%) of OWO children did not correctly perceived their body size, underestimating it. OWO misperceived children were significantly younger (p-value <0.001) compared to those perceived correctly. At multivariable analysis, OWO misperceived children were less likely to be involved in a program to lose weight (p-value <0.001), together with those who ate more frequently snacks (cookies particularly).

**Conclusions:** Present findings clearly showed that the chance of being involved in a program to lose weight is affected by maternal perception of her child's body size. These results highlight the fact that parental misperception must be taken into account in the planning of public health interventions fighting childhood obesity, since it might negatively affect the effectiveness of such interventions.

**Keywords:** Children, Overweight, Obesity, Misperception, Weight-loss

## IMPACT OF CHILEAN LAW ON FOOD LABELLING AND ADVERTISING ON CHILEAN POPULATION'S KNOWLEDGE ABOUT AND ATTITUDES TOWARDS FOOD LABELLING: A BEFORE-AFTER STUDY

**Background and objectives:** Childhood obesity represents a severe public health burden, especially in South American countries.

<footnote>(1)Gafare, Claudia; (2)Lorenzoni, Giulia; (2)Azzolina, Danila;</footnote>

<footnote>(3)Hochdorn, Alexander; (4)Gregori, Dario.</footnote>

<footnote>(1)BS. Dietitian. Department of Nutrition. University of Buenos Aires. Food and Diet Therapy Service. Acute General Hospital Juan A. Fernández of Buenos Aires. Argentina.; (2)MA. PhD student. Unit of Biostatistics, Epidemiology and Public Health. Department of Cardiac, Thoracic and Vascular Sciences. University of Padova. Italy.; (3)PhD. Post-doctoral fellow in Psychology. Generational processes, violence and collective imaginary (GEVIM). Post-graduation Program in Psychology. Catholic University of Brasília. Brazil.; (4)PhD. Full Professor in Biostatistics. Unit of Biostatistics, Epidemiology and Public Health. Department of Cardiac, Thoracic and Vascular Sciences. University of Padova. Italy.</footnote>

<footnote>(1)Gregori, Dario; (2)Lorenzoni, Giulia; (2)Azzolina, Danila; (3)Lanera, Corrado; (4)Gafare, Claudia.</footnote>

<footnote>(1)PhD. Full Professor in Biostatistics. Unit of Biostatistics, Epidemiology and Public Health. Department of Cardiac, Thoracic and Vascular Sciences. University of Padova. Italy.; (2)MA. PhD student. Unit of Biostatistics, Epidemiology and Public Health. Department of Cardiac, Thoracic and Vascular Sciences. University of Padova. Italy.; (3)MS. PhD student. Unit of Biostatistics, Epidemiology and Public Health. Department of Cardiac, Thoracic and Vascular Sciences. University of Padova. Italy.; (4)BS. Dietitian. Department of Nutrition. University of Buenos Aires. Food and Diet Therapy Service. Acute General Hospital Juan A. Fernández of Buenos Aires. Argentina.</footnote>
tries where the highest obesity rates worldwide have been registered. Several governments are trying to fight such epidemic by adopting food labelling interventions aimed at reducing the purchase of caloric-dense food. However, real-world data on effectiveness of such interventions are lacking, in particular in this area. The present study aimed to compare Chilean population knowledge about and attitudes towards food labelling before and after the introduction of the Chilean Law on food labelling and advertising.

**Methods:** A Computer-Assisted Telephone Interview (CATI) was performed in 2012 and 2016 on a sample of Chilean population, enrolled in 2012, using a stratified random sampling procedure. The questionnaire aimed at investigating subjects' socio-demographic characteristics, attitudes towards nutrition and food labelling, willingness-to-pay an additional fee for detailed labels.

**Results:** One hundred and sixty-seven subjects were interviewed in both 2012 and 2016. Subjects declared to read usually food labelling, and a significantly higher proportion of subjects (32% in 2016 vs 9% in 2012, p-value 0.003) thought that food labelling is the most effective intervention fighting obesity epidemic introduced so far. Unfortunately, the proportion of subjects who provided a correct definition of GDA (guideline daily amount), "per 100 grams", and "per 100 Kcal", did not improve, along with subjects' willingness to pay (46% of subjects in 2016 stated to be not willing to pay an additional fee for more detailed labels compared to none in 2012, p-value <0.001).

**Conclusions:** Despite the declared interest by consumers in food labeling, worryingly, consumers' understanding of food labelling did not improve after the introduction of the Law in 2016.

**Keywords:** Chilean Law, Food labelling, Attitudes

**Methods:** Blood samples were collected from 18 young-adults and a fragment of the FTO gene was sequenced, body mass index (BMI) and two-compartment body composition were determined. Dietary intake and physical activity were recorded.

**Results:** The SNP rs8050136 risk polymorphism (variant A) was found in 33.33% of subjects. Risk carriers were more likely to be obese, they had higher weight (71.97 ± 11.07 vs. 60.66 ± 8.39 kg, p = 0.015), Body Mass Index (BMI) (25.57 ± 3.09 vs. 22.65 ± 2.30 kg / M2, p = 0.021) and energy intake (2684.94 ± 689.01 vs 1828.72 ± 343.06 kcal, p = 0.004) compared to no-risk polymorphism. Also variant A carriers showed higher fasting plasma glucose levels (89.66 ± 4.48 vs 84.71 ± 5.45 mg/dL, p=0.036) and tended to have higher triglycerides levels (p=0.093) and lower HDL-cholesterol levels (p=0.059).

**Conclusions:** Circulating polymorphism SNP rs8050136 of the FTO gene, was found among young-adults from Northwest Mexico (Sonora) and is an important risk factor for obesity.

**Keywords:** Obesity, Young-adults, FTO, snp rs8050136

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DEVELOPMENT OF COMPETENCY SCALE FOR HEALTHCARE STAFF WORKING ON NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL IN FIJI

(1)Ishikawa, Midori; (1)Nomura, Marika; (1)Miyoshi, Miki; (2)Tukana, Isimeli; (3)Matsuura, Shinya; (1)Nishi, Nobuo; (1)Silatolu, Anasaini;

(1)Yokoyama, Tetsuji; (4)Kikuchi, Masako; (5)Miura, Hiroko.

(1)PhD; (2)MBBS; (3)BS; (4)MSc.

**Background and objectives:** This study aimed to develop a scale of competency in healthcare workers for prevention and control of non-communicable diseases in Fiji, and to examine their competency by social factors.

**Methods:** A cross-sectional survey was conducted with 378 healthcare workers in central Fiji from May to June 2016, and data from 179 complete responses (47.4%) were used for analysis. The survey comprised social factors (sex, age, marital status, academic qualification, ethnic background and religion), working situation factors (facility type, professional qualifications, experience, and location), and competency in 42 items based on previous studies on public health. Exploratory factor analysis was used for competency, and validity and reliability of scale items were assessed using Cronbach's α coefficient, item-total analysis, good-poor analysis, and analysis of variance. The respondents' factor score was compared by social and working situation factors.

**Results:** Using factor analysis, 16 items were selected to identify four work types of competency: work management, monitoring and evaluation, community partnership, and community diagnosis. The reliability and the validity were confirmed. Ethnic background was related to work management (p = 0.014), monitoring and evaluation (p = 0.002), and community partnership (p = 0.003). Academic qualification was related to monitoring and evaluation (p = 0.026) and community diagnosis (p = 0.004).

144/1011

PRESENCE OF A RISK POLYMORPHISM FOR OBESITY IN NORTHWEST MEXICO

(1)Astiazarán-García, Humberto; (2)Rendon Del Cid, Pablo Alejandro;

(3)Anduro-Corona, Ivan; (3)Contreras Vergara, Carmen; (4)Morales-Figueroa, Gloria Guadalupe; (5)Pacheco-Moreno, Bertha Isabel.

(1)PhD. Research professor. Centro de Investigacion en Alimentacion y Desarrollo. CIAD. Mexico; (2)MSc. Nutritionist. Centro de Investigacion en Alimentacion y Desarrollo. CIAD. Mexico; (3)PhD. Research Associate. Centro de Investigacion en Alimentacion y Desarrollo. CIAD. Mexico; (4)MSc. Research Associate. Centro de Investigacion en Alimentacion y Desarrollo. CIAD. Mexico; (5)BSc. Laboratory Technician. Centro de Investigacion en Alimentacion y Desarrollo. CIAD. Mexico.

**Background and objectives:** Obesity is an important public health problem due to morbidity and mortality associated to it. There are polymorphisms that may explain, in part, the interaction between obesity and some risk factors. We searched for the presence of FTO SNP rs8050136 and its possible relationship with obesity, diet and metabolic condition, in a cross-sectional study in young-adults from Northwest Mexico.
**Conclusions:** We developed a scale of competency for four work types, and found that social factors such as ethnic background and academic qualification were related to the competency. The scale will help healthcare workers to engage in better management of residents with non-communicable diseases in Fiji.

**Keywords:** Non-communicable diseases, healthcare worker, competency, social factors, Fiji

144/1018

## CHANGES IN DIET QUALITY INDEXES AND SUBSEQUENT RISK OF MORTALITY IN THE MULTI-ETHNIC COHORT

(1)Park, Song-Yi; (1)Boushey, Carol; (2)Wilkens, Lynne; (3)Le Marchand, Loïc.

(1)PhD. Cancer Epidemiology Program. University of Hawaii Cancer Center. USA.; (2)DrPH. Cancer Epidemiology Program. University of Hawaii Cancer Center. USA.; (3)MD. PhD. Cancer Epidemiology Program. University of Hawaii Cancer Center. USA.

**Background and objectives:** Healthy eating patterns assessed by diet quality indexes (DQIs) have been related to longevity. Little is known about the influence of changes in diet quality over time on subsequent risk of mortality. We investigated the associations between changes in 4 DQIs (the Healthy Eating Index 2010, the Alternative Healthy Eating Index 2010, the alternate Mediterranean diet score [aMED], and the Dietary Approaches to Stop Hypertension [DASH] score) and mortality in Multiethnic Cohort Study (MEC).

**Methods:** We analyzed data from the food frequency questionnaires on changes in the 4 DQIs between the baseline (1993-1996) and the 10-year follow-up (2003-2007) in relation to subsequent mortality among 58,837 participants in the MEC in Hawaii and California. The participants were African American, Native Hawaiian, Japanese American, Latino, and white, aged 45-75 years at baseline, and did not report heart diseases or cancer at either survey. Cox proportional hazards model was used with multivariate adjustment.

**Results:** During an average of 8.2 years of follow-up after the 10-year survey, 7,480 deaths were identified. Compared with individuals whose DQIs changed minimally, those with the largest increase showed the lowest risk for all-cause mortality (8-14%), while those with the largest decrease had the highest risk of death (14-39%) for all 4 DQIs both in men and women (P's for trend < 0.001, P's for heterogeneity by sex > 0.33). In men and women combined, the associations did not vary by age group (45-54, 55-64, and ≥65 years at baseline, P's for heterogeneity > 0.08) and race/ethnicity (P's for heterogeneity > 0.16). An inverse trend for cardiovascular disease mortality was found with all 4 DQIs (P's for trend < 0.004), whereas for cancer mortality this was only found with aMED and DASH.

**Conclusions:** Our findings suggest that improving diet quality is related to a reduced risk of mortality and a decline in diet quality is related to an elevated risk of mortality. These relationships seen in older adults imply that it is probably never too late to improve the quality of one's diet to achieve better health.

**Keywords:** cohort, diet quality index, mortality, multiethnic population

144/1023

## ANAEMIA AND IRON DEFICIENCY IN PREGNANT WOMEN LIVING IN AREAS OF LOW AND HIGH IRON IN GROUNDWATER IN BANGLADESH: IMPLICATIONS FOR IRON-FOLIC ACID SUPPLEMENTATION PROGRAMME

(1)Ahmed, Faruk; (2)Khan, Moududur Rahman; (2)Shaheen, Nazma;

(3)Chowdhury, Ireen.

(1)PhD. Associate Professor. Public Health. School of Medicine. Griffith University. Gold Coast. Australia; (2)PhD. Professor. Institute of Nutrition and Food Science. University of Dhaka. Dhaka. Bangladesh.; (3)MPH. Nutrition Officer. Unicef. Dhaka. Bangladesh.

**Background and objectives:** National Micronutrient Status Survey 2011-12 showed a low prevalence of iron deficiency anaemia (IDA) in reproductive-age women of Bangladesh. It was attributed to drinking water. IFA supplementation during pregnancy has been running in Bangladesh for few decades. Given findings of Micronutrient Status Survey 2011-12, relevancy of this intervention needs investigation. Therefore, the objective of this study was to assess the benefits and/or risks of routine IFA supplementation in pregnant women living in both low and high groundwater iron areas in Bangladesh.

**Methods:** Pregnant women living in low groundwater iron areas (n = 260) and high groundwater iron areas (n = 262) were given iron (60 mg) and folic acid (400 µg) supplements daily for 3.5 months. Data on socio-demographic, pregnancy-related information and dietary pattern were collected. Blood samples were collected at baseline and at the end the supplementation. Haemoglobin and serum ferritin concentrations were measured at both points.

**Results:** At baseline, mean haemoglobin and serum ferritin concentrations were significantly higher in women of high groundwater iron areas. However, post-supplementation haemoglobin concentrations in two groups were not different, but mean ferritin concentration was significantly higher in the women of high iron areas. Mean change in haemoglobin in women of low groundwater iron areas was higher than in the women in high iron areas and approached statistical significance (p = 0.052). Mean change in serum ferritin did not differ significantly between the groups. No significant changes were observed in the prevalence of anaemia and iron deficiency in either group, while IDA decreased significantly in the women of low groundwater iron areas. However, a significant proportion of pregnant women in areas of high and low iron in groundwater remained anaemic and iron deficient after IFA supplementation for 3.5 months. The risk of anaemia, iron deficiency and IDA after supplementation did not differ significantly between the groups. None had iron overload.

