nant women. Future studies are needed to measure levels of vita-
min A, C, and E as well as Iron, Zink, Selenium, and Copper to test
their correlation with TAS in order to analyze the effect of multi
micronutrient accurately.

**Keywords:** MMN, TAS, Periconception

**Further collaborators**

Theodora Chintya, Researcher. Banggai District Health Office.

could be responsible for this condition such as lack of conscious-
ness of parents about their children's dietary habit, inappropriate
food intake, preference of fast foods, physical impairment of au-
tistic children, less physical activity and so on. Awareness should
be raised to pay attention to this vulnerable group for improving
their situation. More future study on this field is now compulsory
in Bangladesh to overcome the situation and reveal more about
this area to add new knowledge and information.

**Keywords:** Nutritional status, autistic, children.

144/715

NUTRITIONAL STATUS OF AUTISTIC AND
NON-AUTISTIC SCHOOL GOING CHILDREN AGED
3-5 YEARS IN DHAKA CITY

(1)Nourin, Israt; (1)Atiya, Naushin; (1)Jahan, Dilara; (2)Ratna, Moffashara Sultana; (3)Akter, Syeda Mahsina; (4)Ara, Ferdous; (5)Roy, Swapan Kumar.

(1)BSc. Food & Nutrition. University of Dhaka. Bangladesh.; (2)MSc. Food & Nutrition. Assistant Professor. Dept. of Food & Nutrition. College of Home Economics. University of Dhaka. Bangladesh.; (3)MSc. (Food & Nutrition). MSc. (Nutrition and Health). Assistant Director. Bangladesh Breastfeeding Foundation. Bangladesh.; (4)MSc. MPhill. Senior Program Officer. Bangladesh Breastfeeding Foundation. 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:** Early childhood (3-5 years) is very important for physical growth and nutritional development. Autistic children are one of the most vulnerable groups, so it is important to measure their growth & nutritional development. Their nutritional status is still unknown as no data about their nutrition-al status was found from previous studies in Bangladesh. So, the study objective was to observe and compare nutritional status of 3-5 years school going children with and without autism in Dhaka city, Bangladesh.

**Methods:** A cross-sectional study was conducted from April to December, 2016 among children aged 3-5 years with autism (n=53) and normal children (n=53), were selected from four schools in urban Dhaka city, Bangladesh.

Anthropometric data (height, weight & MUAC) were collected
by following the standard method of WHO. Data was entered by
WHO Anthro software and Z score classification was used to clas-
sify their nutritional status.

**Results:** The prevalence of stunting (<-2 HAZ) among autistic and normal children were 3.8% vs.1.9%. About 7.5% wasting (<-2 WHZ) was seen in both groups of children. However, weight for age was significantly different in both groups of children. Among autistic and normal children underweight (<-2 WAZ) was found 1.9% vs. 7.5% and overweight (>2 WAZ) was 35.8% vs. 28.3%. According to MUAC reference value (>13.5) about 98.1% children of both groups had normal nutritional status.

**Conclusions:** It was seen that overweight percentage was found more among autistic and normal children. Many reasons

144/718

COMPARATIVE STUDY ON FOOD PREFERENCE
OF SCHOOL GOING CHILDREN AGED 3-5 YEARS
WITH AND WITHOUT AUTISM IN DHAKA CITY

(1)Atiya, Naushin; (1)Nourin, Israt; (1)Jahan, Dilara; (2)Ratna, Moffashara Sultana; (3)Akter, Syeda Mahsina; (4)Roy, Swapan Kumar.

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

**Background and objectives:** Food consumption pattern is one of the major contributors for optimal nutritional status of among children. A food consumption pattern varies due to food preference, acceptance and rejection behavior. It is therefore need- ed to explore the food preference, acceptance and refusal among the autistic children. The children with autism are most vulnera- ble who are disregarded from evidence. So, we considered autistic and non-autistic children of 3-5 years aged to compare their food preference, acceptance and rejection to understand their eating behavior. To the author's knowledge, such studies have not been conducted yet in Bangladesh. This research objective was to ob- serve and compare food preference, acceptance and refusal of 3-5 years school going children with and without autism in Dhaka city, Bangladesh.

**Methods:** A cross-sectional study was conducted from April to December, 2016 among 3-5 years old children in four selected schools in urban Dhaka city, Bangladesh. Both normal and autistic groups contained 53 samples (n=53) each. The data was collected by a structured questionnaire to the parents of children about their children's food preferences, acceptance and refusal. The data was entered by IBM SPSS software (version 20.0) and analyzed by Chi- square test.

**Results:** There was a difference between the food preferences of two groups of children. However, both the group had special preferences. Homemade food was most accepted to the autistic children (58.5%), where the percentage for normal children was 52.8%; on the other hand 60.4 % normal children preferred fast food where the percentage for autistic was 56.6%. Soft drinks were
also more preferred by normal children (73.6%) than autistic chil-
dren (58.5%). Street food was less preferred to the autistic children
(22.6%), than normal children (15.1%).

**Conclusions:** The total amount and variety of consumed food by the autistic children was lower than children without autism. The reason could be their physical disability, chewing problem, carbohydrate intolerance, lack of caring practice etc.

**Keywords:** Food preferences, most preferred food, autistic children, and normal children.

ation support the importance of preconception tailored nutrition-
al counselling.

[1] Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the Globe, Reprod Biol Endocrinol. 2015;13:37

[2] Liu CY, Chou YC, Chao JC, Hsu CY, Cha TL, Tsao CW. The Association between Dietary Patterns and Semen Quality in a General Asian Population of 7282 Males. PLoS One. 2015; doi: 10.1371/journal.pone.0134224

**Keywords:** food frequency, vegetables and fruits, semen quality

(1)Danielewicz, Anna; (2)Przybylowicz, Katarzyna Eufemia.

(1)MSc. Nutritionist. Department of Human Nutrition. University of Warmia and Mazury. Olsztyn. Poland.; (2)Associated Professor. Department of Human Nutrition. University of Warmia and Mazury. Olsztyn. Poland.

**Background and objectives:** It is estimated that in Central and Eastern Europe 8-12% of men are infertile, and in the case of 20% of infertile couples in the region, indicates a 56% part of the male factor in the occurrence of infertility [1]. Numerous studies have shown that a healthy diet with a high intake of fish and seafood, poultry, vegetables, fruits, legumes, through the high content of antioxidants are associated with better parameters of semen quality and reduced risk of asthenozoospermia [2].

To explore association between the frequency of intake of food
groups and quality parameters of semen.

**Methods:** A study included 81 men attending an infertility clinic. Diet was assessed using validated food frequency questionnaire (FFQ). Sperm concentration, progressive motility and morphology were evaluated by computer-aided semen analysis (CASA) according WHO criteria. Additionally evaluated weight and height, BMI and physical activity levels (IPAQ). Differences between tertiles of quality parameters of semen and the frequency of intake of food groups were assessed.

**Results:** We observed significant differences only between tertiles of sperm concentration and BMI (T2=25.0±2.0 vs. T3=25.4±2.3 times/day), progressive motility and processed meat (T1=0.22±0.32 vs. T3=0.43±0.46 times/day) and beer (T1=0.17±0.16 vs. T2=0.36±0.57 times/day). We also found differences in tertiles of sperm morphology and plant oils (T1=1.09±2.0 vs. T2=0.57±0.45 times/day), cottage cheese (T1=0.26±0.29 vs. T3=0.69±0.63 times/day), fresh legumes (T2=0.05±0.11 vs. T3=0.14±0.21 times/day), cruciferous vegetables (T2=0.29±0.24 vs. T3=0.59±0.48 times/day) vegetables rich on vitamin C or β-carotene (T2=1.15±0.81 vs. T3=2.20±1.86 times/day), and yellow-orange vegetables (T2=0.26±0.27 vs. T3=0.59±0.61 times/day). No relationship between physical activity and sperm parameters were identified.

**Conclusions:** Our findings suggest that a higher frequency of intake of cottage cheese, fresh legumes and various kind of vegetables may be associated with quality of semen. This positive associ-

(1)Danielewicz, Anna; (2)Przybylowicz, Katarzyna Eufemia; (3)Morze, Jakub.

(1)MSc. Nutritionist. Department of Human Nutrition. University of Warmia and Mazury. Olsztyn. Poland.; (2)Associated Professor. Department of Human Nutrition. University of Warmia and Mazury. Olsztyn. Poland.; (3)Student. Department of Human Nutrition. University of Warmia and Mazury. Olsztyn. Poland.

**Background and objectives:** Pre-sarcopenia is a significant association factor for functional impairment among older adults [1]. Low muscle mass could be associated with increased morbi-mortality and should be identified for optimizing preventive and therapeutic nutritional strategies [2]. The aim of the present evaluation was to describe association of the nutrients intake in dietary patterns and the risk of pre-sarcopenia in perimenopausal women.

**Methods:** A study included 530 women aged 32 - 63 years in Warmia and Mazury province in Poland. Low muscle mass was defined by Appendicular Lean Mass index based on Newman's equatation on the basis of total fat tissue mass and body height assuming the cut-off points for the Polish population. The nutrients intake evaluation was performed by a 24-hour recall repeated sevenfold at irregular intervals was taken into account. Dietary patterns were defined by principal component analysis with varimax rotation. Dietary patterns were included variables with loading vector > 0.7. The risk of pre-sarcopenia was assessed using logistic regression model.

**Results:** The Varied dietary pattern the risk of pre-sarcopenia decreased with the intake of total protein (OR=0.92, 95%CI=0.86-0.98), animal protein (OR=0.89, 95%CI=0.81-0.98), carbohydrates (OR=0.98, 95%CI=0.97-0.99), fiber (OR=0.85, 95%CI=0.72-1.00), calcium (OR=0.99, 95%CI=0.99-1.00), magnesium (OR=0.98, 95%CI=0.97-0.99), iron (OR=0.74, 95%CI=0.56-0.97), zinc (OR=0.61, 95%CI=0.41-0.90), vitamin A (OR=0.99, 95%CI=0.99-0.99), niacin (OR=0.78, 95%CI=0.63-0.97) and vitamin B6 (OR=0.17, 95%CI=0.02-0.83). There was no association between risk of pre-sarcopenia and nutrient intake in Fatty dietary pattern. In both dietary patterns, the risk of pre-sarcopenia decreased with increasing BMI and body fat content.

**Conclusions:** The identification of dietary patterns in pre-sarcopenia has important implications for dietary interventions that
might delay age-associated loss of skeletal muscle mass. It will al-
low to setting dietary recommendations to improve the quality of
life of the elderly.

References:

[1] Hashemi R, Shaffie G., Motlagh AD, et al. Sarcopenia and its associated factors in Iranian older individuals: Results: [2] Graf CE, Pichard C, Herrmann FR, et al. Prevalence of low muscle mass according to body mass index in older adults. Nutrition. 2017; 34:124-129

**Keywords:** pre-sarcopenia, low muscle mass, dietary patterns, women

144/738

CHARACTERIZATION OF MEDITERRANEAN DIET PATTERN AND THEIR ADHERENCE IN A PREPUBERAL POPULATION OF METABOLIC- LY HEALTHY OBESE

(1) Vargas Candela, Antonio; (2) Vilches, Alberto; (3) Moya, Paula;

(4) Benítez Porres, Javier; (5) Romance, Angel Ramón; (6) Rosales-Jaime, Antonio; (7) Díaz-Ruiz, Juan; (8) Gómez-Martín, Antonio; (9) Gómez-Huelgas, Ricardo; (10) Bernal-López, M. Rosa.

(1)BS. Technician. Internal Medicine Department. Institute of Biomedical Research in Malaga (IBIMA). Regional University Hospital of Malaga (Carlos Haya Hospital). Spain.; (2)BS. Nutritionist. Endocrinology and Nutrition Department. Institute of Biomedical Research in Malaga (IBIMA). Regional University Hospital of Malaga. CIBER Obn. Spain.; (3)BS. Nurse. Internal Medicine Department. Institute of Biomedical Research in Malaga (IBIMA). Regional University Hospital of Malaga. CIBER Obn. Spain.; (4)PhD. Researcher. Biodynamic and Body Composition Laboratory. Department of Didactics of Language, Arts, and Sport. University of Malaga. Spain.; (5)PhD. Professor. Biodynamic and Body Composition Laboratory. Department of Didactics of Language, Arts, and Sport. University of Malaga. Spain.; (6)MD. Doctor. Medical team orientation north Malaga. Spain.; (7)MD. Doctor. Cartama Stacion Health Center. Spain.; (8)BS. Teacher of physical education. Internal Medicine Department. Institute of Biomedical Research in Malaga (IBIMA). Regional University Hospital of Malaga. CIBER Obn. Spain.; (9)MD. Professor. Internal Medicine Department. Institute of Biomedical Research in Malaga (IBIMA). Regional University Hospital of Malaga. CIBER Obn. Spain.; (10)PhD. Researcher. Internal Medicine Department. Institute of Biomedical Research in Malaga (IBIMA). Regional University Hospital of Malaga. CIBER Obn. Spain.

**Background and objectives:** The prevalence of child obesity is increasing rapidly worldwide. It is associated with several risk factors for later heart disease and other chronic diseases including hyperlipidaemia, hyperinsulinaemia, hypertension, and early atherosclerosis. A subgroup of obese subjects classified as “metabolically healthy obese” (MHO) present a favorable metabolic profile despite having excess body adiposity. The aims of this study were to study the obesity prevalence in our environment and analyzed

how is the characteristics of their Mediterranean Diet (MedDiet)
of a population of prepuberal MHO.

**Methods:** Seventy-eight prepuberal obese with a body mass index (BMI) ≥95 of 25.1±3.4 kg/m2 and aged 7.8±1.3 years. They present ≤1 of the following criteria: abdominal circumference and blood pressure, ≥90 percentile, impaired fasting glucose, HDL-C <40 mg/dL and triglycerides >90 mg/dL were included in this study. Food consumption was evaluated with a validated food-frequency questionnaire, exploring the consumption of carbohydrates, meat, milk derives, fish, fruit, vegetables, and olive oil. Adherence to the traditional MedDiet was assessed by a 13-point MedDiet scale that incorporated the main characteristics of this diet. Physical activity was evaluated by accelerometry (Actigraph TM GT3X).

**Results:** All population showed discrete levels of adherence to the MedDiet (7.1±1.8 points). On the other hand, we observed in baseline conditions an important energy intake in all subjects (2041.0±353 kcal), intake of total carbohydrate (217.0±44.2%), total proteins (85.2±15.1%), total fat (93.3±22.0%), saturated fatty acids (29.8±8.3), monounsaturated fatty acids (40.0±8.5), polyunsaturated fatty acids (14.6±5.7), cholesterol (336.8 ± 87.2 mg/d), fiber intake (12.7±4.0 g/d) and lastly, vitamin D intake was 1.6±1.2 g/d, without significant differences by gender. On the other hand, physical activity showed the high prevalence of sedentarism (866.1±284.3 min/d), and discrete physical exercise with light to moderate (94.5±52.6 min/d), moderate to vigorous (18.6±15.0 min/d) and total physical activity (367.7±148.8 counts/min*d).

**Conclusions:** A healthy lifestyle, adequate eating habits, and physical activity should be encouraged. A lack of physical activity has been reported to be a major predicting factor of childhood obesity, superseding compliance with a MedDiet.

**Keywords:** childhood, physical activity, nutrition, questionnaire.

**Further collaborators**

Granted by Institute of Health Carlos III, cofinancial by the Fondo Europeo de Desarrollo Regional-FEDER (Miguel Servet Type 1 program CP15/00028), and University of Málaga (Campus of International Excellence Andalucía Tech).

144/742

KETOGENIC DIET (KD) FOR THE TREATMENT OF REFRACTORY EPILEPSY AND OTHER DISEASES IN CHILDREN AND ADOLESCENTS

(1) Grippo, Beatriz; (2) González, Silvana; (3) Benavente, Héctor Rodolfo.

(1)Licensed in Nutrition. Adolescence Program. Hospital of Clinics. Buenos Aires University. Buenos Aires. Argentina.; (2)Pediatric Resident Physician. Department of Pediatrics. Hospital of Clinics. Buenos Aires University. Buenos Aires. Argentina; (3)Pediatric Neurologist. Children's Neurology Section. Hospital of Clinics. Buenos Aires University. Buenos Aires. Argentina.

**Background and objectives:** KD is a high fat, low carbohydrate diet, which controls refractory epilepsy when efficacy of antiepileptic drugs (AED) is limited. The aim of this study is analyze
efficacy, tolerability (T), and adverse effects (AE) of the KD on patients attended in KD program at Hospital of Clinics.

**Methods:** We used data of patients in KD between 2013-2017. Efficacy was measured by seizure frequency (SF) decrease and AED reduction. SF was evaluated according to parents' chart SF per month prior to KD, and were compared with data obtained at baseline. Response to KD was measured after 6 months. T of diet acceptance by patients was evaluated as presence of nausea or vomits. AE and reasons for diet discontinuation were registered. Response to KD was effective if was free of seizure from the start or if were seizure control >50%.

**Results:** The patients were 9 boys (82%) and 2 girls (18%). The ages, ranged from 18 months to 18 years and 10 months. Diet duration ranged from 3 months to 31 months. By the 6 month on diet, 7 patients (64%) presented more than 50% decrease in SF, 3 of them (27%) were seizure free (one from the start; the others at 3 and 8 months, respectively). AED have been reduced, one patient (9%) cut drugs in half. All patients experienced cognitive improvement in life quality and cognitive skills. During the KD none patient refused the diet by its palatable characteristics, and none presented nausea or vomiting. Adverse effects were observed in four patients (36%) that presented hypertriglyceridemia, symptomatic hypoglycemia, heartburn, selenium deficiency and hypocalcemia. The only reason for diet interruption was in one patient (9%) that presented psychiatrics symptoms.

**Conclusions:** KD has proven to be an effective clinical treatment for children with difficult-to-control seizures, often allowing medication reduction. All patients accepted KD very well. Adverse effects occurred, but none of patients needed discount the diet.

**Keywords:** ketogenic diet, efficacy, adverse effects

n-3)/ in 200 mL of formula when the product is reconstituted. The product was formulated as an alternative to provide n-3 PUFA with the aim to reduce deficit in the intake of DHA during the pregnancy and breastfeeding period.

**Methods:** Forty three healthy pregnant women (22-33 year-old), were randomly separated into two groups: control group (CG) with normal feeding (n = 21) and "Purita mama" group (PG) (n = 22), which received 400 mL/day of the formula from the third trimester of pregnancy until the first six months of nursing. The fatty acid profile of erythrocyte phospholipids, measured at six months of pregnancy, at the time of delivery and at six months of nursing, and the fatty acid profile of the milk collected during the first six months of breastfeeding period were assessed by gas-chromatography.

**Results:** PG, compared to the CG showed (i) a significant increase in DHA and EPA ingestion, no showing modification for ALA, linoleic acid (LA, 18:2, n-6) and arachidonic acid (AA, 20:4, n-6); (ii) a significant increase of erythrocyte DHA and EPA, whereas ALA, LA and AA were not modified; (iii) an increased milk content of DHA during the six months of breastfeeding period. ALA, LA, AA and EPA were not modified in breast milk in this period.

**Conclusions:** Consumption of "Purita mama" during the last trimester of pregnancy and the six months of breastfeeding increases the DHA content in breast milk. Acknowledgment: Supported by Grant 11140174 from FONDECYT (Initiation Program).

**Keywords:** Docosahexaenoic acid (DHA); pregnancy and breastfeeding period; milk formula "Purita mama"; breast milk.

**Background and objectives:** Background: Docosahexaenoic acid (DHA, 22:6, n-3) is a LCPUFA fundamental for brain and visual function in humans. Western diet provides low DHA, which is reflected in low DHA in maternal milk. "Purita mama" is a milk formula distributed by the Chilean government as part of a social nutrition program (no cost by the beneficiary) for the women during of pregnancy and breastfeeding period. The formula provides 60 mg of DHA and 19 mg of eicosapentaenoic acid (EPA, 20:5,

**Background and objectives:** Infant nutrition is an integral part of infant health. The infant is more sensitive to abnormal nutritional situations and less adaptable than in later life to different types, forms, proportions and quantities of food (Ekpunobi, 2007). The study aims at assessing the infant feeding practices of mothers/caregivers and the Anthropometric Indices of infants (0-12 months) in Etche Local Government Area, Rivers State, Nigeria.

**Methods:** 207 infants (0-12 months) and their mothers were randomly selected from five communities in Etche by method of balloting without replacement. Information on infant feeding practices, demographic data, socio-economic data of the infants were obtained from the mothers using a structured and pre-tested questionnaire. Anthropometric measurement of the infants were carried out using standard methods and datas obtained were

<footnote>(1)Valenzuela Baez, Rodrigo Wladimir; (2)Barrera, Cytnhia;</footnote>

<footnote>(1)Bascuñan, Karla; (1)Chamorro, Rodrigo; (3)Valenzuela, Alfonso.</footnote>

<footnote>(1)Nutritionist. PhD. Nutrition Department, Faculty of Medicine, University of Chile. Chile; (2)Nutritionist. MSc. Nutrition Department, Faculty of Medicine, University of Chile. Chile;</footnote>

<footnote>(3)Biochemistry. PhD. Lipid Center, Institute of Nutrition and Food Technology (INTA), University of Chile. Chile.</footnote>

<footnote>(1)Oly-Alawuba, Nkeiruka; (2)Nwuzi, Ogechi.</footnote>

<footnote>(1)PhD. Nigeria.; (2)BS. Nutrition. Nutrition and Dietetics. Imo State University. Nigeria.</footnote>
converted to WHO standard using Anthro-Software. Information
gathered from questionnaires were analyzed using the Statisti-
cal Package for Social Sciences (SPSS) Version 20. Results were
presented in frequencies and percentages and categorized using
(WHO) anthro software. Comparison was done using Chi- square
test for statistics and variables were categorized using Anova.

**Results:** The study showed that 85% of mothers/caregivers practiced breastfeeding and put their infants to breast in less than one hour after delivery while 1.7% delayed till after 7days of delivery. 17% discarded the first milk after delivery, due to ignorance and lack of encouragement from the family. 49.1% of infants were breastfed for 5-10minutes at each feeding, 74.9% were given water and other foods apart from breastmilk. 44.5% were given complementary food, like pap. and 44.4% practiced bottle feeding.

The study depicted high rate of stunting as 39.1% and 8.7% of infants were severely and moderately stunted, 27.6% and 8% were severely and moderately wasted and 23.6% and 10.9% were severely and moderately overweight.

**Conclusions:** Poor infant feeding practices majorely result-
ed in high rate of stunting among the infants as observed in this
study. Adaptation of appropriate infant and child feeding practices
and Nutrition Education could remedy the situation and reduce
the prevalence of malnutrition in children.

**Keywords:** Infant feeding practices, Caregivers, Anthropometric indices, Malnutrition.

lation were performed. This study was approved by the Research
Ethics Committee of the University of Brasilia.

**Results:** Most mothers (50.9%) were dissatisfied with child's body size, 27.1% of those desired child weight gain and 23.8% child weight loss. 39.1% of mothers of normal weight children would like the child to gain weight. Regarding mothers of overweight and obese children, 48.7% and 83.1% wanted their child to lose weight, respectively. Mothers of boys and younger children were more likely to want their child to gain weight. Mothers of girls and overweight children were more likely to want their child to lose weight. A positive correlation was observed between maternal dissatisfaction with her own body size and with child's body size.

**Conclusions:** It was found that most mothers were dissatisfied with their child's body size and that mothers tend to transfer dissatisfaction with their own body size to their child's body size. Given this, it is important to control the silhouettes conveyed by the media, seeking to idealize a healthy silhouette as a pattern of beauty. In addition, it is also necessary to raise the awareness of families, so that, if dissatisfied with the child's body size, they seek qualified health professionals who can guide them.

**Keywords:** nutritional status; body size; children; mother-child relations.

**Background and objectives:** The presence of maternal dissatisfaction with the child's body size may affect maternal attitudes and practices related to child's food consumption. The aim of this study was to investigate the prevalence of maternal dissatisfaction with children's body size and its associated factors among mothers of first- to-third-grade elementary school students of private schools in the Federal District, Brazil.

**Methods:** A cross-sectional study with 554 mother-school-
children pairs was conducted. Children had their weight and
height measured and mothers completed an online questionnaire
that evaluated sociodemographic data, maternal nutritional status
(self-reported weight and height), maternal dissatisfaction with
her own body size and maternal dissatisfaction with child's body
size (using silhouette scales). Mothers identified the silhouettes
that best represented them and their child's current and desired
body. Disagreements were identified as dissatisfaction. Descriptive
analyses, chi-square test, logistic regression and Spearman's corre-

The progressive aging of the population brings with it sever-
al health problems; mainly nutritional. Malnutrition and factors
that determine them are a worldwide concern; for this reason, the
identification of these is fundamental because many of them could
be modified, impacting in favor of a healthy aging.

To determine the prevalence of malnutrition and associated
factors in elderly in Gualaceo town, Ecuador.

**Methods:** Analytical cross-sectional study that involved 250 senior citizens. Sampling was probabilistic, stratified and randomized in 9 parishes of Gualaceo town, from the Azuay Province, in Ecuador. Nutritional status was assessed using the Mini Nutritional Assessment (MNA); associated factors such as depression, with the Yesavage Geriatric Depression Scale; physical activity with the International Physical Activity Questionnaire (IPAQ), socioeconomic level with the Survey Of Stratification of the Socio-economic Level of the National Institute of Statistics and Censuses (INEC), and laboratory parameters: (hemoglobin, lymphocytes,

<footnote>(1)Pedroso da Silva, Jéssica; (2)Toral Bertolin, Maria Natacha;</footnote>

<footnote>(2)Bauermann Gubert, Muriel.</footnote>

<footnote>(1)MSc. Nutritionist. Postgraduate Program in Human Nutrition.
University of Brasília. Brazil.; (2)PhD. Nutritionist. Department of
Nutrition. University of Brasília. Brazil.</footnote>

<footnote>(1)Espinosa Espinosa, Hermel Medardo; (2)Abril-Ulloa, Victoria;</footnote>

<footnote>(1)Encalada Torres, Lorena Esperanza.</footnote>

<footnote>(1)MSc. Medical doctor. Faculty of Medicine. University of Cuenca.
Ecuador.; (2)PhD. Nutrition and Metabolism. University of Cuenca.
Ecuador.</footnote>
cholesterol and albumin). The analysis was performed using de-
scriptive statistics and the association was measured with preva-
lence ratio (PR) and its 95% confidence interval (CI). A multivari-
ate analysis was performed to corroborate this association.

**Results:** The prevalence of malnutrition was 20.4%, the risk of malnutrition was 47.2%, and 32.4% presented a satisfactory nutritional status. The mean age was 76.31 years (± 8.19). Factors with statistical association were: PR depression = 4.90 (95% CI: 3.08 - 7.79, p = 0.000); Sedentary lifestyle RP = 4.52 (95% CI: 2.81 - 7.28, p = 0.000); Low socioeconomic status RP = 4.04 (95% CI: 1.51-10.7, p = 0.001); Anemia in men and women PR = 2.43 (95% CI: 1.23 - 4.77, p = 0.018) and PR = 4.02 (95% CI: 2.17 - 7.63, p = 0.000) respectively. Hypoalbuminemia RP = 2.87 (95% CI: 1.08 - 4.58 p = 0.000). Multivariate analysis corroborated this association except for hypoalbuminemia.

**Conclusions:** One-fifth of the adult population of the Gual-
aceo town is malnourished and it is associated with: depression,
sedentary lifestyle, low socioeconomic status and anemia.

**Keywords:** Older adults, elderly, malnutrition, associated fac-
tors

144/795

DIETARY PATTERNS AND BLOOD LIPIDS IN AD-
OLESCENTS AT 18 YEARS: CROSS-SECTIONAL
ANALYSIS NESTED IN THE 1993 PELOTAS (BRA-
ZIL) BIRTH COHORT

(1)Vaz, Juliana; (2)Buffarini, Romina; (3)Kac, Gilberto; (2)Bielemann, Renata; (4)Oliveira, Isabel; (5)Menezes, Ana; (6)Assuncao, Maria Cecilia.

(1)PhD. Nutritionist. Postgraduate Program in Epidemiology.
Federal University of Pelotas. Pelotas. Brazil.; (2)PhD. Nutricionist.
Postgraduate Program in Epidemiology. Federal University of
Pelotas. Pelotas. Brazil.; (3)Professor. PhD. Nutritional Epidemiology
Observatory. Federal University of Rio de Janeiro. Rio de
Janeiro. Brazil.; (4)PhD. Institute of Biology. Federal University
of Pelotas. Pelotas. Brazil.; (5)PhD. M.D. Post-Graduate Program
in Epidemiology. Federal University of Pelotas. Pelotas. Brazil;
(6)PhD. Post-Graduate Program in Epidemiology. Federal
University of Pelotas. Pelotas. Brazil.

**Background and objectives:** Dyslipidemia in youth popu-
lation indicates the need to understand its factors and the need
to implement prevention measures. Dietary pattern analyses have
emerged as a practical application to delivery information to the
population. Here we aimed to establish dietary patterns and to ex-
amine whether these dietary patterns are associated with blood
lipids at 18 years.

**Methods:** Cross-sectional analysis of 3,616 participants of the 1993 Pelotas (Brazil) Cohort Study followed up at 18th year. Semi-quantitative food frequency questionnaire was administered, and dietary patterns were established using principal component analysis. Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were determined using an automatic enzymatic colorimetric method. Dietary pattern scores were analyzed by tertiles

of factor scores, and the independent association of each tertile
on lipids was tested using crude and adjusted linear regression
models stratified by sex. Triglycerides were log-transformed due
to their asymmetric distribution.

**Results:** Meat and Fast Foods, Fruit and Vegetables, Candies, Sodas, and Dairies and Common-Brazilian patterns were derived. In the adjusted models in which the highest and lowest tertiles of DP scores were compared, we observed that for girls: 1) the third tertile of the Meat and Fast Food pattern presented 1.7 mg/dl (95%CI -3.21;-0.28) lower HDL-cholesterol; 2) the third tertile of the Candies, Soda and Diaries pattern presented triglycerides 5% higher; 3) the second (Beta -4.08, 95%CI -7.47;-0.68) and the third (Beta -4.46, 95%CI -8.41;-0.51) tertiles of the Common-Brazilian pattern presented 4 mg/dl lower total cholesterol, and 6% lower triglycerides; for boys 4) the third tertile of the Common-Brazilian presented 4.6 mg/dl (95%CI -7.91;-1.37) lower total cholesterol. The Fruit and Vegetables pattern was not associated with blood lipids.

**Conclusions:** Dietary patterns were associated with blood li-
pids in adolescents at the age of 18. Higher scores for the Com-
mon-Brazilian pattern were associated with lower total cholesterol
in both sexes. Our results emphasize the importance in under-
standing the perception of eating patterns among adolescents and
the efforts to maintain traditional foods in their diets.

**Keywords:** Food consumption; Dietary patterns; Adolescents; Lipid profile; 1993 Pelotas Birth Cohort

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CORRELATION OF PARENTAL ECONOMIC STATUS WITH LUNCH INTAKE AND LIFESTYLE BEHAVIORS IN PRESCHOOL CHILDREN IN JAPAN

(1)Naoko, Yamada; (2)Akiko, Shikano; (2)Shingo, Noi.

(1)MD. Nutritionist. Graduate school of Nippon Sports Science
University. Japan.; (2)PhD. Nippon Sports Science University. Japan.

**Background and objectives:** In Japan, concerns about childhood poverty have recently increased, and the “Measures to Counter Child Poverty Law” was enacted in 2014. Various support initiatives have also been introduced at the community level; for example, cafeterias called “kodomo shokudo” have been established where local children and parents can gather for a low-priced meal and food banks. This reflects the fact that childhood poverty is a serious social problem in Japan, and that measures to combat it are urgently needed. In this context, there is concern that the eating and lifestyle behaviors of children who are raised in economically deprived households will negatively affect their health and subsequent development. Nevertheless, very few reports exist on these issues. Similarly, few studies have been published on the effects of poverty on childhood lifestyle behaviors, which can affect eating habits and health in Japan. Thus, by focusing on the lunchbox that each child brings to preschool, this study aimed to investigate the relationship of parental economic status with children's lunch intake and lifestyle behaviors.
**Methods:** This study was conducted at a public kindergarten in Tokyo in November 2016, and it included 67 children and their parents. The study surveyed lifestyle behaviors and food intake (in weight) at lunchtime. For the survey on food intake, the lunchbox was weighed before and after the meal for 4 days, and the average was calculated. For the survey on lifestyle behaviors, a questionnaire was distributed for anonymous completion by parents. Data were collected on the child's physical activity, sleep, eating habits, and parental economic status.

**Results:** With body mass index as the control variable, the results showed a weak correlation (r=0.308, p=0.014) with lunch intake. By dividing economic status into two groups and using Fisher's exact test, a significant correlation was found between bedtime (p=0.014) on school nights and bedtime on non-school nights (p=0.043).

**Conclusions:** The results of this survey showed several links between economic status, food intake at lunchtime, and lifestyle behaviors; however, due to the small number of participants, further study with a larger numbers of test subjects is required.

**Keywords:** toddler, child, lifestyle, box lunch

timely initiation of breastfeeding, while prematurity and low birth weight reduced the chance of the outcome.

**Conclusions:** The studied proximal factors were the most strongly associated with timely breastfeeding, bringing evidence about the importance of adopting Baby-Friendly Hospital Initiative to improve perinatal practices and timely breastfeeding initiation. Special attention should be given to the negative association found between caesarean section delivery without clinical indication and breastfeeding in the first hour after birth, bringing more evidence to the ongoing government efforts to diminish this harmful practice in Brazil. We recommend the reinforcement of BFHI implementation, extending this initiative to the private sector. This measure could contribute not only to improve timely breastfeeding rates, but also reducing unnecessary caesarean section delivery.

**Keywords:** Breastfeeding, Maternal-Child Health Services, Cross-Sectional Studies, Postpartum Period, Baby-Friendly Hospital Initiative

144/808

THE BABY-FRIENDLY HOSPITAL INITIATIVE AND BREASTFEEDING AT BIRTH IN BRAZIL: A CROSS SECTIONAL STUDY

(1)Siqueira Boccolini, Cristiano; (2)Couto de Oliveira, Maria Inês;

(2)Lázaro de Carvalho, Márcia; (2)Leal, Maria do Carmo.

(1)ICICT/Fiocruz. Brazil.; (2)Rio de Janeiro. Brazil.

**Background and objectives:** Breastfeeding in the first hour after birth is important for the success of breastfeeding and in reducing neonatal mortality. Government policies are being developed in this direction, highlighting the accreditation of hospitals in the Baby-Friendly Hospital (BFH) initiative. The aim of this study was to analyze the association between delivery in a BFH (main exposure), compared to non BFH, and timely initiation of breastfeeding (outcome).

**Methods:** Data came from the "Birth in Brazil" survey, a nationwide hospital-based study of postpartum women and their newborns, coordinated by the Oswaldo Cruz Foundation. A sample of 22,035 mothers/babies was analyzed through a hierarchical theoretical model on three levels, and all analyzes considered the complex sample design. Odds ratios were obtained by logistic regression, with a 99 % CI.

**Results:** Among all births, 40 % occurred in hospitals accredited or in accreditation process for the BFHI and 52 % of women underwent caesarean section. In the final model, at the distal level, mothers less than 35 years old, and those who lived in the North Region, had a higher chance of timely initiation of breastfeeding. At the intermediate level, prenatal care in the public sector and advice on breastfeeding during pregnancy were directly associated with the outcome. At the proximal level, being born in a Baby-Friendly Hospital and vaginal delivery increased the chance of

144/844

THE INFLUENCE OF PRENATAL EXPOSURE TO TRANS-FATTY ACIDS FOR DEVELOPMENT OF CHILDHOOD LEUKEMIA

(1)Specht, Ina Olmer; (2)Huybrechts, Inge; (3)Frederiksen, Peder;

(4)Steliarova-Foucher, Eva; (2)Chajes, Veronique; (5)Heitmann, Berit Lilienthal.

(1)PhD. Research Unit for Dietary Studies at The Parker Institute. Bispebjerg and Frederiksberg Hospital. Denmark; (2)PhD. International Agency for Research on Cancer (IARC). Nutritional Epidemiology Group. France.; (3)Dr. Research Unit for Dietary Studies of The Parker Institute. Frederiksberg and Bispebjerg Hospital. Denmark.; (4)PhD. International Agency for Research on Cancer (IARC). Cancer Surveillance Section (CSU). France.; (5)Professor. Research Unit for Dietary Studies of The Parker Institute. Frederiksberg and Bispebjerg Hospital. Denmark.

**Background and objectives:** Industrial trans-fatty-acids (TFA) can be found in fried and industrially-processed baked foods and have been associated with negative health outcomes including cancers in adults. Neonates with high umbilical TFA levels have shown less favorable neurodevelopment and increased risk for metabolic diseases. TFA has pro-inflammatory properties and can inhibit metabolism of essential fatty-acids which might be the mechanisms behind the observed associations with cancer risk. Despite the alarming evidence and the fact that millions of Europeans have high TFA intake, currently no EU legislation regulates TFA in foods. In Denmark, a maximum TFA content of 2g/100g is allowed in all Danish produced and imported food since 2004. We aimed to investigate if low gestational TFA exposure, due to the TFA legislation in Denmark, decreased the offspring's childhood leukemia risk.

**Methods:** In this national, registry-based study, onset of leukemia before the age of 8 years was compared between the trans-
fat exposed cohorts born between January 1st 2000 – August 31st 2004, and the non-exposed cohorts born between September 1st 2004 – December 1st 2007. The incidence trends were evaluated using piecewise linear splines in a Cox proportional hazard model.

**Results:** Among all 305,220 children born in Denmark in the defined cohort before the TFA-legislation in 2004, 176 were diagnosed with leukemia before their 8th birthday, compared to 125 among 215,216 children born after the TFA-legislation. The hazard ratios and 95% confidence intervals were 1.10 (0.99,1.23) and 0.97 (0.84,1.04), respectively. This corresponds to an increase of 10% in leukemia rates per year before the TFA-legislation and a decrease of 3% per year after the legislation (p=0.38).

**Conclusions:** The small, albeit statistically non-significant, decrease in leukemia incidence after the legislation supports the need for further analysis including additional birth cohorts. Additional analysis of biomarkers of neonatal TFA in cases and matched controls on individual level will help to separate the TFA effect from other risk factors.

**Keywords:** Trans fatty acids, childhood leukemia, childhood cancer, in utero, prenatal, haematopoietic neoplasms

144/852

CONCENTRATIONS OF CAROTENOIDS AND TOCIPHEROLS IN BREAST MILK FROM URBAN CHINESE MOTHERS AND THEIR ASSOCIATIONS WITH MATERNAL CHARACTERISTICS

Xue, Yong; Zhang, Yumei; Zhao, Ai.

PhD. Nutritionist. Department of Nutrition & Food Hygiene.
School of Public Health. Peking University Health Science Center.
China.

**Background and objectives:** This cross-sectional study aims to quantify of carotenoids (β-carotene, β-cryptoxanthin, lutein, lycopene and zeaxanthin) and tocopherols (α-tocopherol and γ-tocopherol) in human milk from healthy Chinese women, to compare their concentrations between different regions and lactation stages, and to identify maternal socio-economic and obstetric factors that may affect these concentrations.

**Methods:** Human milk was obtained from 509 healthy nursing mothers from Beijing (n = 151), Suzhou (n = 180) and Guangzhou (n = 178) cities. The compounds of interest (β-carotene, β-cryptoxanthin, lutein, lycopene, zeaxanthin and vitamin E as α-tocopherol and γ-tocopherol) were analyzed by high-performance liquid chromatography after mild saponification and solvent extraction. Socio-economic and obstetric characteristics of the mothers and their dietary intakes through a single 24-hour dietary recall were evaluated.

**Results:** The concentration of the studied compounds in human milk varied greatly among individuals. The median contents of each component [microgram per 100 mL, median (interquartile range)] in colostrum and mature milk was, respectively, β-carotene 8.0 (4.7-15.2) and 1.8 (1.4-2.7), β cryptoxanthin 6.2 (2.4-12.9) and 1.8 (1.1-3.4), lutein 5.7 (2.9-10.2) and 3.4 (1.5-6.0), lycopene 6.3

(4.0-9.9) and 1.4 (1.1-2.0), zeaxanthin 1.0 (0.6-1.5) and 1.0 (0.6-1.4), α-tocopherol 645 (388-1176) and 211 (131-321), γ-tocopherol 68 (48-121) and 77 (45-120). The levels of all those vitamins presented regional differences, and decreased as lactation stage increased except for zeaxanthin and γ-tocopherol. Associations of carotenoid contents with maternal education, delivery mode, and present body mass index were found in multivariate analyses.

**Conclusions:** These results suggest that some regional, obstetric, and socio-economic factors have an effect on human milk concentrations of carotenoids and vitamin E in healthy Chinese mothers. Thus, it is necessary to continue research to provide biological significance of such results and improve knowledge on the unique composition of human milk.

**Keywords:** Breast milk; carotenoids; tocopherols; cross-sectional study

144/854

ADHERENCE TO DIETARY RECOMMENDATIONS MODIFIES GUT MICROBIOTA RICHNESS AND COMPOSITION DURING PREGNANCY

(¹)Laitinen, Kirsi; (²)Mokkala, Kati; (³)Vahlberg, Tero; (⁴)Röytiö, Henna.

(¹)PhD. Nutritionist. Institute of Biomedicine. University of Turku.
Finland.; (²)MSc. Institute of Biomedicine. University of Turku.
Finland.; (³)MSc. Department of Clinical Medicine. University of
Turku. Finland.; (⁴)PhD. Institute of Biomedicine. University of
Turku. Finland.

**Background and objectives:** Pregnant women, particularly those with manifest overweight or obesity, are encouraged to follow dietary recommendations to advance the health of both mother and child. The extent to which diet composition influences gut microbiota during pregnancy is not known. This regardless the increasing knowledge of the importance of gut microbiota in regulating host metabolism and health. The objective was to explore the impact of the adherence to the dietary reference values on gut microbiota in pregnant women.

**Methods:** Overweight and obese women (n=100) were studied at early pregnancy (<17 weeks). Intakes of nutrients were calculated from 3-day food diaries, and the subjects were grouped according to adherence to the dietary recommendations. Faecal microbiota composition was analysed using 16S rRNA gene sequencing. Chao1 index was defined as a measure of species richness. Differences in microbiota among dietary groups were tested by Mann-Whitney U-tests using Bonferroni corrections following significant Kruskal-Wallis tests.

**Results:** The recommended dietary intake of fibre and fat was related to higher gut microbiota richness: Chao1 index was higher in the high-fibre/moderate-fat group compared to the low-fibre/high-fat group (mean 406.2 vs. 341.0, P=0.006), whilst low-fibre/moderate-fat group did not differ from the other groups (Chao 1 index: 380.0). Moreover, the relative abundance of specific microbial phyla, families and genera were significantly different among the three dietary groups, the most evident difference being in the Bacteroidaceae.
**Conclusions:** Adherence to the recommended dietary intake, particularly that of fibre intake, was linked to a richer gut microbiota. Dietary manipulation could be an effective means for improving the gut microbiota balance during pregnancy with potential health benefits.

**Keywords:** diet, dietary recommendations, pregnancy, microbiota, microbiota richness

144/857

THE RELATIVE IMPORTANCE OF WASTING AS A PREDICTOR OF LATER STUNTING OR DEATH

(1)Wright, Charlotte; (2)Tough, Fraser; (3)McColl, John; (4)Cole, Tim;

(5)Bland, Ruth; (6)Zaman, Shakila; (7)Ashorn, Per.

(1)MD. Dept Child Health. University of Glasgow. UK.; (2)PhD. Medical Statistics. University of Glasgow. UK.; (3)PhD. Medical Statistics. University of Glasgow. UK.; (4)ScD. UCL Great Ormond Street Institute of Child Health. UK.; (5)Wellcome Africa Centre. South Africa.; (6)PhD. School of Public Health. Lahore Medical and Dental College. Pakistan.; (7)Center for Child Health Research. University of Tampere. Finland.

**Background and objectives:** It is generally assumed that wasting occurs early in the malnourished state and then progresses onto stunting, but most studies lack the repeated measurements needed to establish this sequence. Our objective was to combine longitudinal growth datasets to describe pathways through different nutritional states to later stunting or death and how this varies by age.

**Methods:** Existing longitudinal datasets from Malawi, South Africa and 4 socio-economically distinct Pakistani communities were combined and the 6907 individuals classified at ages 3, 6, 9 and 12 months as normal, wasted (BMI <-2SD; 2-5%), stunted (Length <-2SD; 17-26%) or wasted & stunted (3-4%). In total 20% had died by 12 months.

**Results:** Up to 14% of all wasted & stunted children went on to die in the next 3 months, with relative risks (95%CI) compared to normal children at 3-6, 6-9 and 9-12 months of 11.1 (6.4, 19.1), 10.0 (1.7, 59.7) and 5.4 (2.6, 11.0). Wasted children also had higher mortality and had the highest risk between 9-12 months (11.5, 1.9 to 68.1). Stunted children were also significantly more likely to die between 3-6 months (3.0, 1.7 to 5.2) and 9-12 months (4.8; 1.2 to 18.5) but not 6-9 months (1.0, 0.5 to 2.1).