**Conclusions:** IFA supplementation significantly increased haemoglobin concentration in pregnant women living in low
groundwater iron areas. Routine supplementation with 60 mg iron and 400 µg folic acid, do not pose any significant risk haemoconcentration or iron overload.

**Keywords:** Anaemia, iron deficiency, iron deficiency anaemia, pregnant women, Bangladesh

144/1030

THE VITAMIN D STATUS AND ITS RELATIONSHIP WITH SLEEP PATTERN AMONG ADULTS IN SOUTH CHINA

(1)Chen, Mengxue; (2)Xue, Hongmei; (2)Liang, Yi; (2)Li, Danting;

(3)Cheng, Guo.

(1)BSc. West China School of Public Health. Sichuan University.
Chengdu China.; (2)MD. West China School of Public Health.
Sichuan University. Chengdu China.; (3)PhD. West China School of
Public Health. Sichuan University. Chengdu China.

**Background and objectives:** Previous studies have suggested that vitamin D may be involved in the regulation of sleep. While, no study focused this issue on Chinese adults. Here we aimed to assess the vitamin D level among adults in South China, and to examine the association between adult's vitamin D level and sleep pattern.

**Methods:** Cross-sectional data on 1056 subjects aged 20-70 years old in South China were analyzed. Using PSQI questionnaire, we obtained main sleep information. The total score of questionnaire ranged from 0 to 21: the lower the score was, the better the quality of sleep was. And the nap time of subjects were collected according to the answer by the question, "How many days do you have a nap in a week? How long does it takes each time". Total sleep duration was calculated as a sum of the night sleep duration and nap time. Anthropometric parameters, including weight and height, were measured to calculate body mass index (BMI). The concentration of serum 25(OH)D3 was detected by HPLC.

**Results:** The median of 25(OH)D3 concentration among all of subjects was 20.90 ng/mL, 19.70 ng/mL for male and 22.10 ng/mL for female. The concentration of serum 25 (OH) D3 in male was lower than that in female (p < 0.0001). Percentages of Vitamin D deficiency (defined as 25 (OH) D3 concentration < 20 ng/mL) was 47.16% (n = 498). For women, 25(OH)D3 concentration was not correlated with sleep quality, total sleep duration or nap time (p > 0.05). For men, the concentration of serum 25(OH)D3 was positively correlated with nap time (p<0.05), but not with sleep quality or total sleep duration (p > 0.05). After adjusting for age, season and BMI, however, the relationship between nap time and male 25 (OH) D3 concentration disappeared (p>0.05).

**Conclusions:** Our data suggests, in South China, deficiency of vitamin D levels are prevalent, and vitamin D level might not associate with sleep pattern.

**Keywords:** PSQI, Vitamin D, 25(OH)D3, Sleep pattern

**Further collaborators:** All phases of this study were supported by research grant from the National Nature Science Foundation of China (No.81472976).

144/1045

DIETARY-LIFESTYLE PATTERNS IN YOUNG MEN:
A CROSS-SECTIONAL STUDY (MEDISH PROJECT)

(1)Lonnie, Marta; (1)Kowalkowska, Joanna; (2)Wadolowska, Lidia;

(3)Bandurska-Stankiewicz, Elzbieta.

(1)MSc. Department of Human Nutrition. Faculty of Food Science.
University of Warmia and Mazury in Olsztyn. Poland.; (2)Full
Professor. Department of Human Nutrition. Faculty of Food
Science. University of Warmia and Mazury in Olsztyn. Poland.;

(3)Full Professor. Department of Internal Medicine. Faculty of
Medical Sciences. University of Warmia and Mazury in Olsztyn.
Poland.

**Background and objectives:** Although some evidence that dietary and lifestyle behaviours may cluster together exist [1], not much is known about the coexistence of different dietary and lifestyle behaviours in a population of young men. Objective: to identify dietary-lifestyle patterns in young men.

**Methods:** In all, 235 men 19-40 years old participated in the study. Food frequency method was applied. Dietary and lifestyle characteristics were collected using food frequency questionnaire (KomPAN) [2]. To identify dietary-lifestyle patterns 31 standardised variables were included in Principal Component Analysis: 25 dietary characteristics and 6 lifestyle characteristics.

**Results:** Four dietary-lifestyle patterns were found explaining 34% of variance (14%,8%,6%,6%). 'Guidelines followers' were characterised by frequent consumption of eggs (factor loading 0.67), groats, oats wholegrain pasta (0.62), poultry (0.59), white rice, pasta, fine groats (0.58), vegetables (0.45), fish (0.45), beans and sprouts (0.43), fruit (0.41), higher number of meals/day (0.55) and leisure-time physical activity (0.54). 'Western diet-active workers' were characterised by frequent consumption of tinned meat (0.49), butter (0.48), red meat (0.47), fried foods (0.46), white bread (0.44), lard (0.42), sweetened beverages (0.37), cheese and processed cheese (0.33), sweets (0.33) and work-time physical activity (0.41). 'Dairy and plant eaters' were characterised by frequent consumption of fermented dairy products (0.59), cheese curd (0.58), milk (0.51), fruit (0.49), wholegrain bread (0.47), vegetables (0.42) and butter (0.32). 'Convenient foods and stimulation seekers' were characterised by frequent consumption of energy drinks (0.55), alcohol (0.46), sweetened beverages (0.41), meat, sausages, frankfurters (0.40), fast foods (0.30) and current and past smoking (0.69 and 0.59, respectively).

**Conclusions:** Two patterns, among four identified, clustered both: dietary and lifestyle behaviours. Only one pattern was consistent with nutritional and physical activity recommendations. Two dietary-lifestyle patterns were clearly unhealthy. One unhealthy pattern clustered work-related activity with western diet, and another: fast foods consumption with stimulants. In prevention programs, focus should be laid on blue-collar workers and stimulants' users.

**References:** [1]Gubbels JS, van Assema P., Kremers SPJ. Physical activity, sedentary behaviour, and dietary patterns among children.Curr Nutr Rep.2013.2:105-112. [2]Polish Academy of Sciences: Committee of Human Nutrition Science. KomPAN: Eating Habits and Believes Questionnaire.2016. Available at: http://
www.knozc.pan.pl/index.php/wydawnictwa/100-kwestionar-
usz-do-badania-pogladow-i-zwyczajow-zywieniowych-oraz-pro-
cedura-opracowania-danych-kompan. Accessed 21 March 2017.

**Keywords:** dietary patterns, lifestyle, FFQ, men, PCA

144/1049

DIETARY CARBOHYDRATES: A REVIEW OF IN-
TERNATIONAL RECOMMENDATIONS AND THE
METHODS USED TO DERIVE THEM

(1)Buyken, Anette; (2)Mela, David J.; (3)Dussort, Pierre; (4)Johnson, Ian T.; (5)MacDonald, Ian A.; (6)Stowell, Julian D.; (7)Brouns, Fred J.P.H.

(1)Institute of Nutrition, Consumption and Health Faculty of Natural Sciences; (2)PhD. Senior Researcher. Unilever R&D Vlaardingen. Vlaardingen. The Netherlands; (3)PhD. Scientific Project Manager. International Life Sciences Institute-ILSI Europe. Brussels. Belgium; (4)Professor. Research Leader. Institute of Food Research. Norwich Research Park. Norfolk. United Kingdom; (5)Professor of Metabolic Physiology. School of Life Sciences. Queen's Medical Centre. University of Nottingham. Nottingham. United Kingdom; (6)PhD. Senior Researcher. DuPont Nutrition & Health. Danisco Ltd. Reigate. United Kingdeom; (7)Professor. Faculty of Health. Medicine and Life Sciences. Department of Human Biology. Maastricht University. Maastricht. The Netherlands.

**Background and objectives:** Renewed dietary recommen-
dations for carbohydrates have recently been published by various
international health authorities. The present work 1) reviews the
methods and processes (systematic approach/review, inclusion of
public consultation) used to identify, select and grade the evidence
underpinning the recommendations, particularly for total carbo-
hydrate (CHO), fibre and sugar consumption, and 2) examines the
extent to which variation in the methods and processes applied
relates to any differences in the final recommendations.

**Methods:** A search of WHO, US, Canada, Australia and Eu-
ropean sources identified 13 authoritative documents with the
desired detailed information. Processes and methods applied to
derive recommendations were compiled and compared.

**Results:** 1) A relatively high total CHO and fibre intake and limited intake of (added or free) sugars are generally recom-
mended. 2) Even where recommendations are similar, the spe-
cific justifications for quantitative/qualitative recommendations sometimes differ across authorities. 3) Differences in recommen-
dations mainly arise from differences in the underlying definitions of CHO exposure and classifications, the degree to which specific CHO-providing foods and food components were considered, and the choice and number of health outcomes selected. 4) Differences in the selection of source material, time frames or data aggregation and grading methods appeared to have minor influence.

**Conclusions:** Despite general consistency, apparent differ-
ences among the recommendations of different authorities would
likely be minimized by: 1) More explicit quantitative justifications
for numerical recommendations and communication of uncer-

tainty, and 2) greater international harmonization, particularly in
the underlying definitions of exposures and range of relevant nu-
trition-related outcomes.

**Keywords:** Recommendation, Guidelines, carbohydrate, dietary fibre, dietary sugar

**Conflict of Interest Disclosure:** This work was conducted by an expert group of the European branch of the International Life Sciences Institute, ILSI Europe. This publication was coordinated by the Dietary Carbohydrates Task Force. Authors DJM and JDS are employed by commercial organizations that manufacture carbohydrate-containing foods and beverages or ingredients used in making these. The expert group received funding from the ILSI Europe the Dietary Carbohydrates Task Force members. Industry members of this task force are listed on the ILSI Europe website at http://ilsi.eu/task-forces/nutrition/dietary-carbohydrates/. Experts are not paid for the time spent on this work; however, the non-industry members within the expert group were offered support for travel and accommodation costs from the Dietary Carbohydrates Task Force to attend a meeting to discuss the manuscript and a small compensatory sum (honoraria) with the option to decline. The research reported is the result of a scientific evaluation in line with ILSI Europe's framework to provide a precompetitive setting for public-private partnership (PPP). ILSI Europe facilitated scientific meetings and coordinated the overall project management and administrative tasks relating to the completion of this work. The opinions expressed herein and the conclusions are those of the authors and do not necessarily represent the views of ILSI Europe nor those of its member companies.

**Further collaborators:**

We gratefully acknowledge the contribution of Dr A.Piekarz (SA Coca-Cola Services NV, Brussels, Belgium) in the selection of relevant documentation and critical inputs.

144/1060

NUTRIENT PATTERNS WITH HYPERTENSION
AND THEIR ASSOCIATIONS TO SOCIO ECONOM-
IC VARIABLES AND OBESITY IN TRIBAL POPU-
LATION OF ADULTS IN INDIA

(1)Balakrishna, Nagalla; (2)Varanasi, Bhaskar; (3)Arlappa, Nimmathota; (4)Rachakulla, Harikuumar; (5)K, Sreeramakrishna;

(3)Indrapal I, Meshram; (6)Avula, Laxmaiah.

(1)Ph.D. Scientist 'E'. National Institute of Nutrition. Hyderabad. India; (2)Bio Statistics. National Institute of Nutrition. Hyderabad. India; (3)MD.Community Medicine. National Institute of Nutrition. Hyderabad. India; (4)DPH.Community Medicine. National Institute of Nutrition. Hyderabad. India; (5)Community Medicine. National Institute of Nutrition. Hyderabad. India; (6)PH.D.Community Medicine. National Institute of Nutrition. Hyderabad. India.

**Background and objectives:** Tribal people constitute 8.6% of the nation's total population, over 104 million people according to the 2011 census. The Objective of the study was to identify nutrient patterns and how they associate with socio-demographic,
and body mass index, WHR and hypertension with nutrient pat-
terns in tribal adults in India.

**Methods:** A total of 4965 men and 7612 women (≥ 20 year of age) in the selected households were covered for various investigations. Nutrients were calculated from 24hr recall diet survey. Factor Analysis was applied to study the nutrient patterns. Multiple linear regression models were fitted and computed respectively for each of the retained factor scores on socio-demographic and obesity variables. Prevalence of hypertension was calculated and associations with nutrient patterns by logistic regression.

**Results:** Three nutrient patterns explaining 69% of the total variance were identified in both genders: First factor explained 28% of variation by protein & fat; Second factor (24%) by B vitamins, thiamine and niacin; 3rd factor (17%) by Vitamin A & C nutrients. Nutrient patterns were significantly associated with various obesity variables. Prevalence of hypertension was 23.5% and 20.6% respectively for men and women. Hypertension was inversely associated with 1st component and positively related with 3rd component after adjusting confounding variables of obesity, age and socio economic variables.

**Conclusions:** Three components namely macro nutrients, B vitamins and Vitamins A & C were explained 69% of total variance. Nutrient patterns were significantly associated with obesity variables. Also hypertension was associated with nutrient patterns.

**Keywords:** Nutrient Pattern, Factor Analysis, Hypertension, Obesity, B Vitamins

2016 was taken from the databases of the selected hospitals in Dhaka City. Information on Mother's age, father's occupation was also taken from mothers of new born babies who were present during data collection.

**Results:** The prevalence of LBW was 30.2%. The mean birth weight was 2.65kg. About 16% of the mothers were adolescent (≤19 years), 82% were between 20-35 years and only 2% was above 35 years. Among the adolescent mothers, the LBW rate was 41%, mothers aged from 20 to 35 years, the percentage was 28 and mothers aged ≥36 years the rate was 27%. There was a significant association between mother's age and birth weight (p value=0.020). A linear co-relationship has been found between mother's age and birth weight. The LBW rate was 14%, 19% and 35% whose fathers were businessmen, service holder and day laborer, respectively (p value=0.046). About two third of the samples were taken from government facilities having LBW of 38% while the rest one third were taken from non-government facilities having LBW rate of 17%.

**Conclusions:** The results of the study indicated that at least three children in every ten live births are born with low birth weight in urban Dhaka per day. The teenage mothers experienced significantly more low birth weight babies than adult mothers. The findings of the study will help to initiate preventive programs and to develop public health nutrition interventions to reduce low birth weight.