Children who were wasted were only significantly more likely than normal children to move into a stunted state between 3-6 months (1.75, 1.21 to 2.53). Over 3-6-9 months only 0.9% of children moved from normal to stunted via wasted, while 17% moved directly from normal to stunted. Once stunted 59-80% remained so, while 39-40% of wasted children reverted to normal.

**Conclusions:** Most children become stunted without prior wasting. Wasting is a major risk factor for death in infancy, but those wasted children who survive are likely to revert to normal rather than become stunted.

**Keywords:** Child, malnutrition, stunting, wasting, mortality

144/859

FACTORS ASSOCIATED WITH EARLY INITIATION OF BREASTFEEDING AND COMPLEMENTARY FEEDING PRACTICES IN INFANTS AND YOUNG CHILDREN IN RURAL AREA OF SENEGAL

(1)Badiane, Abdou; (2)Diouf, Adama; (3)Sarr, Mariama; (3)Dione, Justine; (2)IDOHOU-DOSSOU, Nicole; (2)Wade, Salimata.

(1)MSc. Nutritionist. Laboratoire de Nutrition. Faculté des Sciences et Techniques. Université Cheikh Anta Diop of Dakar. Senegal.;

(2)PhD. Nutritionist. Laboratoire de Nutrition. Faculté des Sciences et Techniques. Université Cheikh Anta Diop. Senegal.; (3)MSc. Nutritionist. Laboratoire de Nutrition. Faculté des Sciences et Techniques. Université Cheikh Anta Diop. Senegal.

**Background and objectives:** Breastfeeding and complementary feeding practices in developing counties are influenced by variety of demographic, socio-cultural, and health-related factors. This study aimed to assess breastfeeding and complementary feeding practices and associated factors among mother-child pairs 0-23 months living in Mbadakhhoune, a rural area of Senegal where malnutrition is still prevalent.

**Methods:** A total of 202 mother-child pairs (102 aged 0-5 months, and 100 aged 6-23 months) were interviewed using socio-demographic and child feeding questionnaire including Early Initiation of Breastfeeding (EIBF), Minimum Dietary Diversity (MDD). Weight and height were measured and WHZ and HAZ calculated. Descriptive statistics and multivariable logistic regression analysis were used to identify factors associated with EIBF and MDD.

**Results:** Stunting and wasting affected 12.7% and 13.7% of the children 6-23 months old, respectively. Among the 0-5 months old infants, 91% (n=96) have received the colostrum after birth but only 32% of the mothers have practiced EIBF. EIBF was associated with mother's occupation [odds ratio (OR) =2.7, p=0.02], breastmilk given as first food between 2-24 hrs after delivery (OR=3.0, p=0.01), and positive view about EIBF of the father (OR=4.1, p=0.005), and the family members or neighbours (OR=3.2, p=0.008). Among the 6-23 months old children, 59% (n=59) met MDD (score ≥ 4). MDD was significantly associated with consumption of family meal that contains at least 4 food groups (OR=7.2, p=0.004), number of meals consumed (OR=14.9, p<0.001), and age group (OR=3.0, p=0.01).

**Conclusions:** Breastfeeding practice is still low in this rural area of Senegal. EIBF was strongly influenced by socio-cultural factors particularly those related to family decision-makers. The prevalence of MDD in the children > 6 months old was more related to family meals consumed as complementary food rather than dietary diversity. Availability of nutrient-rich foods, along with new communication strategies targeting key decision-makers, are urgently needed to improve infant and young child feeding.

**Keywords:** Early initiation of breastfeeding, minimum dietary diversity, rural area, Senegal

**Further collaborators:** Supported by the Laboratoire de Nutrition of Cheikh Anta Diop University of Dakar and the Cellule de Lutte contre la Malnutrition (CLM).
# DETERMINANTS OF ANEMIA AMONGST GERI-ATRIC SUBJECTS LIVING IN HIGH ALTITUDE REGIONS OF INDIA

Gupta, Aakriti.

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

**Background and objectives:** Anemia has been identified as a risk factor for increased morbidity and mortality amongst geriatric subjects. There is lack of scientific evidence on the prevalence of anemia amongst the geriatric population living in high altitude regions of India. Hence, we conducted the present study to fill the gap in the existing knowledge.

**Methods:** A community based cross-sectional study was conducted during 2015-2016 in District Nainital, Uttarakhand state, India. A total of 958 geriatric subjects were enrolled from 30 clusters (villages) identified by using population proportionate to size sampling methodology. Hemoglobin was estimated amongst the subjects using cyanmethemoglobin method. The Hemoglobin values were adjusted for smoking and altitude. Data was also collected on dietary pattern using 24hr recall, food frequency questionnaire from all the geriatric subjects.

**Results:** We found that all the geriatric subjects living at high altitude regions had anemia. The prevalence of moderate anemia (Hb 8-10g/dl) was 85% (n=814) and severe anemia (Hb <8g/dl) was observed in 15% (n=144) of the subjects. Female subjects (6.9±0.8g/dl) had significantly lower hemoglobin level than the male subjects (7.45±1.0g/dl) (p<0.001).

Majority of the geriatric subjects did not consume the recommended daily intake for nutrients such as energy (78%), protein (78%), iron (72%), folic acid (72%) and vitamin C (42%). Food groups rich in micronutrients such as pulses, green leafy vegetables, fruits, nonvegetarian food items, and were consumed irregularly (less than once a week) by the subjects. Subjects with severe anemia had significantly lower dietary intake of iron (16.8 ±12.3mg) (p<0.01), folic acid (161.3 ±87.7µg) (p<0.01) and vitamin C (57.9 ± 52.2 mg) (p<0.001) in the diet as compared to the subjects with moderate anemia for iron (23.8 ±16.3mg), folic acid (224.3 ± 125.6 µg) and vitamin C (97.0 ± 75.6mg).

Presence of fatigue was reported to be significantly higher in subjects with severe anemia (29.4%) as compared to subjects with moderate anemia (20.2%) (p<0.05).

**Conclusions:** The present study suggests that anemia is a major public health problem in the geriatric population residing in high altitude region of India, possibly due to less intake of total quantity of food with poor micronutrient quality.

**Keywords:** Anemia, geriatric, elderly, dietary pattern

# DIET QUALITY, MEDITERRANEAN DIET AND BONE HEALTH IN ADOLESCENTS: THE HELENA STUDY

(1)Julian Almarcegui, Cristina; (2)Huybrechts, Inge; (3)Gracia-Marco, Luis; (4)González-Gil, Esther; (5)Gutierrez, Ángel; (6)González-Gross, Marcela; (7)Marcos, Ascensión; (8)Widhalm, Kurt; (9)Vicente-Rodríguez, Germán; (9)Moreno, Luis A.

(1)MSc. Nutritionist. GENUD (Growth, Exercise, Nutrition and Development) Research Group. Department of Physiatry and Nursery. University of Zaragoza. Spain.; (2)PhD. International Agency for Research on Cancer. France.; (3)PhD. CHERC (Children's Health and Exercise Research Centre). College of Life and Environmental Sciences. Sport and Health Sciences. University of Exeter. UK.; (4)MSc. GENUD (Growth, Exercise, Nutrition and Development) Research Group. Department of Physiatry and Nursery. University of Zaragoza. Spain.; (5)PhD. Department of Physiology. School of Medicine. University of Granada. Spain.; (6)PhD. ImFine Research Group. Department of Health and Human Performance. Faculty of Physical Activity and Sport Sciences-INEF. Universidad Politécnica de Madrid. Spain.; (7)PhD. Department of Metabolism and Nutrition. ICTAN Spanish National Research Council. Spain.; (8)PhD. Department of Pediatrics. Medical University of Vienna. Austria.; (9)PhD. GENUD (Growth, Exercise, Nutrition and Development) Research Group. Department of Physiatry and Nursery. University of Zaragoza. Spain.

**Background and objectives:** Among other predisposing factors, diet determines peak bone mass during adolescence. Describing and quantifying diet through dietary scores enables the study of the entire diet, rather than individual foods and nutrients. The aim of the present study was to assess the associations between different dietary scores and the bone mineral content (BMC) measured with dual-energy X-ray absorptiometry (DXA) at the whole body (WB), lumbar spine (LS), femoral neck (FN) and hip sites among Spanish adolescents.

**Methods:** 197 participants (48% males), 12.5-17.5 y, from the HELENA study were included. The Mediterranean diet score for Adolescents (MDS-A), and the Diet Quality Index for Adolescents (DQI-A) were calculated based on two 24h dietary recalls obtained with the HELENA DIAT software. The relationship between dietary patterns and bone outcomes was analyzed using logistic regression models taking into account different covariates as follows: model 1 included sex, Tanner, mother education and family affluent scale index and model 2 included model 1 + physical activity and lean mass.

**Results:** DQI-diversity was positively associated with WB BMC (1.089; 1.014-1.168). According to the MDS-A, fruits and nuts intake was positively associated with WB (3.613; 1.508-8.653) and FN (3.937; 2.003-18.652) BMC. Cereals and roots intake was positively associated with hip BMC (3.033; 1.436-6.406). According to the DQI-A, fruit equilibrium (1.018; 1.002-1.034) and adequacy (1.020; 1.004-1.037) were positively associated with WB BMC. Vegetable adequacy was inversely associated with WB (0.984; 0.969-0.997) and hip (0.986; 0.972-0.999).
**Conclusions:** A specific dietary score is not associated with bone health in European adolescents. Some dietary components, like diet diversity or fruit and nuts intake may be associated with an increased likelihood of having an adequate BMC during adolescence.

**Keywords:** Keywords Fruit intake. Diet quality index. Dietary Patterns. Dietary scores. Mediterranean diet.

**Conclusions:** Urbanization and increasing socioeconomic status are strongly related to rising prevalence and co-occurrence of cardio-metabolic diseases as women move from middle to older adulthood.

**Keywords:** nutrition transition, aging, cardiometabolic disease, Philippines

144/881

PREVALENCE, AND CO-OCCURRENCE OF CAR-
DIO-METABOLIC DISEASE IN THE CONTEXT OF
THE NUTRITION TRANSITION IN THE PHILIP-
PINES: THE CEBU LONGITUDINAL HEALTH AND
NUTRITION SURVEY

(1)Adair, Linda; (2)Carba, Delia; (2)Duazo, Paulita.

(1)PhD. Professor. Department of Nutrition. University of North Carolina at Chapel Hill. North Carolina. USA.; (2)Senior Research Associate. Office of Population Studies Foundation Inc. University of San Carlos, Philippines.

**Background and objectives:** The nutrition transition, marked by changes in dietary patterns and physical activity, is associated with increases in obesity, hypertension, and diabetes in many low and middle income countries. Despite their contribution to mortality, the patterns and changes in co-occurrence of these conditions change with age and over time has not been studied in LMICs. We examine predictors of prevalence, and patterns of co-occurrence of overweight and obesity [OW=BMI>25 kg/m2], high waist circumference [WC>80 cm], diabetes, and hypertension from 1998-2016 among Filipino women participating in the Cebu Longitudinal Health and Nutrition Survey [CLHNS].

**Methods:** The CLHNS is a community-based study that recruited >3000 pregnant women in 1983-84, and has followed them in multiple survey rounds across > 30 years. Data from the 5 most recent survey rounds (1998-2016) also included blood pressure measured by trained interviewers, and diabetes status (self-reported in 1998 and 2002, fasting glucose in 2005, and HbA1c in 2012 and 2016). Hypertension and diabetes were defined according to International Diabetes Federation cutpoints. Women, who ranged in age from 29 to 62 in 1998, were grouped in each year according to the presence/absence of OW, high WC, Hypertension and diabetes, and we used multinomial logistic regression to identify factors associated with membership in each group

**Results:** Comparing 1998 to 2016: The occurrence of having none of these conditions declined from 50% to 20%; being “metabolically healthy” (OW or high WC but no hypertension or diabetes) declined from 26% to 17%, hypertension increased from 21% to 59%, and diabetes increased from 2% to 14%. On average across all years, only about half of women with hypertension were OW or had high WC. In general, women in groups that included OW or high WC were older, taller, from more urbanized communities, and households with higher assets. The lowest prevalence of these adverse conditions was in rural, more disadvantaged women. Further analyses will explore the role of diet and other lifestyle factors.

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MATERNAL PERCEPTION OF CHILDREN'S NU-
TRITIONAL STATUS IN THE FEDERAL DISTRICT,
BRAZIL

(1)Pedroso da Silva, Jéssica; (2)Toral Bertolin, Maria Natacha;

(2)Bauermann Gubert, Muriel.

(1)MSc. Nutritionist. Postgraduate Program in Human Nutrition. University of Brasília. Brazil.; (2)PhD. Nutritionist. Department of Nutrition. University of Brasília. Brazil.

**Background and objectives:** Maternal perception of child's nutritional status can influence child's feeding, maternal controlling feeding practices and the prevention and treatment of childhood overweight. Thus, the aim of this study was to evaluate the prevalence of misperception and factors associated with maternal perception of the nutritional status of first- to third-grade elementary school students from private schools in the Federal District, Brazil.

**Methods:** This cross-sectional study was conducted with 554 mother-child pairs. Children's nutritional status was assessed by anthropometric measures. Mothers completed an online questionnaire about sociodemographic data, mother's self-reported weight and height and maternal perception of child's nutritional status (silhouette scale for children). Mothers identified the silhouette that best represented the current body of their child, and it was verified the agreement between this and the real silhouette of the child, measured by anthropometry. If the chosen silhouette was smaller than the real silhouette, it was considered that the mother underestimated the child's nutritional status, and if it was larger, it was considered that the mother overestimated the child's nutritional status. Descriptive analyses, chi-square test and logistic regression were performed. This study was approved by the Research Ethics Committee of the University of Brasilia.

**Results:** Only 30.0% of the mothers chose the appropriate silhouette to represent child's nutritional status, whereas 28.0% overestimated and 42.0% underestimated it. Regarding mothers of normal and overweight children, 46.2% and 39.3% underestimated the nutritional status of their child, respectively. About a quarter (25.3%) of the mothers of obese children, underestimated the nutritional status of their child, whereas almost half overestimated it (47.9%). Highly educated mothers and mothers of male children or of non-overweight children were more likely to underestimate child's nutritional status. Conversely, mothers below 35 years of age and mothers of female children or of overweight children were more likely to overestimate child's nutritional status.

**Conclusions:** There was a high prevalence of misperception, with most of the normal weight and overweight children having
their nutritional status underestimated. However, for obese chil-
dren, almost half of mothers overestimated their nutritional status.
This situation is worrying, since maternal distortion influences child
feeding and can lead mothers to controlling feeding practices.

**Keywords:** maternal perception; child nutrition; nutritional status; body image; silhouette.

is a cause or a consequence of their malnutrition, but it does not seem to be a result of maternal feeding behaviour. A better understanding of the role of force-feeding and factors that motivate eating is required to design effective feeding interventions.

**Keywords:** force-feeding, appetite, malnutrition, childhood, Nairobi

**Background and objectives:** Feeding practices influence nu-
trient intake but few studies assess how child eating and maternal
feeding behaviour relate to child malnutrition. This study aimed
to describe eating and feeding behaviour in healthy and malnour-
ished infants aged 6-24 months in Nairobi, Kenya.

**Methods:** We recruited 415 infants from child welfare clinics and outpatient therapeutic programs in urban slums in Nairobi, of whom 172 (41.4%) were healthy (weight for age >-2 Z scores) and 243 malnourished (weight for age or weight for length <- 2 Z scores or length for age <-3 Z scores) using WHO growth standards. A structured interview guide was used to collect information on breastfeeding, meal frequency and dietary diversity and generate scores for child interest in food and food refusal, maternal force-feeding and anxiety.

**Results:** Compared to healthy children, malnourished children were more likely not to be breastfeeding (malnourished 11.5%; healthy 5.2% P=0.002) but there was no association between meal frequency, dietary diversity and child nutritional status.

They also had lower interest in food (malnourished 34.2%; healthy 14.0% P=<0.001) and higher food refusal (malnourished 30.9%; healthy 10.5% P=<0.001); and their mothers were more likely to be anxious about feeding them (malnourished 20.6%; healthy 6.4% P=<0.001). Within the malnourished group, 49.4% had either low interest in food or high food refusal compared to 19.8% in the healthy group (P<0.001).

Force-feeding was common in both groups, with a non-sig-
nificant trend towards more force-feeding in the malnourished
infants (malnourished 41.4%; healthy 34.5% P=0.087). Children
with low interest in food odds ratio [95% CI] 3.72 [1.93 to 7.15]
P<0.001 and high food refusal 4.83 [2.38 to 9.78] P <0.001 were
more likely to be force-fed, after controlling for maternal anxiety
and child nutritional status.

**Conclusions:** This study shows that many malnourished chil-
dren had a low interest in food and ate poorly. It is not clear if this

**Background and objectives:** Choline has been positively as-
sociated with weight and fat mass in animal and human studies.
As evidence examining maternal choline status and offspring body
composition in human infants/children is lacking, we investigated
this in two cohorts.

**Methods:** Maternal plasma choline concentrations were as-
sessed in the UK SWS (n=1002, 11 weeks gestation) and in Sin-
gapore GUSTO (n=970, 26-28 weeks gestation) mother-offspring
cohorts. Infant anthropometry was measured from birth until 5
years of age at regular intervals. Total body fat mass was deter-
mined using DXA for SWS, and using air displacement plethys-
mography for GUSTO. Linear regression models were performed
adjusting for confounders.

**Results:** Mean (SD) plasma choline concentrations were 6.03 (0.86) µmol/L for SWS and 9.2 (1.6) µmol/L for GUSTO. In SWS, higher maternal choline concentrations were associated with higher neonatal total body fat mass [β=0.60 SD/5 µmol/L maternal choline (95% CI 0.04-1.16)] and higher subscapular skinfold thickness [β=0.55 mm/5 µmol/L (0.12-1.00)] at birth. In GUSTO, higher maternal choline concentrations were associated with higher neonatal BMI-for-age z-score [β=0.31 SD/5 µmol/L (0.10-0.95)]
0.51)], higher triceps [β=0.38 mm/5 µmol/L (0.11-0.65)] and subscapular skinfold thicknesses [β=0.26 mm/5 µmol/L (0.01-0.50)] at birth. No clear trends were observed between maternal choline and offspring growth in BMI-for-age, skinfolds, abdominal circumference, weight-for-age, length/height-for-age, and adiposity measures in later infancy and childhood.

**Conclusions:** Our study provides evidence that maternal choline concentrations status during pregnancy are positively associated with offspring BMI, skinfolds and adiposity at birth, but not with growth in the first 5 years of life.

**Keywords:** Choline, pregnancy, offspring, body composition, growth

**Conflict of Interest Disclosure:** YS Lee, KM Godfrey, and Y-S Chong have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. These authors are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, and Danone. The other authors have no conflict of interests.

**Further collaborators**

Mya Thway Tint, PhD, Sian M Robinson, PhD, Cyrus Cooper, MD, Marielle V Fortier, MD, Peter D Gluckman, MD, Kok Hian Tan, MD, Lynette PC Shek, MD

144/895

SLEEP QUALITY AND DURATION ON DIET AND BEHAVIOURS DURING PREGNANCY: THE GUSTO STUDY

(1)Chong, Mary; (2)van Lee, Linde; (3)Chia, Airu; (4)Loy, See Ling; (2)Tham, Elain KH; (5)Godfrey, Keith M; (6)Tan, Kok Hian; (7)Gooley, Joshua;

(8)Chong, Yap Seng; (9)Broekman, Birit FP.

(1)PhD. Assistant Prof. Saw Swee Hock School of Public Health. National University of Singapore. Singapore; (2)PhD. Research Fellow. Singapore Institute for Clinical Sciences. A*STAR. Singapore; (3)BSc. PhD student. Department of Obstetrics and Gynaecology. Yong Loo Lin School of Medicine. NUS. Singapore; (4)PhD. Research Fellow. Duke-NUS Medical School. Singapore.; (5)PhD. Professor. MRC Lifecourse Epidemiology Unit. University of Southampton.UK; (6)MD. Professor. Department of Reproductive Medicine., KK Women's and Children's Hospital. Singapore.; (7)PhD. A. Prof. Duke-NUS Medical School, Singapore; (8)MD. A Prof. Singapore Institute for Clinical Sciences. A*STAR. Singapore; (9)PhD. A Prof. Singapore Institute for Clinical Sciences. A*STAR. Singapore.

**Background and objectives:** Evidence on the association between sleep, diet and dietary behaviours in pregnant women is lacking. We examined this in a cohort of pregnant women in Singapore.

**Methods:** Pregnant women at 26-28 weeks gestation (n=719) from the GUSTO cohort completed the Pittsburgh sleep quality index to assess sleep quality (score 0-21; higher scores represent poorer sleep), sleep duration (hours), dietary intake and behaviours were assessed. Diet quality was defined by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP) on a

0-100 scale and three dietary patterns were derived from principal component analysis of food records: fruit-vegetables-rice, seafood-noodles, and pasta-cheese-meat. Dietary behaviours examined included longest fasting duration during night- (19:00-06:59), meal frequency, breakfast skipping, and predominantly night-time eating. Multivariate linear regression and Poisson regression were used to examine the relationship.

**Results:** Mean (SD) sleep quality score was 5.5 (2.9) and sleep duration 7.2 hours (1.5). Poorer sleep quality was associated with lower HEI-SGP sores [β -0.04 (95%CI -0.07, 0.00)], lower adherence to the fruit-vegetables-rice pattern [β -0.02 (-0.02, 0.00)], shorter night-time fasting intervals [β -0.05 hours (-0.09, -0.01)] and higher likelihood of skipping breakfast [prevalence ratio 1.06 (95% CI 1.01-1.10)]. Longer sleep duration was only associated with a longer night-time fasting interval [β 0.08 hours (95%CI 0.00, 0.16)].

**Conclusions:** Poorer sleep quality was associated with unhealthier diets and dietary behaviours, while longer sleep duration was associated with longer night-time fasting. Prospective studies are warranted to investigate the direction of causality.

**Keywords:** dietary patterns, diet quality, sleep quality, sleep duration, dietary behaviours

**Conflict of Interest Disclosure:** KM Godfrey, and Y-S Chong have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. These authors are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, and Danone. The other authors have no conflict of interests.

**Further collaborators**

Marjorelee Colega, BSc, Fabian KP Yap, MD, Lynette PC Shek, Teo Oon Hoe, Daniel Goh, MD.

144/905

POTENTIAL STRATEGIES TO DECREASE THE HIGH SUGAR INTAKE IN ARGENTINIAN YOUNG CHILDREN TO GENERATE HEALTHIER EATING HABITS

(1)Desclée de Maredsous, Caroline; (2)Ketelhohn, Belen; (3)Zapata, María Elisa; (4)Oukid, Inès; (5)Van der Merwe, Liandré; (1)Delaere, Fabien; (6)Rovirosa, Alicia; (2)Olagnero, Gabriela; (7)Carmuega, Esteban.

(1)PhD. Centre Daniel Carasso. Danone Nutricia Research. Palaiseau. France.; (2)BSc. Danone Nutricia. Buenos Aires. Argentina.; (3)MSc. Centro de Estudios Sobre Nutrición Infantil (CESNI). Buenos Aires. Argentina.; (4)MSc. Centro Daniel Carasso. Danone Nutricia Research. Palaiseau. France.; (5)PhD. Danone Nutricia Research. Utrecht. Netherland.s.; (6)BSc. Centro de Estudios Sobre Nutrición Infantil (CESNI). Buenos Aires. Argentina.; (7)MD. Centro de Estudios Sobre Nutrición Infantil (CESNI). Buenos Aires. Argentina.

**Background and objectives:** In Argentinian young children aged 6-23 months, table sugar and sodas alone represent 12% of the Total Energy Intake (TEI), which exceeds the 10% upper limit
for free sugar intake recommended by WHO. The present study
aimed to evaluate a relevant and realistic dietary lever to reduce
free sugar intakes, based on actual consumption practices.

**Methods:** The diets of 220 Argentinian 12-36 months toddlers were captured in a 7-day food diary. A probability-based statistical tool, which evaluates the potential of one food category to be substituted by another using actual dietary data, was applied. Potential nutritional effects of estimated switches were evaluated by simulation modeling.

**Results:** The main food categories contributing to sugar intake were cow's milk (18.3%), fruits (16.4%) -both containing mainly intrinsic sugars- and powdered juices and sodas (11.4%) containing exclusively free sugar. Powdered juices and sodas were consumed by 82% of the studied population (90% of the 24-36 mo population) at an average frequency of 1.21 times/day/individual, predominantly at lunch and dinner. In analyzing consumption dynamics, water was identified as the most probable, realistic substitution alternative (far above all other food and drinks categories), with a potential to substitute an estimated 0.97 and 1.02 consumption acts/individual/week during lunch and dinner, respectively. Considering this realistic switching scenario at lunch and dinner, simulation modeling estimated a reduction of free sugar intake of 18.5 g/individual/week (2.64 g/individual/day), based on only this one dietary modification.

**Conclusions:** This probability-based statistical tool has shown, through actual practices, that a few simple food replacements in young children's diet can be a successful strategy, not only to help achieve WHO recommendations, but also to accomplish a gradual development of healthier early eating habits.

**Keywords:** sweet drinks, free sugars, switch, simulation, substitution alternatives

**Conflict of Interest Disclosure:** CDM, IO, LvdM and FD are employed by Danone Nutricia Research. BK and GO are employed by Danone Nutricia.

(1)Malpeli, Agustina; (2)Gonzalez, Horacio Federico; (2)Fasano, María Vicctoria; (3)Tournier, Andrea; (4)Varea, Ana; (4)Disalvo, Liliana.

(1)Nutritionist. Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri"(IDIP). Hospital de Niños de La Plata. Ministerio de Salud. Comisión de Investigaciones Científicas. Pcia. De Bs As. Argentina.; (2)PhD. Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri"(IDIP). Hospital de Niños de La Plata. Ministerio de Salud. Comisión de Investigaciones Científicas. Pcia. De Bs As. Argentina.; (3)Biochemist. Laboratorio Central Hospital de Niños de La Plata. Ministerio de Salud. Pcia. De Bs As. Argentina; (4)Biochemist. Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri"(IDIP). Hospital de Niños de La Plata. Ministerio de Salud. Comisión de Investigaciones Científicas. Pcia. De Bs As. Argentina.

**Background and objectives:** The metabolic complications of overweight and obesity are widely studied in children above 6 years and adolescents. However, little is known about such complications in children less than six years.

Aim

To compare glucose metabolism in children aged 1-5 years with normal weight and overweight/obesity.

**Methods:** A prospective, analytical, cross-sectional study was conducted in 2011 on children aged 1-5 years attending primary health care units from the cities of Berisso and Arturo Segui, province of Buenos Aires, Argentina.

Anthropometric assessments included weight, height and waist circumference (WC). Fasting blood tests were taken in all children to determine blood glucose and insulin, insulin resistance by the homeostasis assessment model for insulin resistance (HOMA-IR) and the blood glucose/insulin (G/I) ratio. Comparisons between groups were analyzed with Mann-Whitney test.

**Results:** We evaluated 795 children aged 1-5 years. Sixty-six percent of children were normal weight, whereas 34% were overweight (24%) and obese (10%). Mean age was 3.35 ± 1.56 years (49.6% male, 50.4% female).

Mean blood glucose levels were similar in normal weight as compared with overweight/obese children. Blood insulin results were higher in overweight/obese (2.21 µU/ml; 1.39-3.95) compared with normal weight children (1.96 µU/ml; 1.32-3.18) (p=0.016). HOMA-IR was higher in overweight/obese (0.43; 0.25-0.80) than in normal weight children (0.37; 0.23-0.60) (p=0.011). The G/I ratio was lower in overweight/obese 35.9 (20.6; 54.0) compared with normal weight children 38.7 (24.9; 58.0) (p=0.039).

The analysis of differences according to sex showed that they remained the same in normal weight and overweight/obese girls, but disappeared in boys.

We found correlation between WC and blood insulin, WC and HOMA-IR and WC and G/I ratio in the whole study sample. Again, when analyzing by sex, such correlations remained only
in girls (WC- blood insulin rho0.32 p<0.0001; WC-HOMA-IR rho0.34 p<0.0001; WC-G/I ratio rho-0.16 p=0.046).

**Conclusions:** We found differences in glucose metabolism parameters in overweight/obese children aged 1-5 years as compared with those of normal weight children. Analysis according to sex showed that such differences remained in girls, but were not significant among boys.

**Keywords:** Overweight - Obesity - Insulin Resistance - Preschool-aged children -

**Background and objectives:** Background:

According to findings from the recent Lancet breastfeeding series, improving breastfeeding practices worldwide will be a fundamental driver in achieving the Sustainable Development Goals by 2030 (Meara, 2015). Among the 17 proposed sustainable goals, breastfeeding; a simple, smart and cost effective practice contributes to the realization of four of these specific goals that is; 1) ending hunger and improving nutrition; 2) ensuring healthy lives and promoting well-being; 3) ensuring equitable education and 4) ensuring sustainable agricultural production and consumption (Meara, 2015). However in Uganda, less than 20 health facilities are designated as "baby friendly" where mothers can safely and readily practice breastfeeding. Objectives: To increase awareness about the benefits of exclusive breastfeeding (EBF), advocate for breast feeding corners in Mulago Hospital and establish factors influencing adherence to EBF by the mothers.

**Methods:** Behavioral change communication using Information, Education and Communication (IEC) materials and nutrition education counselling of 150 participants. Pre and post semi-structured questionnaires were used to determine adherence of the mothers to EBF as well as factors for adherence before and after the intervention.

**Results:** Out of 150 breastfeeding mothers, 64% reported adhering to exclusive breast feeding before nutrition education and counselling was done. 87% were willing to exclusively breastfeed their children after improving their awareness about EBF and its advantages. The following factors significantly influenced adherence to EBF positively (p< 0.05): 1) accessibility of antenatal care

clinic p= 0.002); 2) attending Anti-Retroviral therapy (ART) clinics for ARV's (p= 0.001), 3) knowledge on risk of MTCT of HIV during mixed feeding (p=0.000).

**Conclusions:** Nutrition education and counselling improved the mother's willingness to exclusively breastfeed their children. Therefore this should be routinely done in health facilities to improve adherence to EBF. While infant and young child feeding regulations are in place, enforcement of the practices needs to be strengthened to increase access to nutrition for the poorest and most vulnerable urban communities.

**Keywords:** Exclusive breast feeding, health centers, breast feeding corners

**Background and objectives:** In Ecuador, adolescents represent 19.3% of the population INEC-Ecuador (2010). This period is characterized by a stage of physical, psychological and psychological changes in which a child becomes an adult. This transition requires an adaptation of the factors that allow the adolescent to develop all the normal functions with normality. Aims: To evaluate the dietary intake, eating disorders and physical activity of adolescents from a population of the Andean region of Ecuador and their difference between urban and rural areas.

**Methods:** Cross-sectional study (n = 131). It was applied: a 24-hour reminder and food consumption frequency questionnaire; It was evaluated anthropometry, physical activity and risk of eating disorder.

**Results:** 19.1% of the population presented short stature by age and 17.6% risk of overweight according to BMI//Age. Macronutrient adequacy percentages throughout the population were low (66.5% carbohydrate, 60.5% protein and 79.8% fat).

Statistically significant differences were found between protein (p = 0.012), fats (p <0.001) carbohydrates (p = 0.013) and energy

<footnote>(1)Nyakake, Lynn; (2)Ssenyondo, Muzafaru; (3)Murungi, Solomon;</footnote>

<footnote>(4)Ainomugisha, Prudence; (2)Ahumuza, Gracious.</footnote>

<footnote>(1)Bsc. Nutritionist. Department of Food Technology and Nutrition. Makerere University. Uganda.; (2)Bsc. Nutritionist. Department of Food Technology and Nutrition. Makerere University. Kampala.</footnote>

<footnote>Uganda.; (3)Bsc. Information Technology Specialist. Department of Information Technology. Makerere University. Kampala. Uganda;</footnote>

<footnote>(4)Bcs. Nutritionist. Department of Food Technology and Nutrition. Makerere University. Kampala. Uganda.</footnote>

<footnote>(1)Carpio Arias, Tannia Valeria; (2)Ramos Padilla, Patricio;</footnote>

<footnote>(2)Villavicencio Barriga, Veronica; (2)Delgado López, Verónica;</footnote>

<footnote>(3)Andrade, Carlos; (4)Valencia Peñaloza, Valeria; (5)Carpio Salas, José Gabriel; (6)Morejon Teran, Yadira Alejandra.</footnote>

<footnote>(1)PhD student. MCs. Nutritionist. Department of Nutrition, Food Science and Gastronomy School of Pharmacy. University of Barcelona. Barcelona. Spain.; (2)MCs. Nutritionist. Research Group on Food and Human Nutrition. Superior Polytechnic School of Chimborazo. Riobamba. Ecuador.; (3)MCs. Engineer. Research Group on Food and Human Nutrition. Superior Polytechnic School of Chimborazo. Riobamba. Ecuador.; (4)MCs. Nutritionist. Specialist in school feeding. Quito. Ecuador.; (5)Bachelor of Languages. Department of Languages. Superior Polytechnic School of Chimborazo. Riobamba. Ecuador.; (6)MCs. Nutritionist. Institute of Collective Health. Federal University of Bahia. Campus Canela. Salvador. Brazil.</footnote>
Semi-structured questionnaires were used to collect data on 363 adolescents (120 non-school going, 109 boarding scholars and 122 day scholars) in a cross-sectional survey. Data was analyzed using SPPS version 20.0.

**Results:** Out of the 363 participants, 81.8% snacked frequently with majority snacking on salted snacks (40.4%) and confectionery (23.7%). Only 6.1% of them snacked on fruits and vegetables while 88.7% consumed fast foods frequently. Significant influences of adolescent dietary practices were taste and preference, lack of appetite, lack of money, readily available fast foods and snacks and busy schedule (p< 0.05). Nutritional knowledge of the adolescents positively influenced their frequency of supper consumption (r= 0.120, p= 0.022) and frequency of breakfast consumption (r= 0.127, p= 0.016) while it negatively influenced their fast food consumption (r= -0.134, p= 0.010).

**Conclusions:** Majority of the adolescents had unhealthy dietary practices and lacked nutrition knowledge. Nutrition education should be widely done to improve the adolescents' nutrition knowledge and hence influence their dietary practices.

**Keywords:** Adolescents, Dietary practices, Attitudes, Nutritional knowledge

**Background and objectives:** Maternal anthropometry taken before and during pregnancy has a close relationship with fetal growth and birth weight, therefore a descriptive observational research with analytical component was designed to determine the maternal anthropometric risk factors and nutritional status of children of women treated Hospital de Clínicas, Department of Gynecology and Obstetrics, during the months of May 2016.

**Methods:** The pre-gestational nutritional status by BMI, gestational by Atalah et al and weight gain as Casanueva et al evaluated. The nutritional status of the child was assessed according to the current WHO growth curves. The data were extracted from the records of patients.

**Results:** The women began their pregnancies overweight (25.6±5,6kg/m2), they earned on average 13.25 ± 6,17kg, as recommended greater (p <0.05). 73.7% were children and the highest percentage AEG presented adequate nutritional status by anthropometric indicators (weight, length and head circumference). Women with excess nutritional status and gestational weight gain excessive weight who had a higher proportion GEG children (p <0.05), respectively). The children of obese women and earning pesos excessively during pregnancy was significantly higher (p<0.05).

**Conclusions:** the results indicate that maternal anthropometric risk factors would be one gestational nutritional status of

overweight and excessive weight gain with the birth weight of the newborn

**Keywords:** Maternal and child nutrition, anthropometry, newborn

**Background and objectives:** The assessment of nutritional status in children is part of the main objective of the Obesity and Overweight Monitoring Program of the Pediatric Gastroenterology, Hepatology and Pediatric Research Group of the University of Valle del Cali, Colombia. The objective is to determine body mass index, height for age, insulin resistance index (HOMA), lipid profile and physical activity in a group of cheerleaders from Cali, Colombia

**Methods:** Non-experimental descriptive observational study type prevalence in schoolchildren (n=3) and adolescents (n=14) who were given socio-demographic (age, sex), nutritional (weight, height, waist circumference), biochemical (glycemia, insulin, lipid profile) variables and physical activity (strength/endurance and aerobic tests)

**Results:** A total of 17 girls, 14.7±27 years (range=9-18), weight=50.3±12.4 kg (range=32.4-74.2), height=157.7±7.9 cm (range=141.6-169.7), circumference (range=57.0-94.5), blood glucose=85.7±6.8 g/dl (range=71-99), insulin=13.4±8.1 g/dl (range=3.6-36.0), cholesterol=155.4±25.4 (range=107-208), triglycerides=119.7±151.9 g/dl (range=49-704), arterial index=2.8±0.5 (range=2.2-4.5), HOMA=2.7±1.6 (range=0.6-6.6) and physical activity=4.6±0.2 (range=4.1-5.0). They presented 11.8% of malnutrition and overweight, respectively; 5.9% hypercholesterolemia, 11.8% hypoglycemia and elevated insulin, respectively; 29.4% HOMA altered and 100.0% good physical activity

**Conclusions:** Despite good physical activity, about 1/3 of this group of cheerleaders presented altered HOMA; 24% altered lipid profile, and 12% malnutrition, overweight, hypoglycemia and altered insulin

**Keywords:** Anthropometry, Insulin resistance index, Lipid profile, Physical activity, Children

<footnote>(1)Salomón de Torres, Viviana Raquel; (2)Morínigo Martínez, Macarena.</footnote>

<footnote>(1)Nutritionist. Faculty of Medical Sciences. National University of Asuncion. Paraguay.; (2)Nutritionist. Department of Nutrition Research. Faculty of Chemical Sciences. National University of Asuncion. Paraguay.</footnote>
# THE MEDIA INFLUENCE ON BODY IMAGE AND DISORDERED EATING ATTITUDES OF BRAZILIAN FEMALE TEENAGERS

(1)Galhardi Lira, Ariana; (2)dos Santos Alvarenga, Marle; (3)Sinhorini Lodi, Aline; (4)de Piano Ganen, Aline.

(1)MSc. Nutritionist. Professional Master Program of Nutrition. São Camilo Center. Brazil.; (2)PhD. Nutritionist. Department of Nutrition. University of São Paulo (USP). Public Health. Brazil.; (3)Nutritionist. São Camilo University Center. Brazil.; (4)PhD. Nutritionist. Master Professional Program of Nutrition. São Camilo University Center. Brazil.

**Background and objectives:** Between the many sources of influence, the media exerts an impact on eating behaviors and body image, being pointed as an important factor for Eating Disorders (ED) development. The Disordered eating, which are unhealthy attitudes to lose or control weight, although less severe than the ED are more frequent, highlighting the female and adolescent public as the most vulnerable group to this behavior due to quick body modifications and body image dissatisfaction. In this way, the objective of the present study was to evaluate the media influence in the body image in the disordered eating with age, nutritional status, body image perception and dissatisfaction, income and maternal schooling level in Brazilian teenagers.

**Methods:** 212 female adolescents of São Paulo State from Brazil answered to the Kakeshita Silhouettes Scale and the subscale 1 of the Internalization-general of the Sociocultural Attitudes Towards Appearance Scale (SATAQ-3), and the Disordered Eating Attitude Scale (EAAT). It was measured the anthropometric variables, such as BMI/age and sociodemographics informations were collected. Student's t-test and Anova followed by the Bonferroni post-hoc were used to compare the SATAQ means. Meanwhile, for EAAT, the Mann-Whitney and Kruskall-Wallis tests were used. It was adopted the significance of p <0.05.

**Results:** It was noted statistically major values in SATAQ subscale of teenagers who showed body image dissatisfaction, who desire to lose weight compared to satisfied with body image. Indeed, the EAAT score, which evaluated the eating attitudes associated to disordered eating behavior, was significantly elevated in overweight and obese compared to eutrophic adolescents, as well as, in female teenagers with body image distortion and dissatisfaction with desire to lose weight. Age, family income and maternal schooling appear to have not influenced the disordered eating.

**Conclusions:** The media can influence body image dissatisfaction of adolescents, which can be considered an important factor, as well as the nutritional status, to disordered eating development.

**Keywords:** adolescence; nutrition; eating attitudes; media influence; disordered eating.

# CONSUMPTION OF COW'S MILK, MILK PRODUCTS AND DAIRY SUBSTITUTES: FINDINGS FROM THE FEEDING INFANTS AND TODDLERS STUDY (FITS) 2016

(1)Jacquier, Emma; (2)Catellier, Diane; (3)Anater, Andrea; (4)Eldridge, Alison.

(1)PhD. MSc. Country Lead Scientist, Institute of Nutritional Science. Nestlé Research Center. Switzerland.; (2)PhD. Senior Statistician. Research Triangle Institute. Chapel Hill. North Carolina. United States of America.; (3)PhD Public Health Analyst. Food and Nutrition Policy Research. Research Triangle Institute. Chapel Hill. North Carolina. United States of America.; (4)PhD. Principle Investigator FITS/KNHS Research. Institute of Nutritional Science. Nestlé Research Center. Switzerland.

**Background and objectives:** Introduction of cow's milk is inappropriate for infants <1-year of age. Whole cow's milk is recommended for children from 12-23.9 months. There is little information on the introduction and patterns of cow's milk and milk product consumption in the first few years of life. The aim of this study is to describe the consumption patterns of cow's milk, milk products and plant milks/dairy substitutes, including both prevalence and amounts consumed, amongst U.S. children aged 0-3.9y, using data from the Feeding Infants and Toddlers Study (FITS) 2016.

**Methods:** The FITS 2016 is a cross-sectional, nationwide survey of caregivers of children aged 0-3.9y in the US. Data about respondent and child characteristics, feeding practices and health-behaviours were collected using a recruitment questionnaire (n=4380). A 24-h dietary recall was used to collect details on food, beverage and supplement intake (n=3428). Each item was assigned to a food group designed for FITS; one-day intakes were used to calculate the percentage of children consuming specific food groups on a given day, along with the amount consumed (g).

**Results:** Among 0-5.9 month olds and 6.11.9 month olds, infant formula was consumed by 62.2% and 64.8%, while breast milk was consumed by 53.5% and 39.2%, respectively. Breast milk consumption was more prevalent that infant formula amongst 12-17.9 month olds (18.4% vs. 7.3%). Only 1.4% of 0-5.9 month olds and 5.8% of 6-11.9 month olds consumed ~480g of whole cow's milk. Plant milk/ dairy substitute consumption was very low (0.5% of 6-11.9 month olds), and amount consumed was ~316g. Prevalence of whole milk consumption was 69.3% at 12 months but was only 26.9% at 2y when children began consuming reduced-fat milk. The prevalence and amount of low-fat, non-fat and flavored milk consumed was higher with increasing age, however, only 23% of preschool children consumed low-fat milk. Prevalence of cheese and yogurt consumption, and the amounts consumed, was higher with increasing age.

**Conclusions:** Opportunities exist to improve the prevalence of breastfeeding, to reduce cow's milk consumption before 12 months of age, and to promote reduced-fat milk consumption beyond 24 months of age in line with dietary recommendations.

**Keywords:** Milk, infant nutrition, breast milk, infant formula, dairy substitutes.
**Background and objectives:** CeSSIAM has an interest in the origins and biology of acquired linear growth retardation, also referred to as “stunting” or “chronic undernutrition.” A photographic approach has been developed to estimate differential body-segment lengths (trunk vs legs) to accompany conventional anthropometric indicators. The purpose of this study was to ascertain whether any sexual dimorphism was evident in comparisons across sexes in pre-school children from the Western Highlands of Guatemala.

**Methods:** We measured the height, clothing-adjusted weight, and head and waist circumferences of 212 individuals between 4-7 y from zones of established high stunting prevalence comprising La Estancia, Quetzaltenango and Santa María Chiquimula, Totoncapán. We further generated height-for-age (HAZ); weight-for-age (WAZ); body-mass-index for age (BAZ); and head-circumference (HCZ) Z-scores along with waist-to-height ratio (WHtR). Sagittal photographs were taken with a digital camera with the children in an erect posture with the Frankfort gaze standing on a stadiometer platform. After printing out the photo, the lengths of the trunk and the legs were measured in mm, allowing the generation of trunk-to-stature ratios. Assorted indicators or ratios are consistently presented in the order of female vs male, along with the probability-value in parenthesis.

**Results:** Comparisons of median indicators or ratios across sexes were: HAZ: -2.36 vs -2.29 (p=0.94); WAZ: -1.51 vs -1.64 (p=0.40); BAZ: -0.16 vs -0.14 (p=0.79); H CZ: -0.53 vs -0.73 (p=0.002); and WHtR: 0.49 vs 0.49 (p=0.08)(n=212). The overall trunk-to-stature median ratios were 0.46 for girls and 0.45 for boys (p=0.001).

**Conclusions:** In every situation in which values were numerically different, males were in quantitative disadvantage; but it was only with H CZ that a statistically-significant diminution was seen for the male participants. With respect to trunk-to-stature ratio, there was high statistical significance. As girls had a slightly higher trunk-to-stature ratio, they are in disadvantage.