**Keywords:** Low birth weight, preterm birth, IUGR, mother's age, Dhaka City.

144/1061

PREVALENCE OF LOW BIRTH WEIGHT IN DHAKA CITY AND ITS ASSOCIATION WITH MOTHER'S AGE

(1)Shaheen, Razia; (1)Roy, Medha; (1)Anny, Aklima; (1)Shova, Nelufa Yeasmin; (1)Hema, Tasmia; (2)Ratna, Moffashara Sultana; (3)Ara, Ferdous; (4)Jahan, Khurshid; (5)Roy, Swapan Kumar.

(1)BSc. Nutritionist. College of Home Economics. University of Dhaka. Bangladesh; (2)MSc. Assistant Professor. Dept. of Food & Nutrition. College of Home Economics. University of Dhaka. Bangladesh; (3)MSc, MPhill. Senior Program Officer, Bangladesh Breastfeeding Foundation. Bangladesh; (4)MSc. Director. Bangladesh Breastfeeding Foundation (BBF). Bangladesh; (5)MBBS, MSc, Dip in Biotech, PhD, FRCP. Senior Scientist. Chairperson. Board of Trustees. Bangladesh Breastfeeding Foundation. Chairperson. Nutrition Foundation Bangladesh.

**Background and objectives:** Low birth weight (LBW) is a major risk factor for perinatal and infant mortality. In Bangladesh, LBW rate was 36% in 2004. Due to lack of information, estimating the current birth weight situation was necessary. The study was conducted to estimate the current rate of low birth weight in Urban Dhaka and to observe its association with mother's age.

**Methods:** This was a cross-sectional study, carried out at six government and non-government hospitals in Dhaka city. Birth weight of seven hundred and thirty six babies born from 2014-

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TYPOLOGY OF FOOD CONSUMPTION AND ITS ASSOCIATION WITH CALCIUM AND PHOSPHORUS METABOLISM AMONG MOROCCAN WOMEN

(1)Nejjar, Basma; (2)Cavalier, Etienne; (3)Bengueddour, Rachid; (4)El Arabi, Fatine; (5)Bour, Abdellatif.

(1)MSc. Departement of Biology. Faculty of Sciences Kenitra. Morocco. Departement of Clinical Chemistry. Faculty of Medicine Liège. Belgium; (2)PhD. Professor. Departement of Clinical Chemistry. Faculty of Medicine Liège. Belgium.; (3)PhD. Professor. Departement of Biology. Faculty of Sciences Kenitra. Morocco.; (4)MSc. Dietician. Departement of Biology. Faculty of Sciences Kenitra. Morocco.

**Background and objectives:** The Moroccan diet, characterized as a Mediterranean regime, has accused a decline in his nutritional quality which affects the health of Moroccan individual particularly the health of the musculoskeletal system. The objective of this study is to describe the typology of food consumption among Moroccan women in Meknes region and to highlight the association between these food profiles and the biological concentration of calcium and phosphorus metabolism.

**Methods:** We enrolled 116 women from a randomized sample. No exclusion criteria have been retained in order to ensure the representativeness of the sample. The data focused on sociodemographic parameters, sun exposure during a week ("less versus
more” than 15 minutes per week), and food frequency question-
naire divided into nine items. A fasting blood sample was made in
order to characterize the concentration of : calcium, phosphorus
and 25 hydroxyvitamin D (25OHD). Sun exposure was used as
an adjustment factor. Factor analysis (FA) described the typology
of food consumption. The association between the calcium and
phosphorus metabolism and the sun-adjusted dietary profiles
was assessed. The sun-adjusted multiple linear regression model
(SAMLRM) was used to identify the food items associated with
calcium-phosphorus parameters.

**Results:** The mean age was 50.1±15.3 years. The FA made a state of two profiles: one based on vegetable consumption and the other on animal consumption. The adjusted-food vegetable profile was associated with phosphorus (p=0.09) however, the adjusted food animal profile was associated with calcium(p<0.001) and 25OHD (p<0.001). The SAMLRM showed that item of oilseeds was associated with the concentration of calcium, phosphorus, and 25OHD (p<0.001). The frequency intake of fruits & vegetable item and fishes item was different depending on personal income (p=0.002) and marital status (p=0.05).

**Conclusions:** The typology of food consumption among Moroccan women in Meknes region was split into two profiles one focusing on vegetable diet and the other on animal diet. Each sun-adjusted food profile was differently associated with calcium and phosphorus metabolism.

**Keywords:** Food, Calcium, Phosphorus, Women, Morocco

**Methods:** We interviewed and collected data from the key informants at the departments and organizations serving as stakeholders for the multisectoral approach, such as the district's irrigation, social, health, family planning, planning and development, agriculture and horticulture, and food security offices. We analyzed the data by examining the results after both the first year (2015) and the second year (2016) of implementation.

**Results:** Multisectoral action was started in the beginning of 2015. All stakeholders received information about the importance of nutrition in the first 1,000 days of life and the role of multisectoral approach from seminars, discussions, posters, and leaflets. Two regulations were produced, and a task force was established to coordinate implementation. After two years, we found that clean water coverage increased, from 81.8% in 2015 to 83.4% in 2016; that the percentage of households using latrines increased from 66.8% to 71.8%; that the median age for the first marriage for women has increased from 21 to 25; that the percentage of women using contraception increased from 62% to 65%; that the percentage of poor people with insurance increased from 39% to 51%; and that the percentage of poor people decreased from 9.84% to 9.48%.

**Conclusions:** Commitment from local leaders has been earned, and indicators related to the nutrition-sensitive intervention have shown increases. However, analysis of nutrition-specific indicators is needed.

**Keywords:** Multisector, nutrition, nutrition-sensitive intervention

**Further collaborators:** Yustiyanty Monoarfa. Ir, Mkes. PhD Student at Airlangga University. Indonesia.

(1)Yatim, Herwin; (2)Labolo, Mustar; (3)Mang, Samsul Bahri; (4)Tongko, Ramli; (5)Salat, Maryam; (6)Suartika, I Wayan; (7)Sutedy, Bambang Eka; (8)Cokropanus, Sin; (9)Otoluwa, Anang Samudera; (10)Thaha, Abdul Razak.

(1)Ir, MM. Regent of Banggai District. Indonesia.; (2)Drs. Vice Regent of Banggai District. Indonesia.; (3)SH, MH. Head of Banggai District House of Representatives. Indonesia.; (4)ST. MSi. Head of Banggai District Planning, Development, and Research Body. Indonesia.; (5)Ir, Msi. Head of Banggai District Agriculture and Horticulture Office. Indonesia.; (6)MD, MEP. Head of Banggai District Women Empowering and Child Protection Office. Indonesia.; (7)Drs. MM. Head of Banggai District Public Works and Housing. Indonesia.; (8)Treasurer of Indonesian Farmers Association, Banggai District. Indonesia.; (9)MD, MPPM, Dr. Head of Banggai District Health Office. Indonesia.; (10)MD, MSc. Dr. Lecturer. Department of Nutrition, School of Public Health. Universitas Hasanuddin Makassar. Indonesia.

**Background and objectives:** Implementation of the Scaling Up Nutrition program requires strong commitment from local leaders and multisectoral action. The present study's objectives were to show evidence of how a multisectoral approach was implemented and to determine whether this approach affected indicators related to the nutrition-sensitive intervention.

(1)Arafat, Yasir; (2)Islam, A B M Muzharul; (3)Bhuiyan, Mamun Mohiuddin; (4)George, Joby; (5)Khan, Marufa Aziz; (6)Mannan, Imteaz.

(1)MPH. Senior Nutrition Manager. Save the Children. Bangladesh.; (2)MBBS. Line Director. National Nutrition Services. Institute of Public Health. Ministry of Health and Family Welfare. Bangladesh.; (3)MPH. Capacity Building and Quality Assurance Manager. MCHIP. Save the Children. Bangladesh.; (4)MHA. Chief of Party. MCHIP. Save the Children. Bangladesh.; (5)MPH. Senior Operations Research Manager. MCHIP. Save the Children. Bangladesh.; (6)MSS. Senior Advocacy and Communications Advisor. MCHIP. Save the Children. Bangladesh.

**Background and objectives:** Attention has increasingly focused on mainstreaming nutrition services in public health programs at different levels, when 14% children <5 years of age are wasted and 33% are underweight in Bangladesh. National Nutrition Services (NNS) of Ministry of Health and Family Welfare and USAID's MaMoni Health Systems Strengthening (MaMoni HSS)
project supports integrated nutrition service delivery through existing maternal, newborn, child health and family planning (MNCH/FP) platforms within the district health system. Aim of this analysis is to understand the contributions of these interventions using DHIS2 data.

**Methods:** Building on existing MNCH/FP services from community to district levels, NNS and MaMoni HSS collaborated to strengthen integrated delivery of nutrition interventions in four low performing districts. This joint effort supported competency based training of all government service providers followed by regular GMP for early case screening and referral at every contact and set up "malnutrition corner" at referral facilities equipped to manage SAM children. The project also institutionalized Joint Supervision Visits (JSV), strengthened record keeping, reporting and use of information for regular performance review.

**Results:** Implementation districts show progress on case screening and referral over the last two years. The integration helped to reach 388,017 children (about 50% of total) to access GMP services between January 2015 and December 2016. As a result, 9,624 children (2.5%) with MAM were identified to receive food based IYCF counseling and all 2,352 (0.6%) children with SAM referred for in-patient care. Only 352 SAM cases admitted to in-patient and managed under existing facility based SAM care protocol that observed very low cure rate (20%) and high defaulter rate (75%).

**Conclusions:** Integration of nutrition interventions into existing MNCH/FP platforms helped leveraging all opportunities to screen a large number of children under 5 years with undernutrition. Immediate attention is crucial to ensure implementation of CMAM in Bangladesh including to improve service readiness, quality and so treatment outcome within the existing program.

**Keywords:** Wasting, health-systems, integration, community, Bangladesh.

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NUTRITION INTERVENTION MAKING A DIFFERENCE: ASSESSMENT OF THE IMPACT OF A FEEDING PROGRAMME ON THE NUTRITIONAL STATUS OF PRE-SCHOOL CHILDREN IN GAUTENG PROVINCE, SOUTH AFRICA

Nyathela, Tshinakaho.

PhD. Senior lecturer. Cape Town Hotel School. Cape Peninsula University of Technology. South Africa.

**Background and objectives:** Feeding programmes are interventions that offer meals at schools with the aim of improving short-term hunger and the nutritional status of the children (Kearney 2009:6). Effective feeding interventions alleviate micro-nutrient, vitamin and mineral deficiencies that have a negative effect on growth and development during childhood (Kounnavong et al. 2011:5).

The purpose of this paper is to report on the impact of a feeding programme on the nutritional status of pre-school children from in Evaton West, Gauteng Province, South Africa.

**Methods:** A cross-sectional survey and descriptive design was used to conduct the study. Nutritional status data was collected from of 100 randomly selected children attending pre-school in Evaton West. Three pre-schools were purposively selected from the area. Four techniques were used for pre and post data collection, namely; dietary intake questionnaire, anthropometric measurements and hemocue. Anthropometric measurements included weight; height and mid-upper-arm-circumference (MUAC) were used to assess the nutritional status. A Hemocue was used to assess haemoglobin levels.

**Results:** During the follow-up study, 37 children dropped out from the study. Malnutrition is still prevalence at baseline; stunting (20.7%), wasting (12.7%) underweight (1.6%) and overweight 7.0%. Improvement was observed after the intervention, whereby 17.4%, 3.2%, 6.4%, 6.9% and 2.1% respectively. The mean±SD for MUAC measurements of the pre-school children was 15.89±1.29 cm and after and 15.97± 1.35cm. These results indicated that more than 95 percent of the children were normal and less than 5 percent were moderately malnourished before and after the intervention. The mean±SD serum Hb levels were normal, however, IDA was observed in 12 percent of the participants and after the intervention, the percentage increased to 20 percent.

**Conclusions:** Few statistically significant differences were observed with regard to nutritional status and IDA, however positive changes were observed, indicating that food provision may have a positive impact on an impoverished and malnourished community.

**Keywords:** Pre-school children, nutritional and biochemical status, feeding programme

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EARLY INTRODUCTION OF FOOD AND FLUIDS FOR HEALTHY INFANTS IN 6 MONTHS OF FOLLOW-UP

**Background and objectives:** Complementary feeding before six months of age are associated with detriment on health of mother and child. Modifiable determinants of early introduction of foods into an infant diet within the six first months of life warrant further investigation in Brazil. To examine determinants of timing and type of additional food on the zero to six months old infants' diet.

**Methods:** In a prospective cohort design, 656 pairs of 0- to 6-month-old children and mother were selected from June/2015

<footnote>(1)Carvalhaes, Maria Antonieta; (2)Mialich, Maiara Aparecida;</footnote>

<footnote>(3)Rossato, Sinara L; (4)Ferrari, Anna Paula; (5)Tonete, Vera Lúcia;</footnote>

<footnote>(5)Parada, Cristina Maria.</footnote>

<footnote>(1)PhD. Nutritionist. Faculdade de Medicina de Botucatu da Universidade Estadual Paulista. Brazil; (2)Ms. Nurse. Nursing Department. UNESP. Brazil; (3)PhD. Nutritionist. Department of Nutrition. Harvard T.H. Chan School of Public Health. United States; (4)Ms. Nurse. Nursing Department. Faculdade de Medicina de Botucatu. UNESP. Brazil; (5)PhD. Nurse. Nursing Department. Faculdade de Medicina de Botucatu. UNESP. Brazil.</footnote>
to January/2016 in the public health neonatal service, covering 80% of the population of Botucatu, in Brazil. Sociodemographic, biological, health status information were documented at the baseline. Mothers were inquired over the introduction of 48 food items into an infant's diet (e.g. water, tea, non-maternal milk, cereal, vegetables, fruits, etc). The age of the introduction of tree foods groups - non-maternal milk, fluids, and solid/semi-solid foods were classified into: before 2-months-old, two to four-months-old, and four to six-months-old. The median age when these

food groups were introduced into an infant's diet was assessed using Kaplan-Meier survival curve for the entire population and per income, education, mother's working status, delivery mode, and the pacifier use as determinants of early introduction of foods into diet. The log-rank test was used to compare the survival distributions.