**Keywords:** stunting, anthropometric Z-scores, body-segments, Guatemala

**Background and objectives:** Prenatal growth has been related to risk factors for chronic disease in adult life, specifically, small body size at birth was associated with elevated blood pressure, insulin resistance and metabolic syndrome. The knowledge of maternal characteristics associated with birth length can be useful information for programming public health interventions focusing in prenatal care. The objectives of this research were to evaluate the relationship between maternal nutritional status and birth length in a sample of Argentinian women.

**Methods:** A sample of 760 healthy pregnant women was selected from antenatal clinics in six different urban regions in Argentina. Height and initial weight were determined in the first control (before 12 weeks of gestation), BMI and weight increments were calculated in the last prenatal control. Infant birth weight, height and gestational age were recorded from the neonate clinical history. Descriptive statistics and adjusted linear regression models were fitted using R-program, version 3.1.0.

**Results:** Most women were primiparous (43.9%) and attended the public health sector (56.6%). Maternal and neonatal characteristics were: (Mean ± SD): age (years) 26.6 ± 5.7; maternal height (m) 1.58 ± 0.06; initial BMI (kg/m2) 24.08 ± 4.5; BMI increment (kg/m2) 4.7 ± 0.4; birth weight (g) 3284 ± 509; gestational age (weeks) 38.7 ± 1.7; length (cm) 48.8 ± 2.4. According to gestational age, birth length was 44.9 ± 3.9 cm (mean ± SD) in preterm and 49.1 ± 2.0 cm in term newborns.

After adjusting for gestational age, gender of the newborn, mother's age, province, type of care and income level, variables associated with length at birth were (Coefficient; p-Value): parity (0.137; 0.043), maternal height (2.881;0.014), BMI at the beginning of pregnancy (0.065;0.000) and BMI increment (0.101;0.009)

**Conclusions:** Although parity and maternal height can not be influenced by health interventions, the relationship of maternal BMI and its increment during pregnancy with length at birth emphasize the need to recognize prenatal care as a valuable opportunity to promote adequate prenatal growth.

**Keywords:** prenatal care, pregnancy weight gain, birth length

**Conflict of Interest Disclosure:** Financial support: Becas Carrillo Oñativia. Ministerio de Salud. República Argentina

**Further collaborators**

Yanina del Valle Balmaceda, Ester Barrientos, Karen Cámara, Silvia Garciarena, Carina González, Lucía Quintana
# DETERMINANTS OF ANEMIA AMONG CHILDREN 6 TO 12 MONTHS OF AGE IN EASTERN BURKINA FASO

(1)Bliznashka, Lilia; (2)Becquey, Elodie; (3)Ruel, Marie; (3)Olney, Deanna.

(1)MA. International Relations. International Food Policy Research Institute (IFPRI). Washington DC. USA.; (2)PhD. Public Health. International Food Policy Research Institute (IFPRI). Dakar. Senegal.; (3)PhD. Nutritionist. International Food Policy Research Institute (IFPRI). Washington DC. USA.

**Background and objectives:** Anemia is nearly universal (92%) among young Burkinabe children, yet scant evidence on its determinants exists for this population. To better understand these predictors, we used structural equation modeling to test a theoretical model of anemia among young Burkinabe children.

**Methods:** We used baseline data on 930 children aged 6-12 mo, their mothers and households from a cluster-randomized trial of Helen Keller International's Creating Homestead Agriculture for Nutrition and Gender Equity program. We tested model fit and examined predictors of anemia (hemoglobin concentration<11 g/dL) considering direct and indirect relationships. Child-level predictors included age, sex, malaria infection, iron deficiency (ID) (plasma ferritin< 12ug/L or transferrin receptor> 8.3 mg/L), inflammation (C-reactive protein> 5 mg/L or alpha-1-acid glycoprotein>1 g/L), and diet. Maternal predictors were knowledge, anemia, stress, age and education. Lastly, household-level predictors included diet, wealth, size, food security, and bednet ownership.

**Results:** Anemia (88%) and ID (90%) prevalence was high. Malaria was also common (21%). The model fit the data well (standard root mean square residual 0.08, coefficient of determination, 0.14). ID (standardized total effect (STE) 0.17, P=0.00), malaria (STE 0.11, P=0.00), inflammation (STE 0.06, P=0.01), maternal anemia (STE 0.04, P=0.06) and child age (STE 0.02, P=0.00) significantly predicted anemia. Malaria directly and indirectly predicted anemia (direct, 0.09 (P=0.00); indirect, 0.02 (P=0.00)). Twenty-two percent of the child age effect on anemia was indirect through ID and malaria. Bednet ownership marginally predicted anemia through its effect on malaria (indirect -0.02, P=0.05). Additionally, maternal knowledge directly predicted lower malaria prevalence (STE -0.01, P=0.02) and higher child consumption of animal-source foods (STE 0.01, P=0.03). Similar results were seen for hemoglobin.

**Conclusions:** This analysis confirms the contributions of ID, malaria and inflammation to anemia among young Burkinabe children. However, the current set of predictors only accounts for 45% of anemia and thus the contribution of predictors such as intestinal helminth infections, genetic factors and other micronutrient deficiencies (e.g. folate and vitamin B-12) should be considered. Programs that aim to reduce anemia among young Burkinabe children should address at least ID and malaria, but should also consider ways to address the other potential predictors of anemia.

**Keywords:** Burkina Faso, child anemia, malaria, iron deficiency, maternal anemia

**Conflict of Interest Disclosure:** L Bliznashka, E Becquey, M Ruel and D Olney no conflicts of interest.

**Further collaborators**

Joanne Arsenault. PhD. Nutritionist. Department of Nutrition. University of California, Davis. CA, USA.

# THE SOCIO-ECONOMIC AND GEOGRAPHIC FACTORS ASSOCIATED WITH ULTRA-PROCESSED FOOD CONSUMPTION IN COLOMBIA

(1)Khandpur, Neha; (2)Cediel, Gustavo; (3)Parra, Diana C; (4)Jaime, Patricia; (4)Monteiro, Carlos.

(1)Postdoctoral research fellow. Department of Nutrition. University of Sao Paulo. Brazil; (2)Postdoctoral research fellow. Department of Nutrition. University of Sao Paulo. Brazil;

(3)Instructor. Institute for Public Health. University of Washington. USA.; (4)Professor. Department of Nutrition. University of São Paulo. Brazil.

**Background and objectives:** Understanding the socio-economic and geographic inequities in the intake of ultra-processed food (UPF) is important to effectively address their consumption and associated health consequences. This study examined variations in UPF consumption in Colombia by sex, age, socio-economic status (SES), and place of residence.

**Methods:** Secondary analysis of nationally representative data from the 2005 Colombian National Nutrition Survey (ENSIN) and National Demographic and Health Survey (ENDS) was conducted. Diet from individuals aged 2 – 64 years was measured using a 24-hour food recall. Food consumption was categorized into the 4 NOVA groups. Individual sample weights were applied to all adjusted regression analysis of SES and geographic variables and their association with mean percentage calories from UPF.

**Results:** The mean age within this weighted sample (n = 39,232) was 26 years. Over 50% of the sample were female, urban residents, with low SES. Mean percentage total calorie intake from UPF for the total sample was 16.7%. Sex, age, SES, geographic regions and areas of residence were all significantly associated with mean percentage calories from UPF in the unadjusted analysis (p<0.05). Multivariate adjusted analysis demonstrated that mean percentage calories from UPF was significantly higher for women than men (16.3% vs 15.4%, p<0.00), highest among individuals <10 years of age and least in those over 50 years of age (20.5% vs 11.2%, p<0.00). Additionally, participants within the highest SES group reported higher UPF consumption compared to those in the lowest group (22.1% vs 12.8%, p<0.00). Significantly high UPF intake was also found among urban residents compared to those in rural areas (17.1% vs 11.3%, p<0.00) and among residents in the Bogota region (21.5%). Lowest consumption was reported among participants in the Atlantic region (12.5%).

**Conclusions:** While overall UPF consumption in Colombia is lower than those in high income countries, marked differences in consumption patterns by SES and geographic factors were evident
within this representative sample. The highest UPF intake was reported among the young, urban-dwelling, high SES residents. This trend may be reflective of the high purchasing power, access to UPFs and susceptibility to marketing, within these segments of the population.

**Keywords:** Ultra-processed foods, Socio-economic factors, Geographic factors, Colombia.

(1)Lavourinha Pinto, Rafael; (2)da Silva Nalin de Souza, Bárbara; (1)da Silva Couto, Camilla; (3)Sichieri, Rosely; (2)Massae Yokoo, Edna.

(1)BSc. Nutritionist. Collective Health Post-Graduation Program. Collective Health Institute. Federal Fluminense University. Brazil.;

(2)PhD. Nutritionist. Collective Health Post-Graduation Program. Collective Health Institute. Federal Fluminense University. Brazil.;

(3)PhD. Physician. Department of Epidemiology. Social Medicine Institute. Rio de Janeiro State University. Brazil.

**Background and objectives:** Sodium intake among adolescents is above the recommendations. The objective of this study is to identify the major sources of sodium intake among adolescent students.

**Methods:** The data is from PAPPAS study, which stands for "Parents, students and teachers for healthy eating" in Portuguese, conducted in a public school from Niterói-Rio de Janeiro, Brazil, in 2015, with students from 5th to 9th grade. Daily sodium intake was estimated by the mean of two 24-hour dietary recall. The food items mentioned was classified into 31 groups. Contribution to total daily sodium intake (%) and sodium density (mg sodium/100g of food items from the group) for each food group were estimated. The software SAS v.9.3 was used to data analysis.

**Results:** A total of 347 adolescents participated in the study and 51% were male. The average age was 12.7 years old. The average daily intake of sodium was 3777.5mg, over the maximum tolerable level (2200mg/d for 9-13 years and 2300 mg/d for 14-18 years). The ten major sources of sodium intake were rice (11.2%), beans (10.2%), sugar-sweetened beverages (9.9%), sweets (6.8%), milk and dairy products (6.3%), bread (6.2%), soft drinks (6.1%), meat (4.8%), poultry (3.7%) and processed meat (3.7%). Among them, processed meat (950mg/100g), bread (642mg/100g) and meat (414mg/100g) presented the highest sodium density. The groups were mostly consumed at home. However, savory biscuits (11th position in the contribution) were mostly consumed at school.

**Conclusions:** Total daily sodium intake among students was over the recommended and high at home. Despite the important contribution of ultra-processed foods, major sources included groups which comprise part of the traditional Brazilian diet. Particular attention should be directed toward educational strategies focused on reducing ultra-processed foods intake, as well as the reduction in voluntary use of salt in food preparation.

**Keywords:** food intake, adolescents, students, sodium.

(1)Hayford, Frank Ekow Atta; (2)Lartey, Louisa; (3)Dolman, Robin.

(1)PhD Candidate. Dietitian. Centre of Excellence in Nutrition. Faculty of Health Sciences. North West University. Potchefstroom. South Africa; (2)BSc. Dietitian. Department of Nutrition and Dietetics. School of Biomedical and Allied Health Sciences. College of Health Sciences. University of Ghana. Ghana;

(3)PhD. Dietitian. Centre of Excellence for Nutrition. Faculty of Health Sciences. North West University. Potchefstroom. South Africa.

**Background and objectives:** As human body gets older, it's nutritional and health needs change due to increasing susceptibility to degenerative diseases. The elderly population is one demographic group at risk of inadequate dietary intake and micro-nutrient deficiencies, due to physiological changes such as reduce efficiency of the gastrointestinal tract and loss of appetite due to decline sensory perception. Fruits and vegetables provide essential nutrients and nutritive compounds, considered vital for healthy as it improves micro-nutrient status. Failure to meet daily recommended intakes may result in micro-nutrient deficiencies, hence the need for this assessment in this important population of Ghanaian. The study sought to investigate and collect data on fruits and vegetable intake among elderly patients attending routine out-patient clinic in a teaching hospital in Accra, Ghana.

**Methods:** A cross sectional study, involving one hundred and fifty (150) ≥60+ year old subjects purposely sampled. Old and fragile subjects with complicated medical conditions with severe nutritional consequences/implications and with severe memory and cognitive impairments were excluded. A validated FFQ and two day 24hr dietary recall (a weekday and a weekend) were used to assess frequency and nutrient adequacy of fruits and vegetables intake respectively. Dietary data was analyzed using FAO food composition database and MICRODIET software version 3.0 (Downlee, UK). Pearson correlation and ANOVA were used to test for associations of variables of interest using SPSS version 20.0.All data were two-tail and statistically significant set at p≤0.05.

**Results:** Though majority alluded to fruits (83.9%) and vegetables (83.2%) intake because of their health benefits, mean daily servings of fruits and vegetables consumed were 1.49±1.66 and 2.22±1.17 respectively. Mean total daily caloric (1331.53±663.77Kcal), fibre (9.03±7.25g) and most micro-nutrient intakes were low. Educational level was significantly associated with fruit and vegetable intake (p≤0.04), as subject disease conditions significantly correlated with their vegetable intake (F=0.55; P< 0.01)

**Conclusions:** Most participants did not meet WHO recommended daily intake of 5 servings of fruits and vegetables and this may result in micro-nutrient deficiencies. Therefore, health facilities must aim at educating patients on the benefits of fruits and
vegetables via health promotion out-patient daily talks in order to promote frequent and adequate intakes.

**Keywords:** Micro-nutrient deficiency, Elderly, Fruits and veg-
etable intake, Ghana, Nutrition education

(1)Kavle, Justine; (2)Landry, Megan.

(1)PhD. Senior Nutrition Advisor. Maternal Newborn Child Health and Nutrition Division. Maternal and Child Survival Program (MCSP)/ PATH. USA.; (2)PhD. Consultant and Adjunct Faculty. Department of Prevention and Community Health. Milken Institute of Public Health. George Washington University. USA.

**Background and objectives:** Background and Objective: Adequate maternal nutrition during the “first 1000 days” window is critical from conception through the first 6 months of life to improve nutritional status and reduce the risk of poor birth outcomes, such as low birth weight and pre term birth. Unfortunately, many programs have focused implementation and evaluation efforts on outcomes of nutrition interventions for infants and young children and not maternal dietary consumption during pregnancy and lactation. A literature review was conducted to identify factors that influence women’s food choice and consumption during pregnancy and lactation and to examine how low and middle income countries (LMIC) countries have addressed maternal nutrition in programs.

**Methods:** Literature review of peer-reviewed and grey litera-
ture was conducted and titles and abstracts reviewed by authors.
Twenty-four studies were included in this review.

**Results:** Barriers to adequate nutrition during pregnancy included cultural beliefs related to knowledge of quantity of food to eat during pregnancy, amount of weight to gain during pregnancy, and “eating down” during pregnancy for fear of delivering a large baby. Foods considered inappropriate for consumption during pregnancy or lactation contributed to food restriction. Drivers of food choice were influenced by food aversions, economic constraints, and household food availability. Counseling on maternal diet and weight gain during pregnancy was seldom carried out.

**Conclusions:** Programming to support healthy maternal diet and gestational weight gain during pregnancy are scant, in light of this evidence and recently released World Health Organization antenatal care guidelines. Nutrition education and counseling on diet during pregnancy and lactation and optimal weight gain during pregnancy is an area of needed attention.

**Keywords:** maternal diet, gestational weight gain, pregnancy, lactation, barriers

(1)Haider, Rukhsana; (2)Karim, Rezaul; (3)Gomes, Ratna; (4)Omer-Salim, Amal.

(1)MBBS. MSc. IBCLC- PhD. Public Health Nutritionist. TAHN Foundation and WABA. Bangladesh and Malaysia. Bangladesh.;

(2)BUMS. MPH. Programme Coordinator. TAHN Foundation.
Dhaka. Bangladesh.; (3)MSS. Field Manager. TAHN Foundation.
Dhaka. Bangladesh.; (4)Co-Executive Director. World Alliance for
Breastfeeding Action (WABA). Penang. Malaysia.

**Background and objectives:** Women in the workforce in Bangladesh are mainly employed in readymade garments and other manufacturing industries. Inadequate access to health care, lack of correct information, and long working hours reportedly contribute to their poor breastfeeding practices. A project trained seven female peer counsellors to provide home-based counselling and skills to encourage factory workers to breastfeed optimally. An end line survey was conducted to assess whether the peer counsellors had influenced these workers' breastfeeding practices.

**Methods:** A cross-sectional survey was conducted among factory mothers with children aged 0-18 months of age in the counselled Intervention areas and neighbouring uncounselling Comparison areas during two weeks in March 2017 in Chittagong. Six external female interviewers trained over 3 days by experienced trainers, interviewed mothers after they returned from work. Data collected was checked, entered into computer and analysed using SPSS.

**Results:** A total of 382 working mothers with children aged 0-18 months were interviewed in Intervention areas (n=188) and neighbouring Comparison areas (n=194). Preliminary analysis shows 167 (89%) of Intervention mothers initiated breastfeeding within one hour of birth versus 42 (22%) of mothers in Comparison areas. Exclusive breastfeeding on 24-hour recall in infants below 6 months of age was 73/75 (97%) in Intervention areas, versus 3/83 (4%) in Comparison areas. Among mothers of older infants, 96/113 (85%) those in the Intervention areas reported having breastfed exclusively from birth for complete 6 months, versus 10/111 (9%) mothers in the Comparison areas. Whereas 182/194 (94%) of the Comparison area infants were bottle fed in the past 24 hours, only 16/188 (8%) of Intervention area infants had done so.

**Conclusions:** With peer counsellors encouragement and support, it seems most of the counselled factory workers could practice 6 months of exclusive breastfeeding compared to those who did not receive such services. These preliminary results highlight an urgent need for establishing and sustaining community-based support systems to improve breastfeeding practices of factory workers.

**Keywords:** Breastfeeding, peer counsellors, factory, workers
144/1050

RELATIONSHIP BETWEEN FOOD INTAKE AND AGE VALUE IN FEMALE UNIVERSITY STUDENTS

Nakajima, Sanae.

PhD.

**Background and objectives:** Advance Glycation End-Products (AGE) are a harmful substances formed through an excess of protein and sugar in human body. Excessive accumulation of these substances has been reported to accelerate the aging process and contribute to multiple diseases such as arteriosclerosis and diabetes. It has also been reported that AGE accumulation is related to food intake. However, AGE data from younger populations has been sparse compared to data collected from older ones, which come with a higher risk of lifestyle-related diseases. This experiment was designed to determine the relationship between food intake and AGE value by researching the food intake of female university students and then measuring their AGE values.

**Methods:** The AGE values presented here are measured with a TruAge scanner, and the measurement is taken from front part of left forearm. This nonintrusive method measures in vivo AGE accumulation by exposing and exciting accumulated AGE to light (mild ultraviolet exposure). The specific fluorescence of AGE is used to measure the amount of AGE accumulation under the skin. The food intake survey was created based on Food Frequency Questionnaire (FFQg).

**Results:** The younger population shows no AGE value differences compared to food intake, and, instead, the AGE values correspond with subjects' ages. Food intake does not appear to have any impact on the subjects' AGE values, either.

**Conclusions:** Further data is necessary, as data from a younger population can be a useful comparison against that collected from middle-age or elderly populations, who tend to show higher AGE accumulation values.

**Keywords:** Advance Glycation End-Products, FFQg

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ERYTHROCYTE FATTY ACID COMPOSITION IN GUATEMALAN PRESCHOOLERS FROM THREE DIFFERENT SETTINGS OF THE WESTERN HIGHS LANDS WITH A COMMON INSTITUTIONAL DIET

(1)Soto-Méndez, María José; (2)Campos, Raquel; (3)Mesa, María Dolores; (4)Solomons, Noel W; (5)Schuemann, Klaus; (6)Gil, Ángel.

(1)PhD. Fellow. Center for Studies of Sensory Impairment Aging and Metabolism (CESSIAM). Guatemala. PhD. Researcher. Department of Biochemistry and Molecular Biology II. University of Granada. Spain.; (2)Bsc. Researcher. Center for Studies of Sensory Impairment, Aging, and Metabolism (CeSSIAM). Guatemala.; (3)PhD. Professor. Department of Biochemistry and Molecular Biology II. University of Granada. Spain.; (4)MD. Scientific Director. Center for Studies of Sensory Impairment, Aging, and Metabolism (CESSIAM). Guatemala.; (5)MD. Professor. Molecular Nutrition Unit. ZIEL Research Center for Nutrition and Food Science. Technical University of Munich. Germany; (6)PhD. Professor. Department of Biochemistry and Molecular Biology II. University of Granada. Spain.

**Background and objectives:** Polyunsaturated fatty acids (PUFA) are important for normal brain development and immune function. Low levels of n-3 fatty acids (FA) have been previously reported for children living in the Pacific coast of Guatemala. This work is aimed to describe the fatty acids status in children from 3 settings of the Western Highlands of Guatemala with a mutually similar dietary intake.

**Methods:** 79 preschoolers (36 girls and 43 boys), beneficiaries of the Guatemalan government's "community homes" system attending one semi-urban (n=19), one marginal-urban (n=23) and one rural center (n=37) delivered a blood sample, fatty acids concentrations in erythrocytes were analyzed using gas-liquid chromatography. Descriptive statistics are presented as mean ± SD. Student t-test, Mann-Whitney U-test, one-way ANOVA or Kruskal-Wallis were used to compare between sexes and among settings.

**Results:** Erythrocyte percentages of selected fatty acids, for the total sample, expressed in weight percentage were arachidonic acid (ARA) 13.03 ± 1.7, eicosapentaenoic acid (EPA) 0.12 ± 0.2, docosahexaenoic acid (DHA) 1.7 ± 0.4, long-chain PUFA n-6 29.7 ± 3.1, long-chain PUFA n-3 2.5 ± 0.5, unsaturation index (UI) 2.4 ± 0.3, and omega-3 Index (EPA+DHA) 1.9 ± 0.4, respectively. Semi-urban center presented significantly lower concentrations of ARA than the rural center. DHA concentration was significantly lower in the marginal-urban center, whereas long-chain PUFA n-3 and n-3 index were significantly higher in the semi-urban center. EPA, long-chain PUFA n-6, and UI did not present any significant difference among settings. No significant differences were found between sexes.

**Conclusions:** Even when low omega-3 biomarkers are consistently found in Guatemalan subjects, children from the Western Highlands presented half of the concentration values for DHA and EPA than those reported in the Pacific Coast. Even with such low values, differences among settings are still present for some variables.