**Results:** From 656, 595 children completed the 6-months of follow-up. Of this, 80.5% initiated the use of non-maternal milk at 90 days-old (median), 99.7% initiated fluids at 120 days-old (median), and 97.5% initiated solid/semi-solid foods at 135 days-old (median). 33.9% of the study participants added non-maternal milk and 20.8% added fluids foods into an infant's diet before the 2-months of age. Between 2- and 4-months of age, 40.9% of infants had eaten solid or semi-solid foods. Introduction of non-maternal milk happened 30 days earlier for Infants who used pacifier than non-users (p=0,0001) and 15 days earlier for infants from cesarean (p=0,007).

**Conclusions:** Modifiable determinants such as cesarean and the pacifier use influenced early introduction of complementary foods into infants' diet before 6-months-old, indicating nutritional vulnerability that demands intervention in public health service.

**Keywords:** Breastfeeding, infant diet, complementary feeding, survival curve.

1-18 years was conducted in 2014. Height and weight of all children were measured. International anthropometric indices and standards were used for assessment of children's nutritional status (WHO Child Growth Standards, 2006 for children from 1 to 5 years old and WHO Growth Reference, 2007 for children 5-18 years old). The relationship between anthropometric status of children and breastfeeding of children, as well as basic socio-economic factors were investigated.

**Results:** The underweight prevalence in children from 1 to 5 years old (Weight-for-age <-2Z) was 1.9% and for children 5-18 years was 1.6%. Stunting (Height-for-age<-2Z) was determined in 7.0% of children from 1 to 5 years and 2.3% of children aged 5-18 years. Rate of stunting was the highest in boys from 1 to 3 years old - 21,4%. Overweight among children from 1 to 5 was 8,3% (Body-mass-index-for-age>+2Z), but in children aged 5-18 years (BMI-for-age>+1Z) it was 30,1%. Obesity were respectively 5,1% (BMI-for-age>+3Z), and 10,3% (BMI-for-age>+2Z). The highest frequency was identified among boys aged 10-13 years (46,2% overweight, 19,8% obesity). Higher prevalence of overweight in children from 1 to 19 years old with mothers with lower education, lower employment status and single mothers was revealed, but statistically significant differences wasn't established (p>0.05). Breastfeeding of infants was related to lower rate of overweight in children from 1 to 5 years old (p<0.05).

**Conclusions:** The study revealed relationship between overweight/obesity among children and some risk factors. Social-economic factors didn't influence the problems in child growth in Bulgaria.

**Keywords:** children, obesity, risk factors

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## NUTRITIONAL STATUS IN CHILDREN FROM 1 TO 19 YEARS OLD IN BULGARIA AND RELATION OF SOME RISK FACTORS

(1)Duleva, Vesselka; (2)Rangelova, Lalka; (3)Petrova, Stefka; (3)Dimitrov, Plamen.

(1)Professor. PhD. MD. National Center of Public Health and Analyses. Sofia. Bulgaria; (2)PhD. MD. National Center of Public Health and Analyses. Sofia. Bulgaria; (3)Professor. PhD. MD. National Center of Public Health and Analyses. Sofia. Bulgaria.

**Background and objectives:** Nutritional status of children has an impact on their health and development and it is important to identify the problems and associated risk factors for adequate interventions.

The aim of this study is to evaluate the prevalence of underweight, overweight and obesity and relation of some risk factors in children from 1 to 19 years of age.

**Methods:** Cross-sectional study on dietary intake and nutritional status of a representative sample of 991 children aged

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## THE IMPACT OF COMMUNITY VOLUNTEER ACTIONS ON CHILD NUTRITION

(1)Pereko, Kingsley; (2)Steiner-Asiedu, Matilda; (3)Nti, Christiana;

(4)Adu-Oppong, Ahmed.

(1)PhD Nutriton. Department of Community Medicine University of Cape Coast. Ghana; (2)Prof. Nutrition. Department of Nutrition and Food Science. University of Ghana. Ghana; (3)Prof. Nutrition. Department of Family and Consumer Sciences. University of Ghana. Ghana; (4)Prof. Public Health. Department of Community Medicine. University of Cape Coast. Ghana.

**Background and objectives:** Despite the age long tradition of involving Community-based volunteers in nutrition and health service delivery as a primary health care concept, gaps exist in literature on the impact of their actions on various service outcomes. The study aimed at assessing the effect of volunteer actions on addressing childhood malnutrition in the KEEA Municipality.

**Methods:** Using a quasi-experimental study design, a pre- and post- surveys were conducted within a period of 9 months for two groups (intervention and control). Six intervention communities of three sub-districts in the KEEA- Municipality where community-based volunteers administer nutrition services for children
**Results:** The mean age was 15.58 ± 2.01 years with the range of [12-19]. The mean body mass index (BMI) was 19.99 ± 2.47. The sex ratio M/F =0.94. The prevalence of anorexia was 10.1%, this prevalence is higher among girls than boys (70.3% vs 29.7%, p <0.015). The depression HAD score was positive in 43.2% of adolescents with anorexia versus 15.1 % in students without anorexia (p <0.000). Anorexia is higher in students with normal BMI (67.6%) compared to those with underweight and overweight (16.2%, p <0.000). The diet was the most widely used method of weight control in adolescents with anorexia (48.5%, p <0.000).

**Conclusions:** Anorexia is a frequent public health problem in our context, where from the necessity of undertaking preventive measures of this pathology.

**Keywords:** Adolescent, anorexia, prevalence, depression, Fez.

The rate of children that were breast-fed in the first days after birth is 86.3%. Only 9.9% were breast-fed during their first hour; 21.7% of the infants were at exclusive breast-feeding. Up to 1 month were breast-fed 13.6%, up to 2 months – 10.5%, up to 6 months – 7.4%. A positive trend for breastfeeding beyond 6 months is observed in 44% of children. Early inclusion of fruit juices is observed in 87.3% of infants up to 6 months of age.

**Conclusions:** National study of risk factors for health among children aged 1-6 years, provide reliable information on the prevalence of major risk factors, leading to the development of chronic non-communicable diseases in later life.

**Keywords:** children, risk factors, survey

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RISK FACTORS FOR HEALTH OF CHILDREN AGED
1-6 YEARS

(1)Rangelova, Lalka; (2)Duleva, Vesselka; (2)Petrova, Stefka; (3)Dimitrov, Plamen.

(1)MD.PhD. Assistant Professor. Department of Food and Nutrition. National Center of Public Health and Analyses. Sofia. Bulgaria; (2)MD.PhD. Professor. Department of Food and Nutrition. National Center of Public Health and Analyses. Sofia. Bulgaria; (3)MD.PhD.Professor.Department of Health promotion and disease prevention. National Center of Public Health and Analyses. Sofia. Bulgaria.

**Background and objectives:** National program for prevention of chronic non-communicable diseases has been launched in 2014 in Bulgaria. The main objective of the program is to improve public health and to enhance quality of life by reducing premature mortality, morbidity and disability. National survey of risk factors for health among the population has been conducted under the program (smoking, drinking alcohol, low physical activity, unhealthy diet) which are causes for the development of chronic non-communicable diseases.

The aim is to examine the level of the leading risk factors for health-related lifestyle of the population.

**Methods:** A cross-sectional study of a representative sample of 307 children aged 1-6 years and their mothers is carried out. The study included direct face-to-face interviews with the mother of each child tested. Major risk factors were studied, which are related to pregnancy, periods of breastfeeding, complementary feeding and socio-economical status.

**Results:** In families with two parents who have entered into an official marriage or de facto marital cohabitation live 93% of the children; The percentage of mothers with secondary (22.6%) or higher (68.2%) education is relatively high.

The proportion of mothers with low weight before pregnancy is 4%, and 12.3% of the mothers are overweight, 4% of mothers have inadequate weight gain during pregnancy; A relatively small proportion of women consumed alcohol during pregnancy (7.3%); 11.1% of the mothers smoked during pregnancy.

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NUTRITION POLICY: A NEW PUBLIC ACTION
MODEL

Sebillotte, Clementina.

PhD. Management sciences. Unité de recherche Alimentation et Sciences Sociales ALISS UR1303. INRA. Ivry-sur-Seine. France.

**Background and objectives:** French National Nutrition and Health Program (PNNS) was implemented in 2001 succeeding many years of separated policy acts. This study analyses how the French government acts and changes to take action on nutrition issue which challenges its traditional intervention strategies. Are the existing traditional regulation strategies adequate or is it necessary to develop other regulation modalities? The study aims to understand the specificity of government action concerning nutrition and how it could constitute a new model for public action.

**Methods:** This empirical research adopts a qualitative approach through the lens of policy instruments. The method applied is longitudinal study (Pettigrew, 1990). Data was gathered through 40 semi-structured recorded and transcribed interviews with public and private players involved in food policy and agriculture sectors, through observation, original written and audio sources and specialized literature. This material was collected between 2007 and 2015. Data was analyzed using table structures for organizing, comparing and ranking.

**Results:** This work demonstrates the emergence of a new original regulation model based on state intervention on food demand and supply. It combines innovative policy instruments (eg. new type of voluntary agreements) with traditional ones in a particular complementary arrangement which we qualified as "discrete coupling of food supply and demand".

By coupling supply and demand in a non-directive way, the state tries to discreetly transform : i) food firms, which invest in developing new skills and capacities of innovation, ii) its food products, which become healthier iii) consumers, who adopt dietary guidelines and new lifestyles. The stake of this long term process is that supply and demand meet in a more desirable position.

We show that policy intervention on nutrition : i) cannot be reduced to the alignment of practices of demand and supply, ii) must allow state to build a frame of legitimacy for its actions, iii)
must consider the offer and supply network and their interactions
and iv) time necessary to allow behavior changes.

**Conclusions:** This new model constitutes a new theory for contemporary state action. It allows economic growth with purpose which goes far beyond economic benefit and which produces a common good, improving individual and collective welfare.

**Keywords:** Nutrition policy, common good, voluntary agreement, public action, discrete coupling

(1)Alias, Nur Atiqah; (2)Md Nor, Norazmir; (3)Mohd Asmawi, Ummi Mohlisi; (2)Mohd Fahmi Teng, Nur Islami.

(1)PhD. Candidate. Faculty of Health Sciences. Universiti Teknologi MARA 42300 Puncak Alam Selangor. Malaysia; (2)PhD. Lecturer. Faculty of Health Sciences. Universiti Teknologi MARA 42300 Puncak Alam Selangor. Malaysia; (3)PhD. Lecturer. Faculty of Medicine. Universiti Teknologi MARA 47000 Puncak Alam Selangor. Malaysia.

**Background and objectives:** Food security is when all people at all times have access to adequate, safe, healthy food to sustain a healthy and active life. Food security in children expressed that the children have adequate food daily and have a normal growth development without suffering any malnutrition. During flood situation, the food security and insecurity may happen to children due to the unavoided risk factor. Bera, Pahang had been selected as the area of research as it was one of the most severe flooding districts in December 2014. In this study, the risk factor of food security faced by children during the flood disaster are being identified. Secondly is the nutritional status of the respected informant are evaluated by using the anthropometry data.

**Methods:** The methodologies used are observation and interview with the respected victims to collect further information and opinion regarding the flood disaster. The selected informant consist of five female and four male from a different village. The post-flood questionnaires are being used to guide the responds from the informant. The data collected are being analysed by using thematic analysis to determine the risk factor of food security associated with children.

**Results:** Findings showed that food supply, food choice and food intolerance might play as a vital part in food security during flood disaster. Children who move to the relocation centre said that they eat less quantity of food during flood due to the repeated menu being cooked everyday. Even though, they may eat less quantity of food than normal, their nutritional status after the flood disaster such as weight and height only had minimal differences as compared to the control subject.Most of them didn't lose any weight during and after the flood.

**Conclusions:** In conclusion, even though there are risk factors associated with the food security, the effect on their nutritional status such as weight and height are minimal.

**Keywords:** Risk factor; Children; Flood disaster; Food security

(1)Alves do Nascimento, Fabiana; (2)Araújo da Silva, Sara;

(3)Constante Jaime, Patrícia.

(1)MSc Fabiana Alves do Nascimento. Nutrition in Public Health Graduate Program. School of Public Health. University of Sao Paulo. Brazil.; (2)MSc Sara Araújo da Silva. General Coordination of Food and Nutrition, Basic Care Department, Health Care Secretariat, Ministry of Health. Brazil.; (3)PhD Patrícia Constante Jaime. Nutrition Department. School of Public Health. University of Sao Paulo. Brazil.

**Background and objectives:** The Food and Nutrition Surveillance System continuously provide data on nutritional status and food intake of the population attended by the Primary Health-care services for the formulation of actions, programs and policies. This study aims to describe and analyze the coverage of the assessment of the food intake of the users of the public health services registered on this System between 2008 and 2013.

**Methods:** This is an ecological study. The population registered on the System is described according to federation units, macro-regions and/or life stages. The indicators used were: percentage of registration and use and coverage. The analyses were performed using descriptive statistics, linear regression models and Spearman's correlation.

**Results:** More the 99% of municipalities presented at least one individual registered and the percentage of utilization varied from 19.39% in 2008 to 32.5% in 2013. The national coverage ranged from 0.13% to 0.41%, with a statistically significant trend of increase. The Center-West region had the highest regional coverage. All life stages presented statistically significant trends of increase in the coverage, especially children and pregnant women. The presence of nutritionists remained close to the statistical significance threshold.

**Conclusions:** Despite the continuity of the collection of these indicators, the assessment of food consumption as a food and nutritional surveillance dimension was incipient and little-lined in Brazilian municipalities.