**Keywords:** omega-3, omega-6, omega-3 index, unsaturation index, Guatemalan children
# CARBOHYDRATES FROM SOURCES WITH A HIGHER GLYCAEMIC INDEX DURING ADOLESCENCE: EVENING INTAKE IS RELEVANT FOR RISK MARKERS OF TYPE 2 DIABETES IN YOUNG ADULTHOOD

(1)Buyken, Anette; (2)Diederichs, Tanja; (2)Roßbach, Sarah; (3)Herder, Christian; (4)Roden, Michael; (5)Wudy, Stefan; (6)Nöthlings, Ute; (7)Alexy, Ute.

(1)Professor of Public Health Nutrition. Institute of Nutrition, Consumption and Health. Faculty of Natural Sciences. University Paderborn. Germany; (2)MSc. Nutritionist. DONALD Study Dortmund. Institute of Nutrition and Food Sciences. University of Bonn. Germany; (3)PhD. Senior Researcher. Institute for Clinical Diabetology. German Diabetes Center. Düsseldorf. Germany; (4)Professor. Director German Diabetes Center. Düsseldorf. Germany; (5)Professor. Pediatric Endocrinology & Diabetology. University of Gießen. Germany; (6)Professor. Nutritional Epidemiology. Institute of Nutrition and Food Sciences. University of Bonn. Germany; (7)PhD. Senior Researcher. DONALD Study Dortmund. Institute of Nutrition and Food Sciences. University of Bonn. Germany.

**Background and objectives:** A higher dietary glycaemic index (GI) and carbohydrates from higher GI food sources consumed during adolescence may affect subsequent type 2 diabetes risk. This study investigated whether morning or evening intakes during adolescence are relevant for insulin sensitivity, hepatic steatosis or low-grade inflammation in young adulthood.

**Methods:** Analyses were based on data from participants of an open cohort study (DONALD study) who had provided at least two 3-day weighed dietary records during adolescence (♀:9-15y, ♂:10-16y) and one blood sample in young adulthood (18-39y). Day-time specific data were used to estimate morning (before 11am) and evening (after 6pm) GI and glycaemic load (GL) as well as carbohydrate intake from low and higher GI sources [low-GI-CHO (GI<55) and higher-GI-CHO (GI≥55) in En%]. Multivariable linear regression models were used to analyse associations with insulin sensitivity (HOMA2%S in %) (N=252), hepatic steatosis index (HSI), fatty liver index (FLI) (both N=253), and a pro-inflammatory-score (N=249).

**Results:** Morning intakes during adolescence were not related to adult risk markers. In contrast, a higher evening intake of higher-GI-CHO (p=0.046) and GL (p=0.07) were related to lower levels of insulin sensitivity (adjusted means of HOMA2%S [95%-CI] in tertiles of higher-GI-CHO: T1: 84.1 [77.8;90.8], T2: 81.9 [75.9;88.0], T3: 76.7 [70.7;82.9]). A higher evening GI (p=0.003) and a higher evening intake of higher-GI-CHO (p=0.006) were associated with a higher HSI (adjusted means of HSI in tertiles of GI: T1: 29.3 [28.6;30.0], T2: 30.4 [29.7;31.2], T3: 30.6 [29.9;31.4]), while a higher evening intake of low-GI-CHO was related to lower indices (p=0.009). No prospective associations were observed with FLI or the pro-inflammatory-score in young adulthood.

**Conclusions:** Our data suggest that young adult insulin sensitivity and hepatic steatosis index are responsive to evening, but not morning adolescent intakes of higher-GI-carbohydrates

**Keywords:** glycaemic index, glycaemic load, daytime, adolescence, type 2 diabetes mellitus

# GLUCOSE AND INSULIN RESPONSES TO DIFFERENT INFANT FORMULAS AND BREAST MILK

(1)Shahkhalili Dulloo, Yassaman; (2)Beaumont, Maurice; (3)Sauser, Julien; (4)Frappier, Sonia; (5)Mace, Catherine.

(1)PhD. Nutrition Scientist. Institute of Nutritional Science. Nestlé Research Center. Lausanne. Switzerland; (2)MD. Medical director. Clinical Development Unit. Nestlé Research Center. 1000 Lausanne. Switzerland; (3)MSc. Biostatistician and data manegment. Clinical Development Unit. Nestlé Research Center. 1000 Lausanne. Switzerland; (4)MSc. Head of Clinical Project Management. Clinical Development Unit. Nestlé Research Center. 1000 Lausanne. Switzerland; (5)PhD. Head of Metabolic Health Department. Institute of Nutritional Science. Nestlé Research Center. 1000 Lausanne. Switzerland.

**Background and objectives:** Different infant formulas are available for infants who are not exclusively breastfed. The impact of such formulas on postprandial insulinemia and glycaemia is not known. As repeated blood sampling required for such studies is not feasible in infants, this study compared cow's milk-based formulas containing either intact (INTACT) or partially hydrolyzed (PH) protein, as well as a PH preterm formula (preterm infants ≥ 1.8-2.1 kg when discharged from hospital, DISCH), on postprandial glucose/insulin responses in healthy adults. A breast milk (BM) reference was studied in a subgroup.

**Methods:** Randomized, double blind, cross-over study in healthy volunteers consuming 600ml of 3 different infant formulas: INTACT (whey/casein ratio of 70/30, 1.9 g protein/100 kcal; 63 kcal/100 ml), PH whey (PHw, 1.96 g protein/100 kcal; 63 kcal/100 ml) and DISCH (PHw, 2.8 g/100 kcal; 73 kcal/100 ml) (n=34); and a BM subgroup (n=10). Formulas had similar fat and total carbohydrate (g/100 kcal): 5.1-5.2 and 10.5-11.6 (3.15 as maltodextrin in DISCH), respectively. Insulin and glucose were measured in venous blood collected after overnight fast, and at different intervals for 2 hr following a meal.

**Results:** INTACT and PHw groups had similar postprandial insulinaemia or glycaemia (Cmax and IAUC) that were not different from those of the BM group. The DISCH group had a higher (p<0.05) insulin response than all other groups, and a glucose response which was higher than those of INTACT and PHw groups (P>0.05), but not different from that of the BM group.

**Conclusions:** This study indicates that glucose and insulin responses to infant formulas with INTACT and PHw proteins are similar and not different from BM in adult subjects. Higher insulin and glucose responses to DISCH formula might be desirable for catch-up growth in low-birth weight infants. There is a
need to gain knowledge on the consequence of insulin and glucose responses to early diet and later metabolic health (i.e., metabolic programming)

**Keywords:** Protein, infant formula, glucose, insulin

**Conflict of Interest Disclosure:** All authors are employees of Nestec Ltd.

**Conclusions:** Our results suggest that the younger elderly ad-here more closely to the Mediterranean diet than the older elderly. Although additional studies are needed, the results are valuable in order to design tailored interventions in terms of public health policy that take into account the special characteristics and needs of the different age groups among older people.

**Keywords:** elderly, Mediterranean diet, oldest old

144/1114

DIET EVALUATION IN YOUNGER COMPARED TO
OLDER GREEK ELDERLY

(1)Mamalaki, Eirini; (2)Ntanasi, Eva; (3)Kosmidis, Mary H.; (4)Dardiotis, Efthimios; (5)Hadjigeorgiou, Giorgos M.; (6)Sakka, Paraskevi;

(6)Scarmeas, Nikolaos; (7)Yannakoulia, Mary.

(1)Msc. Nutritionist. Department of Nutrition and Dietetics. Harokopio University. Greece.; (2)Msc. Psychologist. Department of Nutrition and Dietetics. Harokopio University. Greece.; (3)PhD. Neuropsychologist. Lab of Cognitive Neuroscience. School of Psychology. Aristotle University of Thessaloniki. Greece.; (4)PhD. Neurologist. School of Medicine. University of Thessaly. Greece.;

(5)PhD. Neurologist. Athens Association of Alzheimer's Disease and Related Disorders. Greece.; (6)PhD. Neurologist. Department of Social Medicine, Psychiatry and Neurology. National and Kapodistrian University of Athens. Greece.; (7)PhD. Nutritionist. Department of Nutrition and Dietetics. Harokopio University. Greece.

**Background and objectives:** Given the rapid increase of older people, especially of the older elderly, the investigation of modifiable factors that can affect healthy ageing, including diet, is of paramount importance. The aim of the present study was to explore the adherence to an a priori defined Mediterranean dietary pattern, as well as the consumption of specific food groups, in younger elderly compared to older elderly adults in a large population-representative sample in Greece.

**Methods:** Participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD) were included. The sample consisted of adults ≥65 years old, and was stratified by age, i.e. those aged ≤75 years old and those aged >75 years old, representing the younger and the older elderly, respectively. Habitual diet during the previous month was assessed using a validated semi-quantitative food frequency questionnaire whereas adherence to the Mediterranean Diet was assessed by an a priori score, the MedDietScore.

**Results:** Among 1835 individuals, 1249 participants were ≤75 years old and 586 >75 years old. Energy and macronutrient intake did not differ by age group. The younger elderly consumed more fruits, vegetables, fish as well as coffee/tea and fewer refined cereals compared to the older elderly. However, when total energy intake, sex and years of education were entered as covariates, the association remained significant only for fruits, vegetables and coffee/tea (B=-0.098, p=0.023, B=-0.094, p<0.001 and B=-0.079, p=0.001, respectively). Furthermore, the younger elderly adhered more closely to the Mediterranean diet compared to the older elderly even when covariates were entered (B=-0.092, p<0.001).

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BABY FRIENDLY COMMUNITY INITIATIVE
(BFCI): FROM GUIDELINES TO IMPLEMENTATION – DEMONSTRATED RESULTS FROM WESTERN KENYA

(1)Ahoya, Brenda; (2)Kavle, Justine; (3)Gathi, Constance; (4)Obade, Mary; (5)Mwando, Rael; (5)Akeyo, Florence; (6)Straubinger, Sarah.

(1)Msc. Nutrition Advisor. Maternal Neonatal Child Health. Maternal and Child Survival Program/PATH. Kenya.; (2)2. PhD. Senior Nutrition Advisor. Maternal Neonatal Child Health. Maternal and Child Survival Program/PATH. Washington DC. USA.; (3)Bsc. Nutrition Officer. Maternal Neonatal Child Health. Maternal and Child Survival Program/PATH. Kenya.; (4)PhD. County Director of Nutrition Services. Nutrition. Ministry of Health. Kenya; (5)Bsc. County Nutrition Coordinator. Nutrition. Ministry of Health. Kenya; (6)BA. Senior Program Coordinator. Maternal Neonatal Child Health. Maternal and Child Survival Program/PATH. Washington DC. USA.

**Background and objectives:** According to Kenya Demographic and Health Surveys (KDHS), a two-fold increase in exclusive breastfeeding (EBF) was documented from 2008/9 to 2014 in Kenya. Yet, according to KDHS, only 22% of children 6-23 months are fed a minimum acceptable diet. Misconceptions and myths which impede exclusive breastfeeding, inadequate capacity of health workers & community health volunteers (CHVs) to support optimal maternal, IYCF and limited scale-up of community support groups (CSGs) are key challenges facing the country. Working hand-in hand with Ministry of Health, United States Agency for International Development Maternal and Child Survival program (MCSP), an integrated maternal, newborn child health and nutrition program, introduces high-impact interventions with the goal of ending preventable child and maternal deaths in Kisumu and Migori counties. MCSP rolled out Baby Friendly Community Initiative (BFCI), to address these challenges at the community level. The objective of this presentation is to share program experience of BFCI roll-out using recently developed national Ministry of Health guidelines.

**Methods:** The Ministry of Health BFCI implementation package (Implementation Guidelines, Training Package, Communication & Advocacy Material, External Assessment protocols) was developed with technical leadership and support from MCSP, UNICEF and other partners. Using the BFCI implementation guidelines, MCSP held sensitizations meetings, BFCI trainings, and formed mother to mother support groups (M2MGs),
and community support groups. Agriculture was incorporated
through the establishment of kitchen gardens.

**Results:** Eighty BFCI M2MSGs were created, and offered an opportunity for community health volunteers taught mothers on one topic from the national MIYCN counseling cards (i.e. initiation, importance of colostrum, positioning and attachment, resolving breastfeeding problems, and maternal nutrition), cooking demonstrations on complementary feeding using locally developed recipes and income generating activities. These mothers were taught to establish household kitchen gardens which were used to improve complementary feeding practices. MIYCN knowledge and skills of health workers and CHVs improved. Monitoring using the newly developed BFCI tools demonstrated improvement in IYCF indicators.

**Conclusions:** BFCI is a successful approach to improve MIYCN at the community level.

**Keywords:** community, baby friendly, breastfeeding, complementary feeding, agriculture

81 cm, range 57–101 cm. WC assorted by action-level as 46.8% (0); 22.4% (1) and 30.8% (2), compared to BMI classification as 51.3% (non-elevated), 32.7% (overweight), and 16.0% (obese). For WHtR, the median ratio was 0.58, range 0.41–0.73, with of 20 values (12.8%) of <0.5.

**Conclusions:** Severe low stature influences WC and WHtR in relation to international references. The median WC would have to be <71 cm for approaching the reference “healthy” WHtR of <0.5. Correspondence of WC action-levels and BMI categories was overdistributed toward higher WC at lesser BMI. Thus, the degree to which abdominal girth dimensions relate to visceral fat and metabolic risk in low-stature women merits further examination with ancillary measures.

**Keywords:** height, stunting, waist circumference, waist-to-height ratio, Guatemala

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## PARADOXES OF WAIST CIRCUMFERENCE IN SHORT-STATURE AND STUNTED GUATEMALAN WOMEN

(1)Kenkhuis, Marlou Floor; (2)Diaz-Jereda, Liza; (3)Garcia-Meza, Rosario; (4)Solomons, Noel W.

(1)Msc Student. Nutritionist. Centre for Studies of Sensory Impairment, Aging, and Metabolism (CeSSIAM). Guatemala;

(2)Nutritionist. Centre for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (3)Centre for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (4)Executive Director. Centre for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.

**Background and objectives:** With decreasing stature, anatomical alterations affecting waist circumference (WC) and derivative indices may modify conventional relationships and associations with intra-abdominal visceral adipose tissue. This is of interest to Guatemala, with the highest prevalence of childhood stunting in the Americas.

**Methods:** Anthropometric measures of clothing-adjusted weight, standing-height (without shoes) and WC (with skin contact) were recorded, 156 adult women aged >35 years, residents of the municipality of Nahualá in the Province of Sololá in the western highlands of Guatemala. The WC “action-levels” classification as normal (0), elevated (1) and excessive (2) from international reference were, respectively: <80, 80-88, and >88 cm. Conventional WHO cut-offs for body-mass index (BMI, weight (kg)/height (cm)²) for not-elevated, overweight and obesity were used. The criterion of <0.5 for “healthy” WC-to-height ratio (WHtR), as proposed by M. H. was adopted.

**Results:** Median stature women was 141 cm, with a range of 126-156 cm, with 78.2% stunted, and the respective values for BMI were 24.9 kg/m², range 16.8–40.7 kg/m². The median WC was

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## FEEDING BEHAVIOURS AS RISK FACTORS FOR UNDERNUTRITION IN INFANTS LIVING IN SEMI-URBAN COMMUNITIES OF THE VOLTA REGION, GHANA

(1)Arthur, Eunice; (1)McDonald, Matthew; (2)Agbozo, Faith; (3)Ellahi, Basma; (1)Mutoro, Antonina; (4)Wright, Charlotte; (4)Garcia, Ada.

(1)MSc. Human Nutrition. University of Glasgow. UK.; (2)MPhil Nutrition. Department of Family and Community Health. University of Health and Allied Sciences. Ghana.; (3)PhD. University of Chester. UK.; (4)PhD. Human Nutrition. University of Glasgow. UK.

**Background and objectives:** Infant malnutrition is a continuing concern in middle-income countries like Ghana but it is still not clear why some infants become malnourished and others do not. Feeding behaviour could be a contributing factor. Therefore we aimed to determine the association between child and maternal feeding behaviour and nutritional status of infants 6-24 months in the Volta Region of Ghana.

**Methods:** A convenience sample of caregiver-infant pairs (n=153, mean age 14 months) were recruited from Child Welfare Clinics in eight semi-urban communities in Ho, the Volta Region's capital. A structured interview was used to collect information on feeding behaviours (force-feeding, food interest and food refusal) and socioeconomic status. Height and weight were measured and converted into Z-scores using WHO reference data. Underweight, stunting and wasting were defined as weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) <-2 standard deviations respectively.

**Results:** Prevalence of underweight, wasting and stunting were 15%, 11.1% and 13.8% respectively. HAZ decreased with age (Mean (SD) 6-9 months -0.04 (1.5), 9-12 months, -0.43 (0.76), 12-24 months -0.86 (1.2), p=0.001). However, there was no association between socioeconomic status and infants' nutritional status. Moderate to high food refusal was reported for 30.6% and the food refusal scores were significantly correlated with force feed-
ing (spearman's r=0.2, p=0.01) and strongly inversely correlated with interest in food (r=-0.638, p<0.001). Over half of the mothers (54%) used some force feeding; the amount of force feeding was significantly inversely associated with WAZ (β=-0.19, p=0.004) and WHZ (β=-0.18, p=0.03). In a multivariable linear regression model including all behavioural variables adjusted for age, food refusal was significantly inversely associated with WAZ (β=-0.21, p=0.04), while both interest in food (β=-0.20, p=0.06) and force feeding (β=-0.19, p=0.06) showed borderline associations respectively, with similar findings for WHZ.

**Conclusions:** Child eating behaviour and the caregiver's response may be important factors in an infant's nutrition. In order to clarify whether force-feeding is a cause or a response to low weight, better measures of infant feeding behaviour are needed as well as trials of interventions to train mothers to feed responsively.

**Keywords:** feeding behaviour, nutritional status, force-feeding, malnutrition

**Background and objectives:** The correlation between changes in lean mass and changes in muscle function after resistance exercise intervention is not well established. Additionally, the effect of protein intake on these correlations is not known. Therefore, the aim of this study was to correlate the changes in lean mass with changes in muscle function (strength and functional capacity) according to protein intake in postmenopausal women after resistance training protocol.

**Methods:** Twenty-three postmenopausal women (63.2±7.8 years) were randomized in two groups: normal protein (NP) (n=12), who received a dietary plan with ~0.8 g protein·kg-1·d-1, and high protein (HP) (n=11), being recommended ~1.2 g protein·kg-1·d-1. Resistance training was performed 3 times/week and the intervention lasted 10 weeks. Muscle strength was assessed by handgrip strength (HGS) and one repetition maximum test. Func-

tional capacity was measured by the Short Physical Performance Battery, 6-minute walk test, 400-meter walk, 10-meter walk and time up and go test. Lean mass (total, arm and leg) was assessed by dual energy x-ray absorptiometry scanning and dietary intake was assessed by nine 24-hour food recall. Pearson's correlation was performed with delta (Δ) of lean mass (total, arm and leg) and Δ of the strength and functional capacity tests.

**Results:** Both groups increased similarly the total lean mass, arm lean mass, leg lean mass, strength and functional capacities tests after intervention. In HP group, Δ total lean mass correlated positively with Δ right HGS (r=0.64; p=0.033) and negatively with Δ time of 400-meter walk test (r=-0.61; p=0.046). In addition, Δ leg lean mass correlated negatively with Δ 400-meter walk test (r=-0.63; p=0.038), also in HP group. There were no significant correlations for NP group.

**Conclusions:** Changes in lean mass correlated with changes in strength and functional capacity tests only in postmenopausal women who consumed higher amounts of protein.

**Keywords:** Diet Intervention, Resistance Training, Muscle Function, Lean Mass.

**Background and objectives:** ApoE gene polymorphism has been reportedly associated with serum lipids and cognition. However, very few studies have explored the combined effects of ApoE gene polymorphism and gender on serum lipid profile with subsequent impacts on cognition in Chinese population.

**Methods:** A total of 1000 Chinese community dwellers aged 55 years and above were recruited in this cross-sectional study. Demographic information of the participants was collected using well designed self-administered questionnaires. The Montreal Cognitive Assessment (MoCA) test was employed to evaluate the cognitive status of the participants. Semi-quantitative food frequency questionnaire (FFQ) was used to obtain the dietary intake information. Fasting venous blood samples were taken for ApoE genotyping and serum lipid measurements.

**Results:** Significant gender differences in cognition, serum lipid profile and dietary fat-rich foods consumption were observed (p < 0.05). Cognition of the subjects was found to be associated with ApoE genotypes (p < 0.05). ApoE rs429358 and rs7412 variants demonstrated a significant effect on cognitive performance in the male subjects; especially within the attention and language ability domains as well as the total MoCA score (p < 0.05) respectively.

<footnote>(1)Nahas, Paula; (2)Rossato, Luana; (1)De Branco, Flávia; (3)Martins, Fernanda; (3)Souza, Aletéia; (4)Carneiro, Marcelo; (5)Orsatti, Fábio;</footnote>

<footnote>(6)De Oliveira, Erick.</footnote>

<footnote>(1)Nutritionist. School of Medicine. Federal University of Uberlândia (UFU). Brazil.; (2)MSc. Nutritionist. School of Medicine. Federal University of Uberlândia (UFU). Brazil.; (3)MSc. Physical educator. Exercise Biology Research Group (BioEx). Federal University of Triangulo Mineiro (UFTM). Brazil.; (4)Physical educator. Exercise Biology Research Group (BioEx). Federal University of Triangulo Mineiro (UFTM). Brazil.; (5)PhD. Physical educator. Department of Sport Sciences. Federal University of Triangulo Mineiro (UFTM). Brazil.; (6)PhD. Nutritionist. School of Medicine. Federal University of Uberlândia (UFU). Brazil.</footnote>

<footnote>(1)Yuan, linhong; (2)Zhen, Jie; (2)Huang, Xiaocheng; (2)Dong, Shengqi;</footnote>

<footnote>(3)Xiao, Rong.</footnote>

<footnote>(1)Capital Medical University. China.; (2)MD. Capital Medical University. Beijing. China.; (3)PhD. Capital Medical University. Beijing. China.</footnote>
**Conclusions:** Serum lipid profile and cognition of Chinese adults are significantly linked with gender and ApoE genetic polymorphism. The ApoE variant rs429358 is found to be notably associated with cognition in aging male Chinese population.

**Keywords:** Apolipoprotein E, Polymorphism, Gender, Lipid Profile, Cognitive Function, Geriatrics

**Conclusions:** Addressing malnutrition among SAC is an important contribution to academic success.

**Keywords:** School attendance, academic performance, malnutrition, school-age children, school feeding programmes

**Conflict of Interest Disclosure:** This work was partially funded by Prembaf Ghana, an affiliate of Prem Rawat Foundation. Dr. Esi Colecraft provided remainder funds. Prembaf Ghana did not have any role in design, analysis or writing of this article.