**Keywords:** Nutrition Programs and Policies; Nutritional Surveillance; State Health Care Coverage.
# THE CONSUMPTION OF ULTRA-PROCESSED FOODS AND THE OVERALL NUTRITIONAL QUALITY OF DIETS IN THE UK

(1)Rauber, Fernanda; (2)Louzada, Maria Laura da Costa; (2)Steele, Euridice Martínez; (3)Millett, Christopher; (2)Monteiro, Carlos; (4)Levy, Renata.

(1)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. FAPESP's Post-Doctoral fellowship nº 16/14302-7. Brazil.; (2)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Nutrição. Faculdade de Saúde Pública. Universidade de São Paulo. Brazil.; (3)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Universidade de São Paulo. Brazil. Public Health Policy Evaluation Unit. School of Public Health. Imperial College London. United Kingdom.; (4)PhD. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. Brazil.

**Background and objectives:** Population-based studies conducted in the United States, Brazil, and Canada suggest an inverse relationship between the dietary share of ultra-processed foods, as defined by NOVA classification, and the overall dietary nutritional quality. This study aimed to describe food intake in UK according to NOVA classification and the association between the dietary share of ultra-processed foods and the dietary nutritional profile.

**Methods:** Data from cross-sectional UK National Diet and Nutrition Survey (2008–12) were evaluated. Dietary information was collected using four-day, unweighted, food-diaries. Total energy intake and percentage provided by each of the NOVA food groups as well as the average nutrient content of the overall diet across quintiles of dietary share of ultra-processed foods.

**Results:** The average energy intake was 1,790.52 kcal/day, 56.8% of calories coming from ultra-processed foods, 30% from natural or minimally processed foods, 9.1% from processed foods, and 4.1% from processed culinary ingredients. As the ultra-processed food consumption increased, the dietary content in carbohydrates, free sugars, total fat, saturated fat, and sodium increased significantly. Most important was the difference in free sugars content which increased by 51% (from 10.1 to 15.2% of total energy) from the first to the last quintile. Protein content and fibre and potassium densities decreased significantly as the dietary share of ultra-processed foods increased. Particularly relevant was the decrease across quintiles in protein from 17.3 to 13.9% of total energy from the first to the last quintile (p<0.05).

**Conclusions:** These results are consistent with previous findings from other countries suggesting that decreasing the dietary share of ultra-processed foods may improve substantially the nutritional quality of diets.

**Keywords:** Food processing; ultra-processed; diet quality; dietary intake; UK.

# COMPARISON OF CONSUMERS' OPINIONS FOR GENETICALLY MODIFIED ORGANISM (GMO)

(1)Sato, Mizuho; (2)Nakano, Masaru; (3)Wunderlich, Shahla.

(1)Ph.D. National Registered Dietician. Senior Assistant Professor. Graduate School of System Design and Management. Keio University. Japan; (2)Ph.D. Professor of Graduate School of System Design and Management. Keio University. Japan;

(3)Ph.D.Professor of Nutrition and Food Science. Montclair State University. USA.

**Background and objectives:** The food label policy for Genetically Modified Organism (GMO) products is different in Japan and USA. In the USA, GMO ingredients are allowed to be used for food products. However, in Japan food using the GMO ingredients are prohibited with the exception of 8 items and 7 additives. Japanese consumers do not accept GMO containing food and normally do not buy these foods and they discard them if they learn that they have GMO which leads to food waste. The same could be true in the USA, consumers do not accept GMO food that can increase the food waste as well. The purpose of this study, therefore, was to investigate and to compare consumers' opinions for GMO in Japan and the USA.

**Methods:** Questionnaire survey were administrated among 123 students at Montclair State University. In Japan, the government have conducted the questionnaires on "The opinion for GMO and biotechnology" to 500 Japanese peoples. Additional questionnaires were conducted among of employees of the supermarket in Japan.

**Results:** The opinion for GMO is different in these two countries. Fifty one percent (51%) of Japanese and 7% of the supermarket employees had negative image of GMO. It was also observed the majority of people (64%), were not satisfy with the information about GMO labeling in Japan. When the question about the non-GMO food label, was asked, 73% of supermarket employees preferred and bought the non-GMO labeled foods. Furthermore, when it was asked, "Do you prefer to purchase the following food items with a non-GMO label? thirty three percent (33%) answered for daily foods, 28% for vegetable and fruits. Majority of Japanese (73%) request for the certification of non-GMO on the food label. It is important to explore the optimum labeling policy of non-GMO foods in order the consumers have correct information about the food they are purchasing.

**Conclusions:** The food label policy and education regarding GMO food is inadequate in Japan. It is desired that consumers and employees in food supermarket be educated so can convey the correct information to consumers.

**Keywords:** Genetically Modified Organism, Consumer Behavior, Food Label, Food Waste, Supermarket
# ASSESSING THE RETAIL FOOD ENVIRONMENT IN CANADA: PROCESS, PROGRESS, AND PRACTICAL IMPLICATIONS

Minaker, Leia.

PhD. Assistant Professor. School of Planning. Faculty of Environment. University of Waterloo. Canada.

**Background and objectives:** Canada's retail food environment is an important setting for population dietary health and equity, since 70 cents of every food dollar is spent in food stores, and this proportion increases with decreasing household income. The objective of this presentation is to share the process, progress to date, and practical implications of assessing the retail food environment in Canada using a standard assessment tool.

**Methods:** A brief history of retail food environments research in Canada will be described, and findings will be synthesized and compared with international research. The process of developing a Canadian retail food environment assessment manual, and international partnerships to advance the retail food environments research agenda will be discussed. Practical implications for the fields of public health nutrition and for urban plan planning will be summarized in terms of research, policy and practice.

**Results:** In 2015, Canada's first Food Environments Symposium was hosted by researchers in partnership with Canada's federal Office of Nutrition Policy and Promotion. Canadian retail food environments researchers came together to present new information and methods, to network, and to build consensus around future directions. With support from the Office of Nutrition Policy and Promotion, a Canadian retail food environment assessment manual was created, and is currently being pilot tested by several urban, rural, and remote Canadian communities. New connections between Canadian researchers and the INFORMAS network have the potential to take existing local, provincial, and national research partnerships in Canada to an international scale. Future research will examine time-space food environment exposures in epidemiological research, future municipal policy will consider zoning and other urban planning approaches to create health-promoting retail food environments, and future practice should include capacity building for community food environment assessment within diverse Canadian contexts.

**Conclusions:** The field of retail food environments research in Canada is relatively new. Momentum at the local, provincial, and national scale has been building, and there is great potential for long-term, practical application of research findings to municipal policy, and to public health and urban planning practice. Embedding the Canadian research within the INFORMAS network will encourage best practices in food environment research, surveillance, and monitoring.

**Keywords:** food environment; partnerships; public health nutrition; surveillance; monitoring

# EATING OUT: FREQUENCY OF EATING FOODS PREPARED AWAY FROM HOME AND ASSOCIATIONS WITH DIETARY AND WEIGHT OUTCOMES IN A POPULATION-BASED SAMPLE FROM ONTARIO, CANADA

Minaker, Leia.

PhD. Assistant Professor. School of Planning. Faculty of Environment. University of Waterloo. Canada.

**Background and objectives:** Eating foods prepared away from home is a growing trend in Canada, and has implications for long-term health. The types of restaurants and other sources of prepared foods where people usually go can influence their overall diet quality and health. This study will describe the frequency with which Waterloo Region residents eat out, reasons for choosing different outlet types, and the extent to which eating out is associated with diet quality, fruit and vegetable intake, and weight outcomes.

**Methods:** A stratified random sample of households in Waterloo Region, Ontario, Canada, were recruited in 2009/2010 to participate in the NEWPATH study. Data from 2223 household (n=4102 individuals over 10 years of age) were used to examine associations between participants' frequency of eating out and dietary- and weight-related outcomes using generalized linear models to account for the nested structure of the data. All analyses accounted for participants' age, sex, education level, and household income.

**Results:** About 30% of residents ate at a fast food restaurant at least once per week. Almost half (49%) ate at a coffee shop and 18% ate at a sit-down restaurant at least once per week. The most popular reasons for people patronizing fast food outlets were: 1) a lack of time to prepare food, 2) convenience (easy to get to), and 3) the taste of the food. Diet quality and fruit and vegetable consumption were poorer among those who frequently patronized fast food outlets compared to those who did not. People who frequently patronized fast food outlets and coffee shops had significantly higher BMI and waist circumference than those who did not.

**Conclusions:** Dietary and weight outcomes vary significantly by participants' eating-out behaviours. Fast food outlets and coffee shops might be especially relevant settings for health promotion interventions, which should consider 1) convenience (in terms of proximity and time), and 2) taste of the food.

**Keywords:** restaurants; public health nutrition; food purchasing; diet quality; foods prepared away from home
# ESTABLISHING A PLATFORM FOR BUSINESS ENGAGEMENT ON NUTRITION. THE SUN BUSINESS NETWORK IN NIGERIA

(1)Theobald, Hannah; (2)Igbeka, Uduak; (3)King-Harry, Ibiso; (4)Attah, Eno Angela; (5)Schofield, Dominic; (6)Aminu, Francis; (7)Tench, Jonathan.

(1)BSc. PhD. Scaling Up Nutrition Business Network & Global Alliance for Improved Nutrition. London. United Kingdom;
(2)BAgric. Scaling Up Nutrition Business Network & Global Alliance for Improved Nutrition. Abuja. Nigeria; (3)BSc. MPH. Scaling Up Nutrition Business Network & Global Alliance for Improved Nutrition. Abuja. Nigeria,; (4)MB,BS, MPH. Scaling Up Nutrition Business Network & Global Alliance for Improved Nutrition. Abuja. Nigeria; (5)MA. MBA. Global Alliance for Improved Nutrition. Ottawa. Canada; (6)Global Alliance for Improved Nutrition. Abuja. Nigeria; (7)Scaling Up Nutrition Business Network & Global Alliance for Improved Nutrition. London. United Kingdom.

**Background and objectives:** The Scaling Up Nutrition (SUN) Movement was established in 2010 to encourage government led, collective action to end malnutrition in all forms. The SUN Business Network (SBN) is one of four networks supporting the SUN Movement and acts to engage and support the private sector to undertake business action on nutrition in support of national nutrition objectives. SBN operates at the global and national levels, with 13 national networks engaging the private sector on nutrition in Africa, Asia and Latin America.

SBN wanted to establish a functioning private sector engagement and commitment platform on nutrition in Nigeria, aligned with the Government's nutrition strategy.

**Methods:** Between August 2015 and April 2016 a strategy for private sector engagement was developed, following a review of national nutrition priorities, stakeholder interviews and analysis of existing business activities to address malnutrition in Nigeria. Priority areas for business action on nutrition were identified and a business engagement and commitment platform on nutrition developed.

**Results:** 'Increasing consumer awareness and demand creation for nutritious foods' and 'nutrition in the agriculture value chain' were identified as priority areas for business action. These areas were validated by stakeholders including the Federal Ministries of Health, Agriculture and Budget and National Planning.

SBN Nigeria launched its membership and commitment platform in April 2016, with 20 business members signing up with commitments to address malnutrition. As of end March 2017, the membership has grown to 44 businesses (59% small-medium enterprises, 23% multinationals). Commitments made include activities to include availability and/or affordability of nutritious products (47%), increasing consumer awareness of nutrition (26%) and increased food fortification and use of bio-fortified crops (13%). Businesses have also signed up to activities within the priority workstreams.

**Conclusions:** SBN Nigeria was successfully launched as the only business platform dedicated to nutrition in the country. In order to deliver impact and ensure business action to improve nutrition, SBN Nigeria will convene workstreams for action in priority areas, facilitate partnerships and the provision of technical assistance as well as track progress of members' nutrition commitments. SBN Nigeria will monitor business progress towards their nutrition commitments and business impact on nutrition.

**Keywords:** Nigeria, multi-sector, scaling up nutrition, business

**Conflict of Interest Disclosure:** HT, UI, IKH, EAA, DS, FA & JT all work or have worked for the SUN Business Network, one of the four support networks of the Scaling Up Nutrition Movement. The SUN Business Network works to encourage private sector action on nutrition and is made up of more than 350 business members. The SUN Business Network does not receive any fees from business members.

# PREGNANCY OUTCOMES AND THE DIAGNOSTIC ABILITY OF TWO STANDARDS TO ASSESS ADEQUACY OF MATERNAL BODY MASS INDEX IN URUGUAY

(1)Mardones, Francisco; (2)Burgueño, Leticia; (3)Rosso, Pedro;

(4)Villarroel, Luis; (5)Bacallao, Jorge; (6)Farias, Marcelo.

(1)MD. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile,; (2)MD. MSc. Department of Public Health. Pontificia Universidad Católica de Chile. Chile,; (3)MD. Department of Pediatrics. Pontificia Universidad Católica de Chile. Chile,; (4)PhD. Department of Public Health. Pontificia Universidad Católica de Chile. Chile,; (5)PhD. Universidad de Ciencias Médicas. Cuba,; (6)MD. PhD. Department of Obstetrics and Gynecology. Pontificia Universidad Católica de Chile. Chile.

**Background and objectives:** The Rosso and Mardones (RM) and the Atalah et al (AEA) maternal weight gain charts are widely used in Latin America. The purpose of this study was to compare birth length (BL) and birth weight (BW) outcomes of both charts at the beginning and at the end of pregnancy using national data from Uruguay.

**Methods:** Data of pregnant women and their children registered at the national level in the maternity hospitals between 2010 and 2012 were considered: 51,420 women and newborns (RN) with valid records were obtained. Just healthy pregnant women and term single live births were included. Maternal nutritional status was classified at the beginning and at the end of pregnancy according to both curves. The diagnostic ability of both instruments regarding inadequate fetal growth was compared using sensitivity and specificity values. Inadequate fetal growth was defined as birth weight < 3000 g, birth weight > 4,250 g, and birth length < 50 cm.

**Results:** The selected sample reached 23,832 pregnant women and their newborns. Proportions of BL < 50 cm and both BW < 3000 g and > 4250 g were similar at each nutritional category of both charts; absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart, both at the beginning and at the end of the pregnancy.
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.

(1)Lisboa Conde, Wolney; (2)Cumpian-Silva, Jéssica; (2)Mazzeti, Camila; (3)Rocha Cruz, Danielle; (4)Enes, Carla Cristina; (5)Rinaldi, Ana Elisa Madalena.

(1)PhD. Nutricionist. Professor of Nutrition Department. School of Public Health. University of Sao Paulo. Brazil; (2)MD. Nutritionist. School of Public Health. University of Sao Paulo. Brazil; (3)Student of Nutrition. School of Public Health. University of Sao Paulo. Brazil; (4)PhD. Nutritionist. Pontifical Catholic University. Brazil; (5)PhD. Nutritionist. Federal University of Uberlandia. Brazil.

**Background and objectives:** Body mass index (BMI) covers a great diversity of body phenotypes (BP). Some of phenotypes are associated to body fat and could be linked to risk for non-communicable disease and mortality. Body phenotypes based on anthropometrics and body composition measures has raised as one response to overcome those handicap. To describe nutritional status from BP anthropometric-based in adults and correlate them to mortality.

**Methods:** We select 3 body composition variables from adults in NHANES 1999-2006. We have performed Principal Component Analysis and estimated individual scores for 4 components (C#) at first and 3 at second surveys. We have described components with eigenvalues >=.7 and characterized them by variables with loadings >=.20. Finally, we linked dataset with diabetes or hypertension mortality register. We estimated each component mortality risk (IRR) by Poisson model adjusting for age at survey.

**Results:** In 1999-2006, C1 was characterized by circumference and adiposity body composition measures; C2 by bone length and lean mass body composition measures; C3 by bioelectrical impedance reactance and lean mass body composition variables. IRR for diabetes mortality was higher in component linked to adiposity: 1.3 for man and 1.1 for woman. For hypertension mortality, BP characterized by lean mass was protection: 0.4 for all sexes combined. For diabetes/hypertension combined mortality, IRR from adiposity pattern (C1) was similar for man and woman: 1.1.

**Conclusions:** Adiposity BP it's a risk for diabetes and diabetes/ hypertension mortalities among men and women. BP refine risk to morbi-mortality estimation and offer possibilities of identifying individuals with BMI characterized by high adiposity to avoid negative or fatal outcomes.

**Keywords:** BMI; Body phenotypes; Mortality; Nutritional assessment; US adults.

(1)EL Hioui, mohamed; (2)Azaoui, Fatima Zehra; (3)Ahami, Ahmed Ot;

(3)Aboussaleh, Youssef.

(1)PhD. Equip of Clinic and Cognitive Neurosciences and Health. Laboratory of Biology and Health. Department of Biology. Faculty of Science. IBN TOFAIL University. Kenitra. Morocco;

(2)Pr. Equip of Clinic and Cognitive Neurosciences and Health. Laboratory of Biology and Health. Department of Biology. Faculty of Science. IBN TOFAIL University. Kenitra. Morocco;

(3)Pr. Equip of Clinic and Cognitive Neurosciences and Health. Laboratory of Biology and Health. Morocco.

**Background and objectives:** Nutritional status is the best indicator of the global well-being of children. However, malnutrition affects physical growth, cognitive development, physical work capacity, and it consequently influences human performance and health. The present study was designed to identify factors that may influence the nutritional status and educational achievements of the children in a rural area of ANTI Atlas of Morocco

**Methods:** The nutritional status of 162 children (12 to 15 years of age) was assessed by nutritional anthropometry and compared with tables of weight-for-age and height-for-age z-scores (WAZ and HAZ) identifying wasting and stunting, respectively. A questionnaire was developed to collect information about socio-economic and demographic status of the children's families. Also, educational achievements were assessed by their score in mathematics

**Results:** A total of 162 children (64 boys and 98 girls), aged 12-15 years. **Results:** **Conclusions:** In this area of study, malnutrition remains a major problem among adolescents' school performances, which can affect their future. The main causes of malnutrition seem to be the bad weaning practices among school children and cultural attitudes of food. The educational achievements of school children are influenced by maternal education and stunting.

**Keywords:** Malnutrition, School Achievements, Morocco

**Further collaborators:** the present work was supported by the Morrocan Ministry of Health and the Ministry of Higher Education.
# FACTORIAL TRIAL OF LIPID-BASED NUTRIENT SUPPLEMENTS WITH INFANT AND YOUNG CHILD FEEDING COUNSELING WITH OR WITHOUT IMPROVED WASH IN KENYA: EFFECTS ON ANEMIA, IRON, VITAMIN A, VITAMIN B12 AND FOLATE

(1)Stewart, Christine; (2)Dewey, Kathryn G; (3)Allen, Lindsay H; (4)Lin, Audrie; (5)Pickering, Amy; (6)Byrd, Kendra; (7)Arnold, Charles D.; (8)Kiprotich, Marion; (9)Arnold, Benjamin F.; (9)Null, Clair.

(1)PhD. Associate Professor. Department of Nutrition. University of California Davis. USA; (2)PhD. Professor. Department of Nutrition. University of California Davis. CA. USA.; (3)PhD. Director. USDA. ARS Western Human Nutrition Research Center. Davis. CA. USA.; (4)PhD. Epidemiologist. Division of Epidemiology. University of California Berkeley. CA. USA.; (5)PhD. Engineer. Department of Civil and Environmental Engineering. Stanford University. Palo Alto. CA. USA.; (6)PhD. Postdoctoral Scholar. Department of Nutrition. University of California Davis. CA. USA.; (7)MS. Statistician. Department of Nutrition. University of California Davis. CA. USA.; (8)MPH. Nutritionist. Innovations for Poverty Action. Kenya.; (9)PhD. Senior Researcher. Mathematica Research Institute. Washington DC. USA.

**Background and objectives:** Anemia may be caused by micronutrient deficiencies, infection, and genetic hemoglobin disorders among children. Nutritional supplementation and improvements in water, sanitation, and handwashing may reduce the burden of anemia and improve micronutrient status.

**Methods:** We conducted a cluster-randomized controlled trial in rural western Kenya enrolling pregnant women and following their children for 2y. A biochemical subsample included children in four intervention groups: combined water, sanitation, and handwashing improvements (WSH); nutrition improvements, including lipid-based nutrient supplements (LNS) for children 6-24 mo and infant and young child feeding counseling (N); WSH+N; and control. Blood samples were collected at the 2y follow-up and hemoglobin, serum ferritin, transferrin receptor, folate, vitamin B12, retinol binding protein, c-reactive protein (CRP), and alpha-1 acid glycoprotein (AGP) measured.

**Results:** 699 children were included in this analysis at a mean (SD) age of 22.1 (1.8) mo. In the control group, there was a high prevalence of anemia (48.8%), iron deficiency (80.9%), and vitamin A deficiency (52.9%), but lower prevalence of folate deficiency (9.6%) or B12 depletion (21.8%). The N and WSH+N groups had significantly lower prevalence of anemia ([Prevalence Ratio, 95% CI] N: 0.74, 0.58-0.94; WSH+N: 0.56, 0.42-0.75), iron deficiency (N: 0.71, 0.62-0.80; WSH+N: 0.77, 0.66-0.90), vitamin A deficiency (N: 0.66, 0.41-0.87; WSH+N: 0.54, 0.40-0.72), folate deficiency (N: 0.12, 0.03-0.54; WSH+N: 0.07, 0.01-0.49), and B12 depletion (N: 0.66, 0.50-0.87; WSH+N: 0.54, 0.40-0.72). Additionally, the prevalence of high folate (>45.3 nmol/L) increased in the N and WSH+N groups. There was a marginally significant 25% lower prevalence of anemia in WSH+N compared to N. There were no differences in micronutrient status or anemia between the WSH and the control groups.

**Conclusions:** The nutrition intervention reduced the prevalence of anemia and deficiencies in iron, vitamin A, folate and B12. It also increased prevalence of high folate status. The WSH intervention did not reduce the risk of anemia, but WSH+N appeared to reduce anemia more than the nutrition-specific intervention. LNS combined with infant and young child feeding behavior change communication is an effective strategy to improve nutritional status.

**Keywords:** Lipid-based nutrient supplement, anemia, micronutrient, children

**Conflict of Interest Disclosure:** No conflicts of interest. Funded by the Bill and Melinda Gates Foundation and the Thrasher Research Fund.

**Further collaborators:**

Setti Shahab-Ferdows, PhD. USDA, ARS Western Human Nutrition Research Center, Davis CA. USA.

Gouthami Rao, MPH. Waterborne Disease Prevention Branch; Division of Foodborne, Waterborne, and Environmental Diseases; Centers for Disease Control and Prevention. Atlanta, GA. USA.

Holly N. Dentz, MPH. Department of Nutrition. University of California Davis, CA. USA

John M. Colford, Jr.MD, PhD. Division of Epidemiology. University of California Berkeley, CA. USA.

# EXPLORING THE RELATIONSHIP BETWEEN ENVIRONMENTAL IMPACT AND NUTRIENT CONTENT OF SANDWICHES & BEVERAGES AVAILABLE IN CAFES IN A UK UNIVERSITY

(1)Graham, Fiona; (2)Russell, Jean; (3)Holdsworth, Michelle; (4)Menon, Manoj; (5)Barker, Margo.

(1)The University of Sheffield. UK; (2)PhD. Statistician. Corporate Information and Computing Services. The University of Sheffield. UK.; (3)PhD. Professor. Public Health. The University of Sheffield. UK.; (4)PhD. Lecturer. Geography. The University of Sheffield. UK.; (5)PhD. Reader. Food and Nutrition Group. Sheffield Hallam University. UK.

**Background and objectives:** Current dietary patterns in the UK are having a negative impact on health and the environment. Adoption of healthier and more environmentally sustainable diets is needed, yet concerns over the nutritional quality of low environmental impact diets have been raised.

We examined the relationship between the environmental impact and nutrient content of sandwiches and beverages commonly consumed in cafes in a UK university to explore how choosing low environmental impact options would affect nutrient intake and subsequent health.

**Methods:** Greenhouse Gas Emission (GHGE) and Water Footprint (WF) values for ingredient foods of sandwiches and beverages were combined with recipe information to calculate GHGEs (gCO2e per portion/serving) and scarcity weighted WFs (litres per portion/serving). These estimates were then combined via orthogonal regression to give a single environmental impact
score (EIS). The relationship between EIS and nutrient content was explored by correlation.

**Results:** Sandwiches that contained meat and animal products (i.e. roast beef, corned beef, cheese and pork) and beverages that contained milk, cocoa and/or coffee had the highest EIS. EIS was positively associated with portion size of sandwiches, but not serving size of drinks. EIS was positively correlated with nutrients to limit for health, namely sodium (sandwiches rs= .67 p<0.01, beverages rs= .76 p<0.01), saturated fat (sandwiches rs= .37 p<0.01, beverages rs= .80 p<0.01), and free sugars (sandwiches rs=.44, p<0.01). However, EIS was also positively correlated with nutrients to encourage for health; protein (sandwiches rs = .45 p<0.01, beverages rs.83 p<0.01), iron (sandwiches rs=.44 p<0.01, beverages rs=.38 p<0.01), calcium (beverages rs =.78 p<0.01) and B12 (beverages rs=.76, p<0.01).

**Conclusions:** Choosing plant-based sandwiches and drinks without milk may help to reduce environmental impact. Selecting smaller sandwiches would also help to reduce environmental burden and calorie intake. However, intakes of health-promoting nutrients may be adversely affected if consumers adhere to environmental dietary messages. This reduction may have health implications for individuals in the population already vulnerable to micronutrient deficiencies.

**Keywords:** Nutrients, Public Health, Greenhouse Gas Emissions, Water Footprint, Environment

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## INTERVENTIONAL PROMOTION FOR CONSUMPTION OF FRUITS AND VEGETABLES IN A PRIMARY HEALTHCARE SERVICE - A RANDOMIZED CONTROLLED TRIAL

(1)Mendonça, Raquel; (2)Mingoti, Sueli; (3)Gazzinelli Bethony, Maria Flávia; (4)Lopes, Aline Cristine.

(1)PhD student. Nutritioner. Department of Nutrition. Universidade Federal de Minas Gerais. Brazil; (2)PhD. Statistic. Department of Statistics. Universidade Federal de Minas Gerais. Brazil; (3)PhD. Biologist. Department of Applied Nursing, Universidade Federal de Minas Gerais. Brazil; (4)PhD. Nutritioner. Departament of Nutrition. Universidade Federal de Minas Gerais. Brazil.

**Background and objectives:** The consumption of fruits and vegetables (FV) is one of the ten main factors in the global burden of disease. Furthermore, the studies are usually developed far from the subjects' reality, with respect to availability to health services in particular. A most of intervention nutritional do not regard to the individual's perception of their consumption. To assess the impact of an intervention aimed to increase fruit and vegetable (FV) consumption.

**Methods:** A seven-month assessment of a randomized controlled trial of a nutritional intervention in the promotion of FV intake was conducted with 3,778 adults (≥20 years of age) in the healthcare service - Brazil. In 18 units' healthcare were randomly assigned to a control (n=9) or intervention group (n=9). The inter-

vention was based on the Transtheoretical Model and Paulo Freire pedagogy and included: group educational sessions, motivational messages by postcard, written material and environment-based activities. The control received periodic health intervention (lecture on nutrition) at the health service. Control and intervention group members participated in physical activity, for three times a week during one hour. The primary outcome was change in FV consumption (grams). Intermediate outcomes included: increase self-efficacy, decrease perceived of barriers of FV consumption and progress of action stages. Analyses utilized a generalized estimating equation analysis.

**Results:** We assessed 3,778 individuals, of these 364 were excluded (112 were not meeting inclusion criteria and 252 declined to participate). 3,414 individuals (intervention group= 1,931; control= 1,483) had completed follow-up at seven month, of whom 1,305 in the intervention group and 936 in the control group. The intervention group participants reported improvement in self-efficacy (<0.001), fewer perceived of barriers (0.003) and greater progression to action stages (57.2% to 70.1%; p<0.001); and participants in the lowest quartile of FV consumption at baseline increased their FV intake (β=27.5; CI95%:6.4 to 48.6) compared to the control group.