NUTRITIONAL STATUS AND ACADEMIC PERFORMANCE OF SCHOOL-AGE CHILDREN ENROLLED IN TWO FEEDING PROGRAMMES IN GHANA

**Background and objectives:** School-age children (SAC) are vulnerable to malnutrition which can negatively influence their academic attainment. There is limited information on relationship between nutritional status and school attendance and performance of school age children enrolled in school feeding programmes in Ghana. We assessed the association between current nutritional status of SAC participating in school feeding programmes, and attendance and performance in selected subjects in the past term.

**Methods:** This was a cross sectional study involving one hundred and eighty-two school age children enrolled in either the Ghana School Feeding Programme or a Non-government Feeding Programme. Haemoglobin concentration, and weight and height of all children were measured using standard procedures. Data on school attendance and performance of SAC were abstracted from class and academic performance registers. Independent t-test was done to assess the differences in school attendance and performance by nutritional status of SAC.

**Results:** About two-thirds (67.0%) of children were either stunted, underweight, or anaemic. No significant associations were observed between haemoglobin levels, body mass index (BMI)-for-age, or height-for-age z-score and either performance or school attendance in the past school term. Albeit, having at least one nutritional deficit was associated with lower scores in mathematics (mean difference = 4.62), English (mean difference = 4.49) and creative arts (mean difference = 4.50) in the past term than better nourished participants p< 0.05).

<footnote>(1) Owusu, Justina Serwaah; (2) Colecraft, Esi; (3) Aryeetey, Richmond;</footnote>

<footnote>(4) Vaccaro, Joan; (5) Darko, Daniel; (6) Huffman, Fatma.</footnote>

<footnote>(1) M.Phil. Doctoral Student. Dietetics and Nutrition Department. Florida International University. Miami. Florida. USA.; (2) DrPH. Lecturer. Department of Nutrition and Food Science. University of Ghana. Legon. Accra. Ghana.; (3) PhD. Senior Lecturer. School of Public Health. University of Ghana. Legon. Accra. Ghana.; (4) PhD. Adjunct Lecturer. Dietetics and Nutrition Department. Florida International University. Miami. Florida. USA.; (5) PhD. Research Fellow. Institute for Environment and Sanitation Studies. College of Basic and Applied Sciences. University of Ghana. Legon. Accra.; (6) PhD. RD. Professor and Chair. Dietetics and Nutrition Department. Florida International University. Miami. Florida. USA.</footnote>
# COVERAGE OF AND FACTORS ASSOCIATED WITH UPTAKE OF ROUTINE VITAMIN A SUPPLEMENTATION IN SUB-SAHARAN AFRICA

Gebremicael, Gebremedhin.

PhD. Epidemiologist. School of Public and Environmental Health.
Hawassa University. Hawassa. Ethiopia.

**Background and objectives:** In many sub-Saharan Africa (SSA) countries routine vitamin A supplementation (VAS) of children has been implemented as a short- to medium-term strategy to combat Vitamin A deficiency (VAD). However, in the subcontinent limited information is available regarding the coverage VAS. The objective of the current study is to assess the coverage of and factors associated with utilization of VAS for preschool children in SSA.

**Methods:** The analysis was made based on the data of 28 Demographic and Health Surveys conducted in SSA since 2010. The data of 152,406 children were included in the analysis. The VAS status in the preceding 6 months was determined based on the reports of the caregivers. Factors association with VAS uptake and its with common childhood ailments (diarrhea, cough, fever and anemia) were assessed using mixed effect logistic regression model.

**Results:** The coverage of VAS was 56.3% (95% CI: 56.1-56.5%). Among the 28 countries represented, six countries (Rwanda, Senegal, Malawi, Namibia, Serra Leone and Togo) achieved 80% or higher coverage; conversely, four countries (Guinea, Nigeria, Comoros and Benin) had less than 50% coverage. VAS coverage appears to vary across categories of children's age and socio-economic status. Children 6-11 months of age were less likely to have received VAS (48.6%) than older children (57.9%). The coverage in urban areas (63.9%) was significantly higher than that of rural areas (53.9%). Better maternal education and household wealth index were associated with higher uptake of VAS. VAS was modestly associated with increased odds of fever [AOR=1.20 (95% CI: 1.17-1.23)], diarrhea [AOR=1.16 (95% CI: 1.13-1.20)] and cough [AOR=1.23 (95%: 1.17-1.29)]. Conversely, in the supplemented children the odds of anemia was reduced by 10.8% (95% CI: 8.2-13.3%). All the associations translated into trivial effect sizes.

**Conclusions:** In SSA the coverage of VAS is unsatisfactory. VAS is associated with trivial increase in the occurrence of common childhood ailments.

**Keywords:** Vitamin A supplementation, Sub-Saharan Africa, DHS, childhood illness.

# USE OF 'DESIGN THINKING' TO ASSESS PARTICIPANT BEHAVIORS TO INFORM THE DESIGN OF A SMALL-QUANTITY LIPID-BASED NUTRIENT SUPPLEMENT (SQ-LNS) COMMUNICATION STRATEGY IN PASTO, COLOMBIA: FORMATIVE RESEARCH

**Background and objectives:** The SPOON project aims to design a social and behavior change communication (SBCC) strategy to prevent malnutrition among children aged 0-24 months through adequate infant and young child (IYC) feeding practices, including home-fortification with SQ-LNS. Design thinking brings together creative methods and graphic design to develop innovative assessment instruments. We aimed to understand participant context and behaviors using these instruments to inform the design of a SBCC strategy for SQ-LNS.

**Methods:** Research and design-thinking teams collaborated to develop unique data collection approaches for use as part of in-depth interviews. The three instruments (communication, free time, and community influence) were administered to a convenience sample of 12 key informants (KI), 28 caregivers (CG), and 10 health professionals (HP) to understand the best methods for reaching them with messaging and communication components. Exercises included elements of graphic design, pictures, and stories that helped respondents identify how they communicate, use free time, and seek advice regarding their children.

**Results:** The design thinking materials were well understood by participants, easy to administer, provided a change of pace and reprieve from open-ended questioning, and enhanced respondent participation. KI, CG, and HP differ in preferred communication methods. HP frequently use computers (100%), WhatsApp (90%), smartphones (80%) and television (80%), while KI and CG frequently use television (89%), radio (67%), and smartphones (44%). In their free time both KI and CG frequent parks (58%), churches (50%), and family homes (47%). In cases of child illness, respondents seek help at hospitals, while in cases of routine check-ups for growth and development they seek advice at health centers.

**Conclusions:** This innovative research technique allowed us to explore practical and available options for the delivery of the SBCC strategy for SQ-LNS. Design thinking instruments can be designed and included in formative studies to capture the local context and develop relevant interventions. In the Pasto setting, the SQ-LNS SBCC strategy should consider use of mass commu-

<footnote>(1)Gust Duque, Tiffany; (2)Cabrera, Leah; (3)Bernal, Ines Jennifer;</footnote>

<footnote>(4)Gonzalez, Wendy; (5)Bonvecchio, Anabelle; (2)Wheeler, Joseph Robert; (2)Varona, Michael; (4)Tumilowicz, Alison.</footnote>

<footnote>(1)MPH RDN. Global Nutrition Consultant. Global Alliance for Improved Nutrition (GAIN). Switzerland.; (2)MFA. SOMOS Design Thinking. USA.; (3)PhD. Consultant. Global Alliance for Improved Nutrition (GAIN). Switzerland.; (4)PhD. Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Switzerland.; (5)PhD. Directora. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México (INSP). México.</footnote>
nication such as television and radio, but also more personal and
targeted methods such as short message service (SMS) and com-
munity spaces to reach the various target populations.

**Keywords:** Small quantity - lipid-based nutrient supplement (SQ-LNS), Design thinking, formative research, Colombia

**Conclusions:** Determinants that affect the timely initiation, establishment and continuation of CF are varied and specific to Baja Verapaz. Findings provide a foundation to design further behavior change interventions that promote appropriate feeding practices among infants and young children.

**Keywords:** Infant and young child feeding practices, complementary feeding, formative research

INAPPROPRIATE TIMING OF INTRODUCTION
OF COMPLEMENTARY FOODS: PRACTICES AND
PERCEPTIONS AMONG MOTHERS OF INFANTS
AND YOUNG CHILDREN IN BAJA VERAPAZ,
GUATEMALA

**Background and objectives:** The WHO recommends exclusive breastfeeding, followed by the timely introduction of adequate complementary foods (CF) at 6 months of age. Little is known about the specific age of introduction of CF in some areas of Guatemala and the perceptions which guide this practice. We aimed to assess the feeding practices of 6-23 months old infant and young children from Baja Verapaz.

**Methods:** As part of the formative research for SPOON, which aims to design social and behavior change communication (SBCC) strategy to prevent chronic malnutrition and reduce the risk of future obesity in children aged 0-23 months, qualitative and quantitative research methods were used to explore infant and young child (IYC) feeding practices and perceptions in 3 municipalities of Baja Verapaz. In-depth Interviews were conducted with 9 mothers and 28 mothers completed a structured survey.

**Results:** A theme that emerged from the in-depth interviews is that mothers delayed the introduction of CF until the infant was 7 or 8 months old, or even beyond the first year of life. Nine of the surveyed mothers started CF at <6 months, 10 at 6 months, 4 at 7 months, and 5 at 8 months. First foods offered included bean-broth, corn-tortilla, potatoes and rice. Fussiness, perceived negative effects of food on children's health, such as diarrhea or indigestion, are some of the reasons for delaying CF. Mother's perceptions are inspired by negative experiences with CF among older siblings and advice from role models, such as grandmothers. Economic restrictions also played a role in delaying CF.

TOWARD A BETTER UNDERSTANDING OF AD-
HERENCE TO MICRONUTRIENT POWDERS: GEN-
ERATING THEORIES TO GUIDE PROGRAM DE-
SIGN AND EVALUATION BASED ON A REVIEW
OF PUBLISHED RESULTS

**Background and objectives:** To generate preliminary theories about factors affecting caregiver adherence to recommendations regarding point-of-use fortification of complementary foods with micronutrient powders (MNP).

**Methods:** A literature search was conducted to identify MNP studies and program descriptions using the following criteria: (1) MNP as an intervention provided to children 6 to 59 months of age at home, (2) content related to adherence, and (3) full text available in English. Thirty-seven studies and 6 program descriptions, representing 27 countries, were identified. We used thematic analyses to generate a comprehensive list of factors that could influence adherence, followed by content analysis to quantify the results. We developed a Program Impact Pathway to concretize the points at which the factors identified in our analysis affect the sequence of caregiver behaviours involved in the process of adherence.

**Results:** We identified 24 factors that pertain to child, caregiver and household levels that are reported to potentially influence adherence. The most influential factors, measured by number of documents reporting the factor having an effect, are: caregivers' perception of positive changes as a result of MNP use (n=14), caregivers' perceived child acceptance of food with MNP (n=12), and caregivers' knowledge of MNP's purpose (n=11). The majority of factors (n=22) identified by investigators can be characterized as pertaining to the "cultural" or "ideational systems".

**Conclusions:** The preponderance of knowledge and perception factors identified likely reflects an underlying assumption by investigators that caregiver behaviour is primarily driven by these two aspects, which may result in emphasis on questions related to these in research related to adherence. To achieve greater impact

<footnote>(1)Garcia-Meza, Rosario; (2)Montenegro-Bethancourt, Gabriela;</footnote>

<footnote>(3)Gonzalez, Wendy; (4)Bonvecchio, Anabelle; (5)Vossenaar, Marieke;</footnote>

<footnote>(6)Tumilowicz, Alison.</footnote>

<footnote>(1)MA. Nutritionist. Center for Studies in Sensory Impairment, Aging and Metabolism. Guatemala.; (2)PhD. Consultant. Research Institute and Higher Education on Health Sciences (IECIS) Rafael Landívar University. Guatemala City. Guatemala.; (3)PdD. Consultant. Global Alliance for Improved Nutrition (GAIN). Geneva. Switzerland.; (4)PhD. Chief of Community Nutrition. Centro de Investigación en Nutrición y Salud (CINyS). Instituto de Salud Pública de México. Cuernavaca. Morelos. México.; (5)PhD. Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM). Guatemala.; (6)PhD. Senior Technical Specialist Monitoring, Learning and Research. Global Alliance for Improved Nutrition (GAIN). Geneva. Switzerland.</footnote>

<footnote>(1)Tumilowicz, Alison; (2)Schnefke, Courtney H.; (3)Neufeld, Lynnette M.; (4)Pelto, Gretel.</footnote>

<footnote>(1)PhD. Senior Technical Specialist. Global Alliance for Improved Nutrition. Geneva. Switzerland.; (2)MPH. RD. RTI International. Research Triangle Park. North Carolina. USA.; (3)PhD. Global Alliance for Improved Nutrition. Geneva. Switzerland.; (4)PhD. Division of Nutritional Sciences. Cornell University. Ithaca. New York. USA.</footnote>
we need to adopt a more cultural-ecological perspective to inform
the design of programs that take into account a broader set of de-
terminants. New studies that assess the progress across the impact
pathway, particularly from caregiver adherence to biological out-
comes would be useful to guide future program evaluation design,
particularly where time or other constraints may limit potential to
measure biological outcomes. Greater understanding of caregiv-
ers' perceptions and other facilitators and constraints to adherence
is also critical for designing and monitoring behavior change strat-
egies to encourage MNP use.

**Keywords:** Micronutrient powders, adherence, infant and young child feeding, micronutrient deficiency, cultural-ecological

sponses. The spectrum of mothers' responses included techniques
to encourage eating, mixing MNP with different foods, hiding the
MNP packet, continuing to try or stopping MNP. Many caregivers
described an eventual acceptance of MNP by the child after re-
peated exposure. After adherence was established, some children
went on to develop negative behavioral and physical reactions. As
with initiation, the effects of these on continuing use were also me-
diated by mothers' beliefs and responses.

**Conclusions:** Like breastfeeding, complementary feeding, utilization of MNP involves a mother-child dyad. Further studies are needed to better define characteristics of mother-child interactions with MNP and differences in cross-cultural and intra-cultural manifestations. It is likely that current promotion efforts would benefit from reorienting key messages and activities to encompass strategies for MNP use as a dyadic interaction, as has been the case with breastfeeding promotion.

**Keywords:** Mother-child dyad, barriers and facilitators for MNP use, child responses to MNP, mother responses to child MNP reactions

THE MOTHER-CHILD DYAD IS A CENTRAL FACTOR IN POINT-OF-USE FORTIFICATION OF COMPLEMENTARY FOODS WITH MICRONUTRIENT POWDERS IN ETHIOPIA AND MOZAMBIQUE

**Background and objectives:** To identify household level barriers and facilitators for initiating and sustaining point-of-use fortification of complementary foods with micronutrient powders (MNP) in Ethiopia and Mozambique.

**Methods:** As part of a mixed-method process evaluation, we used the focused ethnographic technique of guided, in-depth interviews to generate narratives of caregivers' experiences and beliefs with respect to MNP, from initial "trying out" through continuation or discontinuation. Interviews were conducted in samples of 30 caregivers in Ethiopia and 60 caregivers in Mozambique by experienced, trained interviewers. Interviews were audio-recorded, transcribed and translated. Coding was facilitated with NVivo software, and a subsample of transcripts were double coded to check for coding bias. Higher level analyses were facilitated by the use of Excel spreadsheets and narrative text notes were compiled to illustrate themes.

**Results:** Child responses to foods prepared with MNP emerged as a central factor in mothers' experiences, assessments and use of MNP. Initial positive child behavioral and physical reactions facilitated continued MNP use. Mother-reported positive child reactions included acceptance of food, visual signs of enjoyment, and consuming the portion. Initial negative child reactions included refusing food, vomiting, crying. Negative child reactions did not always lead to stopping, but depended on mothers' beliefs and re-

INTRODUCTION TO OBESOGENIC FOODS AND
OVERWEIGHT IN CHILDREN AT 2 YEARS

**Background and objectives:** The prevalence of overweight (OW) has been increasing, even among young children. There is no conclusive evidence on the relationship between the development of childhood OW and the time of food introduction. Even if the relationship exists, it is not known if there is any peculiarity regarding the association of this condition and the type of food introduced. Studies show that complementary feeding (CF) starts early and with food not always nutritionally adequate. The purpose of the study was to find if there is a relationship between the time of introduction of obesogenic foods and the OW in children in early preschool age.

**Methods:** A historical cohort study of children attending municipal day care centers in Taubaté - State of São Paulo. Weight and height of children and information on the age of introduction of obesogenic foods were collected - using a self-filled questionnaire completed by those responsible. The classification of the nutritional status was by the body mass index z-score (zBMI), and children with zBMI ≥ 1 were classified as having OW. The data analysis was performed using the Stata statistical package, version 9.2. The study was approved by the Research Ethics Committee - School of Public Health/University of São Paulo.

<footnote>(1)Pelto, Gretel; (2)Tumilowicz, Alison; (3)Kjaer Pedersen, Kirstine;</footnote>

<footnote>(4)Schnefke, Courtney H.; (5)Vettersand, Julia; (6)Possolo, Edna;</footnote>

<footnote>(7)Hagos, Seifu.</footnote>

<footnote>(1)PhD. Division of Nutritional Sciences. Cornell University. Ithaca. New York. USA.; (2)PhD. Global Alliance for Improved Nutrition. Geneva. Switzerland.; (3)CandScientAnth. Consultant for Global Alliance for Improved Nutrition. Geneva. Switzerland.; (4)MPH. RD. RTI International. Research Triangle Park. North Carolina. USA.;</footnote>

<footnote>(5)Consultant for Global Alliance for Improved Nutrition. Geneva. Switzerland.; (6)Ministry of Health. Mozambique.; (7)PhD. Nutrition Unit. School of Public Health. Addis Ababa University. Ethiopia.</footnote>

<footnote>(1)Forster Lopes, Amanda; (1)Forster Lopes, Amanda; (2)Mara Braga Rocha, Elida; (3)Leone, Claudio.</footnote>

<footnote>(1)Msc. Nutritionist. Department of Maternal and Child Health. School of Public Health. University of São Paulo. Brazil.; (2)PhD. Nutritionist. Department of Nutrition. School of Public Health. University of São Paulo. Brazil.; (3)PhD. Pediatrician. Department of Maternal and Child Health. School of Public Health. University of São Paulo. Brazil.</footnote>
**Results:** The final sample consisted of 463 children, 50.5% female, with a mean age of 2.4 years. The prevalence of OW was high (27.5%). The mean age at the beginning of the introduction of obesogenic foods was 10.4 months (median: 10.0; SD: 4.9) and the mode was to start consuming these foods between 9 and 12 months. In this sense, it should be noted that almost half of the children (46.9%) started eating obesogenic foods between the ages of 3 and 9 months. It was found that the age at the beginning of the introduction of obesogenic food did not correlate with the BMI z-score (r= -0.07, 95% CI from -0.16 to 0.02, p=0.1021).

**Conclusions:** It was observed that there is an important prevalence of overweight children, however, in this population, no correlation with the time of introduction of obesogenic foods occurring early in age was observed.

**Keywords:** Obesity, Overweight, Preschool, Complementary feeding, Obesogenic Food.

**Further collaborators**

Ciro Bertoli. PhD. Pediatrician. Department of Maternal and Child Health. School of Public Health. University of São Paulo. Brazil.

**Background and objectives:** More than 200 million children <5 years of age in low/middle-income countries are at risk of not reaching their full developmental potential. This deficit has important economic consequences. Multiple factors contribute to this burden, including poor stimulation/learning opportunities, environmental toxins, and nutritional deficiencies, particularly dets deficient in animal source foods (ASF). However, few studies have explored longitudinal associations between household livestock ownership, child ASF consumption, and child development.

**Methods:** Child development was assessed using the Ages & Stages Questionnaire (ASQ-3, 3rd edition) in all 307 children age 23-38 months whose families were enrolled in a randomized trial of an intervention implemented over 33 months by Heifer Nepal in Banke, Nepal. Groups included (1) Intensive community development plus nutrition/livestock training ("full intervention") (2) Nutrition/livestock training alone, or (3) Control. Regular household visits were made to administer surveys/conduct child growth monitoring. The ASQ-3 was included in the 3rd visit (15 months after baseline). We used logistic regression to explore longitudinal associations between household livestock score, child ASF consumption (24-hr recall), and total ASQ-3 score in the bottom 25% of the distribution, adjusting for household wealth and maternal education.

**Results:** Mean number of ASFs consumed by children was low (Rounds 1-2-3, respectively): 0.51+/-0.73, 0.87+/-0.88, 0.90+/-0.92. Maternal education, household wealth and livestock ownership, participation in Heifer full intervention, and greater ASF consumption were significant or meaningful factors protecting children from an ASQ-3 score in the lowest quartile in unadjusted models. In multivariate models adjusted for wealth and maternal

<footnote>(1) Miller, Laurie; (2) Thorne-Lyman, Andrew; (3) Shrestha, Merina;</footnote>

<footnote>(4) Fawzi, Wafaie; (5) Joshi, Neena; (6) Lohani, Mahendra; (7) Rogers, Beatrice; (8) Kvestad, Ingrid; (9) Hysing, Mari; (10) Strand, Tor.</footnote>

<footnote>(1) Tufts University Department of Pediatrics. USA.; (2) ScD. Associate Scientist. Johns Hopkins Bloomberg School of Public Health. Baltimore. Harvard T.H. Chan School of Public Health. Boston. USA.; (3) M.D. Assistant Professor. Department of Pediatrics. Institute of Medicine. Kathmandu. Nepal.; (4) Richard Saltonstall Professor of Population Sciences. Professor of Nutrition, Epidemiology, and Global Health. Chair Department of Global Health and Population. Harvard School of Public Health. Boston. USA.; (5) Director of Programs. Heifer Nepal. Kathmandu. Nepal.; (6) Senior Vice-President of Programs. Heifer International. Little Rock. AR. USA; (7) Professor of Food Policy and Applied Nutrition. Friedman School of Nutrition Science and Policy. Tufts University. Boston. USA.; (8) Regional Center for Child and Youth Mental Health and Child Welfare. Uni Research Health. Bergen. Norway.; (9) Adjunct Professor. Centre for International Health. University of Bergen. Bergen. Norway.</footnote>
education, the sum of ASFs consumed during the three 24-hour
recalls collected over 15 months of observation significantly pro-
tected against a lower child development score (OR [95%CI]: 0.74
[0.60, 0.90]).

**Conclusions:** In this prospective longitudinal study, household livestock ownership, child ASF consumption, and participation in full Heifer intervention were each associated with better developmental testing results, even after accounting for socioeconomic status. Importantly, ASF consumption in early life (ages 8-23 months) was associated with later developmental performance. A trial to explore the potential benefits of ASF production and consumption on child development may be warranted.

**Keywords:** child development/Animal source food consumption/community intervention/livestock ownership

**Further collaborators**

Prakash Shrestha. Department of Pediatrics. Institute of Medi-
cine. Kathmandu Nepal.