**Conclusions:** The intervention reached the goal. The intervention promoted consumption among people who had low FV consumption, maintenance along with adequate of the FV intake, of decreasing perceived barriers and to increase self-efficacy. More research on longer-term FV intake maintenance is needed.

**Keywords:** Fruit, Vegetable, Feeding Behavior, Nutrition Education, Clinical Trial

**Further collaborators:**

Funding for this study was provided by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) (CDS APQ-0376-4.08/07) and Conselho Nacional de Pesquisa (CNPQ) (APQ 476686/2013-0).

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## RELATIONSHIP OF SOCIO-DEMOGRAPHY, PARTRENTAL ANTHROPOMETRY AND BIRTH HISTOLOGY WITH WEIGHT STATUS AMONG URBAN AND RURAL ADOLESCENTS (13-18 YEARS)

(1)Chopra, Mansi; (2)Siddhu, Anupa; (3)Tandon, Nikhil.

(1)MSc. Assistant Professor. Department of Food and Nutrition. Lady Irwin College. University of Delhi. India.; (2)PhD. Associate Professor. Department of Food and Nutrition. Lady Irwin College. University of Delhi. India.; (3)PhD. Professor. Department of Endocrinology and Metabolism. All India Institute of Medical Sciences. New Delhi. India.

**Background and objectives:** Increasing prevalence of adolescent obesity in a developing country like India, undergoing socio-economic and epidemiologic transition warrants assessment of associated risk factors. The study aims to determine socio-demographic, birth history and parental characteristics among adolescents and assess their relationship with weight status.
**Methods:** Using a cross-sectional study design, a total of 499 school-going adolescents (13-18 years) belonging to urban (New Delhi; n=261) and rural areas (Harsaru Village, District Gurgaon and Duhai Village, District Ghaziabad; n=238) of north India were enrolled. Information on socio-demography, including date of birth, gender, location (urban/rural), facilities at home (car, television, computer, air conditioner, cooler), number of living rooms (<3, 3-5, >5), ownership of house; birth history, including birth weight, number of siblings (0, 1-2, ≥3), birth order (1, 2-3, >3), total breastfeeding duration; information on parents anthropometry and weight status computation based on BMI (WHO), educational status (≤high school/ ≥graduation), occupational status (working/not working), smoking and alcohol status (never/sporadic/ regular), were obtained by a parent-administered questionnaire. Anthropometric measurements including height and weight were measured and adolescents were classified based on weight status (overweight/obese [OW/OB], normal [NW] and lean weight [LW], respectively) using BMI for age reference values (WHO).

**Results:** Parental educational status, paternal occupational status, facilities at home and number of living rooms were significantly higher among OW/OB as compared to NW and LW group, respectively (p<0.05). Mean values of paternal height, parental weight and BMI were significantly higher among OW/OB group as well (p values ranging from <0.001-0.039). Furthermore, OW/OB adolescents had significantly higher birth weights, were least breastfed, were first born and majority were less likely to have siblings (p values ranging from <0.001-0.038). Logistic regression analyses adjusted for age, gender and location showed higher maternal educational status (OR:2.60), paternal (OW, OR:1.84; OB, OR:3.27) and maternal (OW, OR:4.16; OB, OR:3.35) weight status, regular parental smoking (OR:2.56) and higher birth weight (OR:2.64) increased, and ≥3 siblings (OR:0.25) and higher breastfeeding duration (OR:0.95) significantly decreased the odds of developing OW/obesity among adolescents (p values <0.001-0.046).

**Conclusions:** The results highlight the importance of socio-demographic, parental characteristics and birth history in the development of OW/obesity among adolescents.

**Keywords:** socio-demography, adolescent obesity.

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THE EFFECT OF DOUBLE FORTIFIED SALT ON HEMOGLOBIN CONCENTRATIONS: A SYSTEM-ATIC REVIEW AND META-ANALYSIS

(1)Ramirez-Luzuriaga, Maria J; (2)Larson, Leila; (3)Martorell, Reynaldo.

(1)MSc. Nutrition and Health Science Program. Laney Graduate School. Emory University. Atlanta. Georgia. USA.; (2)MPH. Nutrition and Health Science Program. Laney Graduate School. Emory University. Atlanta. Georgia. USA.; (3)PhD. Nutrition and Health Science Program. Laney Graduate School and Hubert Department of Global Health. Rollins School of Public Health. Emory University. Atlanta. Georgia. USA.

**Background and objectives:** Background: Double-fortified salt (DFS), containing iron and iodine, has been proposed as a feasible and cost-effective alternative for iron fortification in low and middle-income countries (LMICs). Objectives: The aims of this meta-analysis were to 1) examine the effect of DFS on hemoglobin concentrations, and 2) assess differential effects on hemoglobin by iron concentrations and type of formulations (ferrous sulfate, ferrous fumarate and ferric pyrophosphate).

**Methods:** A systematic search of randomized and quasi-randomized controlled trials using MEDLINE, EMBASE, Cochrane, Web of science, and other sources identified 220 articles. A total of 12 studies, all efficacy studies, met pre-specified inclusion criteria.

**Results:** All studies were conducted in LMICs; eight in India, two in Morocco, one in Cote d'Ivoire and one in Ghana. The pooled analysis showed that DFS increased hemoglobin concentrations significantly (SMD 0.28; 95% CI: 0.11, 0.44; P< 0.001). Significant heterogeneity was observed and random effects models were used. Stratified analyses by population sub-groups indicated significant effects among school-age children (SMD 0.32; 95% CI: 0.04, 0.60; P< 0.05; n=7) and women of childbearing age (SMD 0.24; 95% CI: 0.04, 0.44; P< 0.05; n=6). Ferrous fumarate (SMD 0.22; 95% CI: 0.05, 0.38; P< 0.05; n=3) and ferrous sulfate (SMD 0.23; 95% CI: 0.01, 0.46; P< 0.05; n=6) showed similar effects. Hemoglobin concentrations and deworming at baseline, sample size, study duration and study quality were not associated with effect size.

**Conclusions:** DFS is efficacious in increasing hemoglobin concentrations in LMIC populations. Effectiveness studies are needed.

**Keywords:** Hemoglobin, double fortified salt, fortification, salt iodization, iron

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PREVALENCE OF OVERWEIGHT AND OBESITY AMONG CHILDREN IN PRIVATE PRIMARY SCHOOLS IN KENITRA, MOROCCO

(1)Sbai, Meriem; (2)Aboussaleh, Youssef.

(1)Phd. Nutrition, Health and Environment laboratory. Department of Biology. Faculty of Sciences. Ibn Tofail University. BP 133 14000 Kenitra. Morocco; (2)Professeur. Laboratory of Biology and Health. Department of Biology. Ibn Tofail University. Faculty of Sciences. Morocco.

**Background and objectives:** Background. The rising prevalence of childhood obesity poses a major public health challenge in both developed and developing countries by increasing the burden of chronic non communicable diseases.

**Objectives**. The aim of our study was to estimate the prevalence of overweight and obesity among primary school age children in Kenitra.

**Methods:** We conducted a cross-sectional study of a random sample of 331 school children including 173 boys and 158 girls aged 6-7 years. Children were recruited from private primary schools. Anthropometric parameters (weight, height, body mass index) were measured. Obesity indices (Thinness, Severe thinness,
normal weight, overweight and obesity) were defined according to WHO standards published in 2007. Data were collected using a questionnaire. Statistical analysis was performed using SPSS version 20.0 and using a macro of WHO Anthro plus.

**Results:** The results showed that 17.8% of school children are overweight/obese, and 2.7% are Thinness /Severe thinness. Age and anthropometric parameters between BMI for age groups showed that the weight, height, BMI z score of weight, size and z score of BMI z score at very high Among overweight/obese groups than other groups. Groups of BMI for age are not influenced by gender as p = 0.665.

**Conclusions:** The prevalence of obesity and overweight among school children is high. School children are at risk of developing diseases associated with obesity. Which may cause problems at the age of adolescence and adulthood. Several studies of nutritional status are recommended for preschool children in Morocco.

**Keywords:** Overweight, obesity, children, Morocco, 6-7 years

people. Among the latter, over half (56.2%) were overweight, this being the principal reason for consultation among nutritional counseling users.

Outdoor gym classes are offered within the HS premises, as well as other programs such as Healthy Awakening, consisting of cognitive stimulation exercises and physical activity for senior citizens, and Game Zones, where physical activities for children are offered. Furthermore, conferences open to the community have convened 16 200 people.

**Conclusions:** The HS Program enables access to the control of a series of NCD risk factors in the population and constitutes an original strategy for promoting healthy lifestyles.

**Keywords:** Health Stations - Health Promotion - Non Communicable Diseases

144/1268

HEALTH STATIONS PROGRAM IN THE CITY OF BUENOS AIRES

(1)Gonzalez, Veronica; (1)Antún, María Cecilia; (2)Lava, María del Pilar;

(1)De Ruggiero, Marina; (1)Mirri, María Eugenia; (1)Alonso, Natalia;

(1)López, María Carla.

(1)BSc in Nutrition. Directorate-General of Health Development. Deputy Mayor's Office. Buenos Aires City Government. Argentina.; (2)BS in Sociology. Directorate-General of Health Development. Deputy Mayor's Office. Buenos Aires City Government. Argentina.

**Background and objectives:** As a response to the growing burden of non-communicable diseases (NCD), in 2012 the Health Stations Program (HS) was created by the Directorate-General of Health Development of the Deputy Mayor's Office of the Buenos Aires City Government.

Among its objectives are the detection of NCD risk factors and the promotion of healthy lifestyles in children and adults. It is available to the community free of charge through 40 health promotion points located within Buenos Aires City.

The object of this paper is to describe the scope of the HS Program through a series of indicators.

**Methods:** Cross-sectional study based on data from HS user database.

**Results:** Since its start in 2012, a total of 1 044 641 people visited the HS 3.4 times on average, totalizing 3 937 422 sessions (3 593 454 health checkups and 693 820 nutritional counselings). Fifty-six percent of users were female, 44% were male, and 56% were over 45 years of age. Fifty-six percent resided in Buenos Aires City and 27% in Buenos Aires Province.

During the past year 13 300 new monthly contacts were made on average, and an estimated one out of five Buenos Aires City residents have attended HS at least once.

Blood pressure controls were carried out on 762 124 people, glycemia on 248 083 people and body weight controls on 346 278

144/1288

ASSOCIATION BETWEEN MARKERS OF INFLAMMATION WITH CARDIO-METABOLIC RISK FACTORS, DIET AND PHYSICAL ACTIVITY AMONG APPARENTLY HEALTHY INDIAN ADOLESCENTS

(1)Chopra, Mansi; (2)Siddhu, Anupa; (3)Tandon, Nikhil.

(1)MSc. Assistant Professor. Department of Food and Nutrition. Lady Irwin College. University of Delhi. India.; (2)PhD. Associate Professor. Department of Food and Nutrition. Lady Irwin College. University of Delhi. India.; (3)PhD. Professor. Department of Endocrinology and Metabolism. All India Institute of Medical Sciences. New Delhi. India.

**Background and objectives:** Obesity is associated with metabolic derangements and sub-clinical inflammation, coexisting with adverse lifestyle behaviours. The study aims to assess the relationship between cardio-metabolic risk factors, diet and physical activity (PA) with inflammatory markers among adolescents.

**Methods:** Using a statistical approach, a total of 499 school-going adolescents from urban (New Delhi; n=261; 3 schools) and rural areas (Harsaru Village, District Gurgaon and Duhai Village, District Ghaziabad; n=238; 3 schools) of north India, were enrolled, based on weight status (overweight/obese [OW/OB], normal weight and lean weight) using BMI for age WHO guidelines, in this cross-sectional study. Measurements of anthropometry, body composition, blood pressure and fasting blood samples for cardio-metabolic variables including glucose, HbA1c, total cholesterol, LDL-c, HDL-c, TG, urea, creatinine, uric acid and inflammatory markers including CRP, IL-6, TNF-alpha, resistin, leptin and adiponectin were done. Diet information was obtained using 24hr diet recall for three non-consecutive days (2 school-days and 1 weekend-day) and Global PA Questionnaire (v.2) was used to compute METs/week spent on total PA and its domains.

**Results:** OW/OB group had higher concentrations of cardio-metabolic and inflammatory markers as compared to other groups (except HDL-c and adiponectin, which were lower; p<0.05). Mean dietary intakes of energy, macronutrients, fatty acids [FA], fibre and select micronutrients were significantly high-
er (p<0.05), with lower METs/week for total PA and for activities related to work, transport and recreation among OW/OB adolescents (p<0.001). Individual linear regression models adjusted for age, gender, location, BMI and fat mass showed significant association of CRP with dietary vitamin B12 (β:-0.28); TNF-alpha with LDL-c (β:0.45), urea (β:2.31), PUFA (β:6.09), sodium (β:0.14), vitamin A (β:0.17); IL-6 with LDL-c (β:0.13), moderate work (β:-0.02); resistin with glucose (β:0.13), PUFA (β:0.68), MUFA (β:-0.45), fibre (β:-0.22); leptin with TG (β:0.01), uric acid (β:0.15), trans-fat (β:0.20), β-carotene (β:0.01); adiponectin with HDL-c (β:14.24), HbA1c (β:298.63), β-carotene (β:0.11) (p values <0.001-0.047).

**Conclusions:** Significant positive associations of TNF-alpha, IL-6, resistin and leptin with select cardio-metabolic variables, dietary PUFA, trans-fat, sodium and vitamin A, and negative associations with MUFA and fibre, highlight the importance of early identification and modification of risk factors to delay the onset of cardio-metabolic complications among adolescents.

**Keywords:** cardio-metabolic risk; inflammation.

after consumption and liking were assessed. Satisfaction related to the overall eating experience was measured with a questionnaire designed for the study. A similar protocol was used for the study on chocolate and the satisfaction questionnaire was improved by adding sensory dimensions.

**Results:** The study on potato snacks allowed to identify the optimal portion size that reduced significantly the appetite while bringing the maximum of satisfaction (between 30 to 40g). For chocolate, drivers of satisfaction and reason to stop consumption were also identified.

**Conclusions:** This new approach has provided promising results to recommend an optimal portion size. It provides relevant information to design satisfying portion sizes of snacks for consumers to help them better manage their daily energy intakes and to adopt healthier food pattern.

**Keywords:** portion size, satisfaction, appetite, consumer studies, sensory drivers

**Conflict of Interest Disclosure:** All authors worked for Mondelēz international at the moment of the study. No specific conflict of interest.

144/1289

DEVELOPMENT OF A NEW METHODOLOGY TO DEFINE AN OPTIMAL PORTION SIZE OF FOOD TAKING INTO ACCOUNT CONSUMER SATISFACTION, APPETITE SENSATIONS AND ENERGY INTAKE

**Background and objectives:** Food portion size has increased over the last decades and can be influenced by a wide variety of internal and external factors (individual characteristics, food related characteristics and food environment). Recommended food portion size are mainly based on calories and recommended daily intake without considering consumers' needs and expectations. The aim of our studies was to develop a new methodology to help defining an optimal portion size by taking into account three dimensions: energy intake, fullness and overall satisfaction.

**Methods:** To achieve this goal quantitative consumer studies were run on different food categories (baked potato snacks and chocolate). The baked potato snacks study was launched on 120 consumers and was repeated in 2 countries. 3 hours after their lunch, 200 g of baked potato snacks were provided in a dispenser so that the consumers did not have visual clues of the quantity provided and eaten. Consumers were asked to eat as much as they wanted to feel fully satisfied for a snack at this moment of the day. Actual consumption (g and Kcal), appetite sensations before and

144/1290

DESIGN, VALIDATION AND APPLICATION OF A MEDITERRANEAN DIETARY INDEX IN CHILE

**Background and objectives:** Diet quality is considered a key factor in the development of chronic diseases. Availability of brief dietary indexes that can effectively evaluate dietary patterns and their association with health is critical for prevention and management of chronic diseases. Based on the increasing scientific evidence that supports the health benefits of adopting a Mediterranean diet, the objective of this study was to develop a valid and self-applicable Chilean Mediterranean Diet Index (Chilean-MDI)

<footnote>(1)Lesdema Laurent, Aurelie; (2)Heyraud, Caroline; (2)Hachefa, Celia;</footnote>

<footnote>(3)Vinoy, Sophie.</footnote>

<footnote>(1)PhD. Research scientist. Global Nutrition Research and Communication. Mondelēz International. USA.; (2)MSc. Nutrition scientist. Global Nutrition Research and Communication. Mondelēz International. France.; (3)PhD. Research scientist. Global Nutrition Research and Communication. Mondelēz International. France.</footnote>

<footnote>(1)Echeverría, Guadalupe; (2)Urquiaga, Ines; (3)Concha, María José; (4)Dussaillant, Catalina; (5)Villarroel, Luis; (6)Velasco, Nicolás; (7)Leighton, Federico; (8)Rigotti, Attilio.</footnote>

<footnote>(1)MSs. Center for Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (2)PhD. Biochemist. Center for Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (3)MSc. Nutritionist. Center for Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (4)MSc. MD. Center for Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (5)PHD. Statistician. Department of Public Health. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (6)MD. Department of Nutrition. Diabetes and Metabolism. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (7)MD. Center for Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile; (8)MD. PhD. Center for Molecular Nutrition and Chronic Diseases and Department of Nutrition. Diabetes and Metabolism. School of Medicine. Pontificia Universidad Católica de Chile. Chile.</footnote>
that evaluates food intake quality -based on adherence to this dietary pattern- in our population.

**Methods:** The Chilean-MDI was developed based on a previous Mediterranean eating score that was adapted to Chilean dietary habits. This index was further validated in a sample of 153 adults by comparing the concordance between the results obtained by self-application of the Chilean-MDI with those obtained by a trained nutritionist. Additionally, this index was applied in 53,366 Chilean adults in order to describe the diet quality of our population.

**Results:** There was an adequate concordance (kappa>0.69 in all items) and high correlation (r=0.94, p<0.001) between findings obtained by self-application of the Chilean-MDI and those achieved by the nutritionist. The application of the index in Chilean adult population showed a better diet quality (high Mediterranean diet adherence) among women, with advanced age and in higher educational levels.

**Conclusions:** The Chilean-MDI can be successfully self-applied to portray the overall diet quality in the Chilean adult population. Additionally, this index showed demographic trends in food intake that are comparable to those obtained with similar indexes applied in other populations. Supported by Fundación Banmédica.

**Keywords:** Mediterranean diet, diet index / diet score, chronic diseases prevention

144/1293

GLOBAL EVIDENCE ON NUTRIENT PROFILE MODELS WITH APPLICATIONS IN GOVERNMENT-LED NUTRITION POLICIES AIMED AT HEALTH PROMOTION AND NONCOMMUNICABLE DISEASE PREVENTION: A SYSTEMATIC REVIEW

**Background and objectives:** Worldwide, government bodies increasingly recognize the importance of using transparent and reproducible methods to evaluate the nutritional quality of foods and beverages for nutrition-related policies. Nutrient profile (NP) models meet this need, but an up-to-date, accessible, and global resource summarizing existing NP models is currently unavailable.

The aim of this study was to develop such a resource which summarizes and evaluates key characteristics of NP models with applications in government-led nutrition policies.

**Methods:** NP models were first identified from a key, but unpublished catalogue of NP models built in 2012 by Rayner and colleagues. A systematic literature search was also conducted in three databases of the peer-reviewed literature (e.g. PubMed) and fifteen grey literature databases (e.g. PAIS Index). Included models had to meet the following characteristics (out of twelve eligibility criteria): a) Developed or endorsed by governmental or inter-governmental organizations; b) Allow for the evaluation of single food items; c) Consider multiple nutrients or food components; d) Have publicly available nutritional criteria.

**Results:** A total of 387 potential NP models were initially identified, including n=119 models from Rayner's catalogue and n=268 models from the full text assessment of >600 publications. Seventy-eight models were included. The majority of models (n=75; 96%) provide summary ratings of the healthfulness of food products as opposed to separate ratings for individual nutrients. Almost half of the models originate from the Americas, followed by the Asia/Pacific region (23%) and Europe (22%). Most (n=55; 71%) were introduced within the last 10 years, and only 6 models (8%) were endorsed as opposed to specifically developed by a governmental or intergovernmental organization. The most common primary applications of the models included school food standards or guidelines (n=27), food labelling (e.g. front-of-pack; n=12), restriction of the promotion of foods to children (n=10), and claims (e.g. health claims; n=7).

**Conclusions:** Given the proliferation of NP models worldwide, this new resource will be highly valuable for assisting health professionals, nutrition professionals and policy makers in the adoption or adaptation of an existing model appropriate for the establishment of specific nutrition policies that require the use of nutrient profiling.

**Keywords:** nutrient profiling, nutritional quality, systematic review, nutrition policy

**Conflict of Interest Disclosure:** Prior to this study, Beatriz Franco-Arellano was a PepsiCo employee. Also, Theresa Poon is currently employed part-time by Intertek Scientific & Regulatory Consultancy. These companies had no connection with the present research. The other authors have no conflicts of interest.

<footnote>(1)Labonté, Marie-Eve; (2)Poon, Theresa; (3)Gladanac, Branka;</footnote>

<footnote>(4)Ahmed, Mavra; (4)Franco-Arellano, Beatriz; (5)Rayner, Michael;</footnote>

<footnote>(6)L'Abbé, Mary.</footnote>

<footnote>(1)PhD. RD. Department of Nutritional Sciences. University of Toronto. Canada.; (2)BSc. Department of Nutritional Sciences. University of Toronto. Canada.; (3)MPH. Department of Nutritional Sciences. University of Toronto. Canada.; (4)MSc. Department of Nutritional Sciences. University of Toronto. Canada.; (5)PhD. Centre on Population Approaches for Non-Communicable Disease Prevention. Nuffield Department of Population Health. University of Oxford. United Kingdom.; (6)PhD. Department of Nutritional Sciences. University of Toronto. Canada.</footnote>
## GENDER IS ASSOCIATED TO MINIMUM ACCEPTABLE DIET AMONG INFANT AND YOUNG CHILDREN AGED 6-23 MONTHS IN SOUTHERN OF BENIN

**Background and objectives:** Socio-demographics factors, childcare practices, poverty, low levels of education, women's disempowerment are the most important factors contributing to persistent child under-nutrition in developing countries including Benin. The achievement of healthy growth and survival of young children in their early years requires appropriate complementary feeding practices. This study aimed to identify socio-economic and demographic factors associated with adequate complementary feeding (CF) practices.

**Methods:** A cross-sectional study of 1219 children aged 6-23 months was carried out in Bopa and Houeyogbe districts in Southern Benin. Socio-demographic information was obtained using a semi-structured questionnaire administered to the child primary caregivers. CF practices were assessed through WHO/ UNICEF infant and young child feeding (IYCF) indicators. "Random Forest" was used to eliminate confounding factors. Logistic mixed regression models performed in "R" software were used to test significant effects of explanatory variables on CF practices.

**Results:** Majority of mothers (67%) did not attend formal school and 6% of households are female-headed. Poor nutritional status was observed in study area with 27% of stunting and 5% of wasting. The proportion of children who achieved minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) was 60%, 71% and 46%, respectively. Education level of mothers was not significant as main effect on MAD. However, there was a significant two ways interaction effect of sex of household head and education level of mothers on MAD (Coef $\beta$ =2.8; OR = 16.5; 95%IC: 1.8-50.7; P=0.013). The probability that a child meets the minimum acceptable diet increased drastically among female-headed households with higher schooling level.

**Conclusions:** The study findings suggest that empowerment of women and their level of education have an important role to play as factors contributing to appropriate IYCF practices. A combination of nutrition specific and nutrition-sensitive interventions including gender aspect are necessary to address child under-nutrition.

**Keywords:** Gender, complementary feeding, diet, children, Benin

## COST AND COST-EFFECTIVENESS OF FOOD-ASSISTED MATERNAL AND CHILD HEALTH AND NUTRITION PROGRAMS IN BURUNDI AND GUATEMALA

**Background and objectives:** Despite the popularity of food-assisted maternal and child health and nutrition (FA-MCHN) programs, little is known about their (cost-)effectiveness. This study examines the cost and cost-effectiveness of two FA-MCHN programs implemented during the first 1,000 days in Burundi and Guatemala. Both programs included food assistance (family + individual ration), strengthening of health services, and a nutrition/health behavior change communications strategy. Using a cluster-randomized controlled trial (c-RCT), the Burundi study evaluated the optimal timing and duration of food assistance: from pregnancy until the child is 24 months (T24), until the child is 18 months (T18), and birth until 24 months (TNFP). The 5-treatment arm Guatemala c-RCT compared the optimal composition of the individual ration (corn-soy blend (CSB), micronutrient sprinkles (MNP), lipid-based supplements) and optimal size of the family ration (full, reduced, none).

**Methods:** We used the activity-based costing-ingredients method and collected detailed data on program activities, inputs (e.g., labor, supplies), and input allocation across activities. We calculated total costs, activity-specific costs, and start-up costs. We also estimated the cost and cost-effectiveness for each version using stunting as the outcome. Since a cost-effectiveness ratio only accommodates one outcome, it is artificially inflated for integrated programs. We thus compare versions across a range of outcomes.

**Results:** In Burundi, T24 was the most expensive (766 USD/beneficiary), had a large range of impacts, and was the most cost-effective in reducing stunting (108 USD/beneficiary/percentage point (pp) reduction in stunting). In Guatemala, the full family ration combined with CSB or MNP were the most expensive (1,076 and 1,086 USD/beneficiary respectively), had the highest concentrations of positive impacts, and were the only versions that reduced stunting. The CSB version led to the largest stunting reductions and was more cost-effective than the MNP version (97 and 161 USD/beneficiary/pp reduction in stunting, respectively). However, the CSB version also had unintended negative effects. In both countries, start-up costs accounted for a significant share of non-food costs (17.3%, Guatemala; 10.1%, Burundi).

**Conclusions:** In both countries, the most expensive program versions were also the most cost-effective. Longer implementa-

<footnote>(1) Mitchodigni, Irene; (2) Amoussa-Hounkpatin, Waliou;</footnote>

<footnote>(3) Ntandou-Bouzitou, Gervais; (4) Termote, Celine; (5) Kennedy, Gina;</footnote>

<footnote>(6) Hounhouigan, Joseph.</footnote>

<footnote>(1) Ph D. Nutritionist Student. Department of Nutrition and Food Science. University of Abomey Calavi. Benin; (2) Ph D. Nutritionist. Lecturer. Department of Nutrition and Food Science. University of Abomey Calavi. Benin; (3) PhD. Nutritionist. Bioversity International. Benin; (4) PhD. Associate Scientist. Bioversity International. Kenya; (5) PhD. Senior Scientist. Bioversity International. Italy; (6) Ph D. Professor. Dean of Faculty of Agronomic Sciences. University of Abomey Calavi. Benin.</footnote>

<footnote>(1) Heckert, Jessica; (2) Richter, Susan; (3) Iruhiriye, Elyse; (4) Leroy, Jef;</footnote>

<footnote>(4) Olney, Deanna; (5) Ruel, Marie.</footnote>

<footnote>(1) PhD. Research Fellow. Poverty, Health and Nutrition Division. International Food Policy Research Institute. USA.; (2) PhD. Independent consultant.; (3) BA. Doctoral student. Arnold School of Public Health. University of South Carolina. USA.;</footnote>

<footnote>(4) PhD. Senior Research Fellow. Poverty, Health and Nutrition Division. International Food Policy Research Institute. USA.;</footnote>

<footnote>(5) PhD. Division Director. Poverty, Health and Nutrition Division. International Food Policy Research Institute. USA.</footnote>