144/1237

EMPOWERING PRESCHOOLERS TO BECOME
HEALTHY HABITS MESSENGER THROUGH SE-
LECTED COMMUNICATION CHANNELS: STORIES
MUSIC DANCE AND MAGIC TRICKS

(1)Zoumenou, Virginie; (2)Khan, Muhammad; (3)Ray, Dionne; (3)Jayne, Susan.

(1)PhD. Professor of Dietetics and Nutrition. Human Ecology Department. 1890 University of Maryland Extension Program. University of Maryland Eastern Shore. USA.; (2)MS. Faculty Research Assistant. 1890 University of Maryland Extension Program. University of Maryland Eastern Shore. USA.; (3)BS. Extension Nutrition Program Assistant. 1890 University of Maryland Extension Program. University of Maryland Eastern Shore. USA.

**Background and objectives:** Education has shifted away from simple dissemination of knowledge to using reinforcing communication channels (i.e. stories, music, dance, and magic tricks). Piaget's theory suggests that 2-7-year olds are in the pre-operational stage. The preschoolers think symbolically, use language, classify and represent objects by images and words. In addition, studies indicated that preschool children need appropriate outlets to express their energy in a positive and creative way. Two outlets, dance and music, should be considered among preschoolers. By adapting an established curriculum to include creative movement and music, preschoolers will have a better understanding of the arts while learning. Magic tricks are ageless and relevant across cultures.

The present program aimed to empower the preschoolers through stories, dance, music, and magic tricks to influence health behavior at school and at home and to measure the effectiveness of selected communication channels in reinforcing nutrition education among 3-5-year old preschoolers.

**Methods:** A two year longitudinal and experimental study design was used. Approximately 300 preschoolers (150/experimental group; 150/control group) participated at three Head START Centers. The Socio-ecological Framework was used. The curriculum, "Eagle Book Series" developed by the Center for Disease Control and Prevention (CDC) in response to the burden of diabetes among Native Americans was evaluated among African American children and implemented. Four lyrics with accompanying movement were created emphasizing each book's main message. The reading of each book was followed by music, dance, visual tools, and magic tricks. The effectiveness of the selected communication channels was measured using surveys and caregivers' feedback. Descriptive statistics (STATA 14), Paired-T-test, and content analysis were used.

**Results:** Approximately 300 preschoolers participated: 90% were African American. More than 80% of the participants in the experimental group understood the main message in each book and remembered the lyrics of the songs. Direct observation indicated that magic tricks increased their attention. Qualitative data indicated that preschoolers were able to share the messages at home with their siblings and caregivers.

**Conclusions:** Overall teaching an established curriculum using the right communication channels could make a difference in nutrition education among preschoolers. Preschoolers may affect the food decision making at home and at school.

**Keywords:** Preschoolers. communication channels. healthy behaviors.

144/1265

IMPAIRED NEURAL TUBE CLOSURE IN MICE
LACKING HIGH DENSITY LIPOPROTEIN RECEPTOR SR-BI IS ASSOCIATED WITH DEFICIENT
VITAMIN E UPTAKE AND ABERRANT GENE EXPRESSION

(1)Santander, Nicolas; (2)Quiroz, Alonso; (3)Perez, Druso; (4)Echeverría, Guadalupe; (5)Rigotti, Attilio; (6)Busso, Dolores.

(1)Biochemist. Ph.D. Department of Nutrition, Diabetes and Metabolism. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (2)Biochemist. Department of Nutrition, Diabetes and Metabolism. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (3)MSc. Center of Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (4)Industrial engineer. Center of Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (5)MD. PhD. Department of Nutrition, Diabetes and Metabolism & Center of Molecular Nutrition and Chronic Diseases. School of Medicine. Pontificia Universidad Católica de Chile. Chile.; (6)PhD. Department of Nutrition, Diabetes and metabolism. School of Medicine. Pontificia Universidad Católica de Chile. Chile.

**Background and objectives:** SR-BI is the main receptor for high density lipoproteins (HDL) and mediates the bidirectional
transport of lipids, such as cholesterol and vitamin E between these particles and cells. During early development, SR-BI is expressed in extraembryonic tissue, specifically in trophoblast giant cells in the parietal yolk sac. We previously showed that approximately half of the embryos in SR-BI-/- conceptuses fail to close the anterior neural tube and develop exencephaly, a perinatal lethal condition, suggesting that SR-BI-mediated transport of lipids is important for neural tube closure. In this work, we evaluated the role of SR-BI in embryonic vitamin E uptake during murine neural tube closure.

**Methods:** We generated heterozygous intercrosses, fed the dams with control chow or a vitamin E-supplemented diet, and obtained the embryos at E9.5, when the neural tube is normally recently closed. We determined the vitamin E content in embryos by HPLC, their reactive oxygen species (ROS) content with dichlorodihydrofluorescein, and gene expression by real time PCR.

**Results:** Our results showed that all the SR-BI-/- embryos analyzed had very low vitamin E content in comparison to SR-BI+/+ embryos. SR-BI-/- embryos with closed neural tubes (nSR-BI-/-) exhibited high reactive oxygen species (ROS), whereas SR-BI-/- with NTD (NTD SR-BI-/-) showed intermediate ROS levels between SR-BI+/+ and nSR-BI-/- embryos. Reduced expression of genes involved in neural tube closure was only found in NTD SR-BI-/- embryos. Maternal α-tocopherol dietary supplementation prevented NTD almost completely (from 54% to 2%, p<0.001), and SR-BI-/- embryos retrieved from those dams showed normal ROS and gene expression levels.

**Conclusions:** Altogether, our results suggest that SR-BI contributes in the provision of appropriate levels of vitamin E to the embryo, suggesting that an abnormal vitamin E uptake transfer from the mother to the embryo mediates NTD in this model.

**Keywords:** Vitamin E, neural tube, HDL, SR-BI

(1)Samith, Barbara; (2)Farias, Marcelo; (3)Villalobos-Labra, Roberto;

(4)Solari, Sandra; (5)Aguirre-Polanco, Carolina; (6)Rojas, María José.

(1)MSc. Nutritionist. UDA Health Sciences, Nutrition and Dietetics. Faculty of Medicine. Pontificia Universidad Católica de Chile. Santiago. Chile.; (2)MD. PhD. Division of Obstetrics and Gynecology. School of Medicine. Faculty of Medicine. Pontificia Universidad Católica de Chile. Santiago. Chile.; (3)BSc. PhD (c). Division of Obstetrics and Gynecology. School of Medicine. Faculty of Medicine. Pontificia Universidad Católica de Chile. Santiago. Chile; (4)MD. Department of Clinical Laboratories. School of Medicine. Faculty of Medicine. Pontificia Universidad Católica de Chile. Santiago. Chile; (5)PhD. Nutritionist. UDA Health Sciences, Nutrition and Dietetics. Faculty of Medicine. Pontificia Universidad Católica de Chile. Santiago. Chile.; (6)Nutritionist. Division of Obstetrics and Gynecology. School of Medicine. Faculty of Medicine. Pontificia Universidad Católica de Chile. Santiago. Chile.

**Background and objectives:** Long chain polyunsaturated fatty acids are an essential component for normal growth and development of the fetus and newborn. They participate in the control of cellular growth, metabolism, intercellular communication and gene expression, relevant for the physiopathology of metabolic and cardiovascular diseases. Docosahexaenoic (DHA) and eicosapentaenoic are the most known fatty acids from omega 3 family. It is known that low concentrations of omega-3 in humans is associated with disturbance of cellular metabolism, including neurological and visual development.

The objective of this study was to describe and compare fatty acid profile from normal and obese pregnant woman, then determine the relationship of mother's nutritional status with neonatal DHA levels.

**Methods:** 17 pregnant women (7 normal weight, 10 obese) were recruited at the Clinical Hospital of Pontificia Universidad Católica de Chile after Ethical Committee approval and informed consent. Mother venous blood was collected, and newborn's blood samples were obtained from the umbilical cord vein at the moment of delivery. Fatty acids profile was determined in red blood cell by liquid gas chromatography.

**Results:** There was a trend of higher omega-6/omega-3 ratio in newborn erythrocytes from obese pregnant women compared to controls (3.78±0.37 vs 2.81±0.09, respectively, p= 0.065, Mean±SEM). There was a negative association between newborn DHA levels and mother's body mass index (r²=0.7, p=0.037). A lower concentration of DHA occurred in neonatal erythrocytes from obese mothers, compared to those with normal weight for height and gestational age at the end of pregnancy (140.3±7.68 vs 103.9±6.83 mg/dL, respectively, p=0.016, Mean±SEM).

**Conclusions:** There is a decreased concentration of DHA in neonatal erythrocytes from obese women. Due to the relevance of DHA during pregnancy and development of the newborn, the results of the present study put in evidence the importance of considering an
adequate reposition of DHA in obese pregnant women. Nutritional status, fatty acid profile, DHA concentrations, their relationship and physiopathology mechanisms involved require further research.

**Keywords:** Long chain polyunsaturated fatty acids; Docosahexaenoic acid; obesity; newborn.

(¹)Wham, Carol; (²)North, Sylvia; (³)Wham, Carol; (⁴)Teh, Ruth; (⁵)Moyes, Simon; (⁶)Rolleston, Anna.

(¹)PhD. Associate Professor of Nutrition and Dietetics. Massey University. Auckland. New Zealand.; (²)MSc. Dietitian. Massey University. Auckland. New Zealand.; (³)PhD. Associate Professor of Nutrition and Dietetics. Massey University. Auckland. New Zealand.; (⁴)PhD. Senior Lecturer. School of Population Health. University of Auckland. New Zealand.; (⁵)MSc. Data Manager/Analyst. School of Population Health. University of Auckland. New Zealand.; (⁶)PhD. Senior Research Fellow. School of Population Health. University of Auckland. New Zealand.

**Background and objectives:** A high prevalence of nutrition risk was previously reported for Māori (49.4%) and non-Māori (38.3%) octogenarians in in Life and Living in Advanced Age a Cohort Study New Zealand. Māori are the indigenous people of Aotearoa, New Zealand comprising 14% of the total population. This study aimed to investigate the association between domains of nutrition risk with hospitalisations and mortality at five years follow up.

**Methods:** Sociodemographic and health characteristics were obtained by face-to-face interviews at baseline. The validated screening tool, Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II) was used to evaluate nutrition risk according to three domains of risk: 1) “Weight Change”, 2) “Dietary Intake”, and 3) “Factors Affecting Intake.” Five years from inception, participant hospitalisations and mortality were matched using National Health Index numbers. Survival analyses were performed to examine independent associations between nutrition risk scores from the three domains of SCREEN II with five year all-cause hospital admissions and mortality.

**Results:** Adjusted for age, gender, socioeconomic deprivation, education level, previous hospital admission, comorbidities and activities of daily living, lower nutrition risk in the “Dietary Intake” domain was associated with reduced hospitalisations and mortality [Hazard Ratios (HR) (95% CI) 0.97 (0.95-0.99), p=0.009 and 0.91 (0.86-0.98), p=0.005 respectively] and the “Factors Affecting Intake” domain was associated with mortality [HR, (95% CI) 0.94 (0.89-1.00) p=0.048] for Māori but not non-Māori.

**Conclusions:** Nutrition risk measured from “Dietary Intake” domain of SCREEN II was significantly related to all-cause hospitalisations and mortality for older Māori and suggests dietary inadequacy and potential lifestyle influences of diet may be the most important factors associated with nutrition risk for Māori.

**Keywords:** octogenarian, nutrition risk, hospitalisations, mortality, New Zealand

**Further collaborators**

Ngaire Kerse MD PhD. Professor of General Practice and Primary Health Care. Head of School of Population Health. University of Auckland. New Zealand

(¹)Klevor, Moses Kwashie; (²)Asomboya, Mirabel; (³)Setorglo, Jacob;

(⁴)Pereko, Kingsley.

(¹)PhD. Lecturer. Department of Clinical Nutrition and Dietetics. School of Allied Health Sciences. University of Cape Coast. Cape Coast. Ghana.; (²)MPH. Department of Community Health. Ensign College of Public Health. Kpong. Ghana.; (³)PhD. Senior Lecturer. Department of Medical Biochemistry. School of Medical Sciences. University of Cape Coast. Cape Coast. Ghana.; (⁴)Pereko. PhD. Senior Lecturer. Department of Community Medicine. School of Medical Sciences. University of Cape Coast. Cape Coast. Ghana.

**Background and objectives:** The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life and appropriate complementary feeding from 6 to 24 months of age, with continued breast breastfeeding. Optimal feeding practices promote the growth, development and health of infants. The aim of this study was to assess infant feeding practices amongst mothers with babies 6-24 months old in the Adentan Municipality of the Greater Accra Region of Ghana.

**Methods:** This was a descriptive cross-sectional study among 391 mothers. Data were collected through face-to-face interviews. Bivariate analysis was used to evaluate the associations between independent variables and infant feeding practices.

**Results:** The age range of women was 17-45 years; half of the mothers had secondary or vocational education and were self-employed. About 98% of the children had normal birth weight (≥ 2.5kg). Most women had more than 4 antenatal visits (81%), delivered at a government (54%) or private (37%) health facility with skilled attendance (90%), and were informed about the importance of EBF at least once during antenatal services (92%). About 70% of mothers initiated breastfeeding within 30 minutes to 1 hour after delivery, 59% exclusively breastfed their infants for the first 6 months postpartum, and 46% initiated complementary feeding at 6 months postpartum. Most mothers fed their children 3-4 times (72%) and gave at least one snack in a day (70%).
Antenatal clinic attendance (p = 0.003), skilled attendance at delivery (p = 0.003), place of delivery (p < 0.001) and time of breastfeeding initiation (p < 0.0001) were positively associated with EBF for the first 6 months postpartum. None of the independent variables were significantly associated with timely introduction of complementary foods at 6 months postpartum.

**Conclusions:** The rate of EBF was low among respondents. Less than half of respondents initiated complementary feeding at 6 months postpartum. Place of delivery, time of breastfeeding initiation, skilled attendance at delivery and antenatal clinic attendance were significantly associated with EBF for the first 6 months postpartum.

**Keywords:** Newborn, breastfeeding initiation, exclusive breastfeeding, complementary feeding, Ghana

weight less than 43 kg. PMNS was significantly and positively associated with fetal growth and offspring HAZ at birth and 2 years. For each 1 standard deviation (SD) increase in maternal height, offspring HAZ at 2 years increased by 0.30 SD. A 1SD increase in maternal preconception weight or 1 SD increase in BMI was associated with an increase in HAZ at 2 years of 0.23 (p < 0.001) and 0.06 SD (p < 0.1), respectively. In structural equation modeling, the indirect effects of mother's height, weight and BMI on HAZ at 2 years were 14%, 31% and 86% of the total effect (through impact on fetal growth and size at birth). Women with pre-pregnancy height < 150 cm, a weight less than 43 kg or BMI < 18.5kg/m2 had 2.7 (2.1-3.6), 2.1 (1.6-2.7) and 1.2 (0.96-1.7) times, respectively, the risk for stunting at 2 years of age.

**Conclusions:** Maternal preconception nutritional status is a critical indicator of offspring linear growth and risk of child stunting across the first 1000 days.

**Keywords:** preconception, nutrition, stunting, Vietnam

## ROLE OF PRECONCEPTION NUTRITION IN OFFSPRING GROWTH AND RISK OF STUNTING ACROSS THE FIRST 1000 DAYS IN VIETNAM

(1)Young, Melissa; (2)Hong Nguyen, Phuong; (3)Gonzalez Canaova, Ines; (4)Addo, Yaw; (5)Tran Mai, Lan; (6)Nguyen, Son; (7)Martorell, Reynaldo; (8)Ramakrishnan, Usha.

(1)PhD. Hubert Department of Global Health. Emory University. USA; (2)MD. PhD. Research Fellow. International Food Policy Research Institute. USA.; (3)PhD. Post Doctoral Fellow. Hubert Department of Global Health. Emory University. USA.; (4)PhD. Assistant Professor. Hubert Department of Global Health. Emory University. USA.; (5)BS. Research Analyst. Thai Nguyen University of Pharmacy and Medicine. Vietnam.; (6)MD, PhD. Pediatrician. Thai Nguyen University of Pharmacy and Medicine. Vietnam.; (7)PhD. Professor. Hubert Department of Global Health. Emory University. USA.

**Background and objectives:** There is growing interest in the health implications of preconception maternal nutritional status (PMNS), but gaps remain. We examine associations between PMNS and offspring growth during the first 1000 days.

**Methods:** This is a secondary analysis using prospective data from women who participated in PRECONCEPT, a randomized controlled trial of preconception micronutrient supplementation in Vietnam. Women/children pairs with information on preconception height/weight, at least one ultrasound measurement before 30 weeks (head and abdomen circumferences, biparietal diameter, and femoral length), singleton birth size and child length at two years were included in this analysis. We used structural equation and multivariate linear and logistic regression models to examine associations between three PMNS indicators (weight, height, BMI) on offspring growth (height for age Z-score, HAZ), and risk of stunting (< -2 HAZ) at 2 years of age. Models were adjusted for child age, gender, gestational weight gain, maternal education, socioeconomic status and treatment group.

**Results:** Of the 1,409 women included in study, a third of the women had a prepregnancy BMI <18.5kg/m2, height < 150cm or

## DIETARY INTAKE, WEIGHT GAIN AND SLEEP PATTERNS IN YOUNG CHILDREN PREDISPOSED TO OVERWEIGHT

(1)Rangan, Anna; (2)Zheng, Miaobing; (3)Olsen, Nanna Julie; (4)Rohde, Jeanett Friis; (5)Heitmann, Berit Lilienthal.

(1)PhD. Associate Professor. Discipline of Nutrition and Dietetics. The University of Sydney. Australia.; (2)PhD. Dietitian. Discipline of Nutrition and Dietetics. The University of Sydney. Australia.; (3)PhD. Nutritionist. Research Unit for Dietary Studies. The Parker Institute Bispebjerg and Frederiksberg Hospitals. the Capital Region. Copenhagen. Denmark.; (4)MSc. Nutritionist. Research Unit for Dietary Studies. The Parker Institute. Bispebjerg and Frederiksberg Hospitals. the Capital Region. Copenhagen. Denmark.; (5)PhD. Professor. Research Unit for Dietary Studies. The Parker Institute. Bispebjerg and Frederiksberg Hospitals. the Capital Region. Copenhagen. Denmark.

**Background and objectives:** Poor sleep patterns have been shown to be a contributor to obesity in both children and adults. Less evidence is available during toddlerhood period and among those with higher obesity risk. The objective of this study was to examine the relationship between sleep patterns and body weight development in a group of young obesity-predisposed children, and to assess whether dietary factors affect this relationship.

**Methods:** Participants included 368 Danish children aged 2-6 years from the Healthy Start Study, a 1.2 year randomised controlled intervention trial. Sleep habits were measured using a 7-day sleep diary, and dietary intake was assessed using 4 day food records at baseline. Multivariate linear regression with adjustment for confounders was used to assess the association of sleep duration and sleep variability with 1.2 year changes (Δ) in BMI z-score from baseline to follow-up. Energy intake was tested as a mediator in this relationship. Dietary factors associated with sleep duration and sleep variability were also examined.
**Results:** A significant inverse association was observed between nighttime sleep duration and ΔBMI z-score (β=-0.090, P=0.046) with a 1-hour difference in sleep being associated with a 239 kJ energy intake. Energy intake was found to mediate this association with all macronutrients contributing to this effect. Sleep variability, although not associated with ΔBMI z-score, was associated with several dietary factors including higher consumption of added sugars and sugary beverages and lower consumption of fruit and vegetables.

**Conclusions:** Shorter sleep duration, mediated by energy intake in early in life, seems a risk factor for weight gain among young obesity-predisposed children. Additionally, dietary factors contribute to sleep variability during childhood.

**Keywords:** children, obesity, sleep duration, sleep variability, diet

144/1321

HOW NUTRITION AND ENVIRONMENTAL INFLUENCES SHAPE CHILD DEVELOPMENT DURING THE FIRST 1000 DAYS: DIRECT AND INDIRECT ASSOCIATIONS IN FOUR PROSPECTIVE COHORTS OF YOUNG CHILDREN IN AFRICA

(1)Prado, Elizabeth; (2)Adu-Afarwuah, Seth; (3)Ashorn, Per; (1)Hess, Sonja Y; (4)Lartey, Anna; (5)Maleta, Kenneth; (6)Ouédraogo, Jean Bosco; (1)Dewey, Kathryn G; (7)Study Group, The iLiNS Project.

(1)PhD. Department of Nutrition. University of California Davis. USA; (2)PhD. Department of Nutrition and Food Science. University of Ghana. Ghana; (3)MD/PhD. Center for Child Health Research. University of Tampere School of Medicine and Tampere University Hospital. Finland.; (4)President. IUNS 2013-2017.; (5)Md/PhD. School of Public Health and Family Medicine. University of Malawi College of Medicine. Malawi; (6)PhD. Institut de Recherche en Sciences de la Santé/DRO. Burkina Faso; (7)The iLiNS Project.

**Background and objectives:** As countries mobilize to reach Sustainable Development Goal 4.2, to ensure "access to quality early childhood development" (ECD), evidence is needed to inform the design of interventions. Previous reviews have identified 44 risk factors for poor ECD in low- and middle-income countries. Our objective was to examine associations of these risk factors with ECD in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n=1023), Malawi (n=675 and 1385), and Burkina Faso (n=1122).

**Methods:** In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In all cohorts, motor and language development were assessed at 18 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors hypothesized to be associated with ECD.

**Results:** Out of 42 indicators of 34 risk factors examined, six indicators of five factors were consistently associated with

18-month language and/or motor development in three or four cohorts: children's variety of play materials, activities with caregivers, dietary diversity, linear and ponderal growth, and hemoglobin/iron status. Caregiving and child factors showed stronger associations with child development, as compared to environmental and maternal factors, even when considering both indirect and direct effects. At age 18 months, children from low socio-economic status (SES) households had fallen behind those from higher-SES households in language development in all four cohorts and in motor development in two cohorts, highlighting the importance of child development interventions targeting this early period. Associations between SES and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child bio-medical conditions. This pattern for motor development was not consistent across cohorts.

**Conclusions:** Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status. Interventions to reduce socioeconomic disparities in ECD should target caregiving behavior.

**Keywords:** language development, motor development, caregiving, growth, iLiNS Project

**Conflict of Interest Disclosure:** Funded by the Bill & Melinda Gates Foundation with additional funding from USAID through FANTA-III/FHI-360. The spouse of SYH works for the Bill & Melinda Gates Foundation. All other authors declare that we have no conflict of interest to disclose.

**Further collaborators**

Souheila Abbeddou, Mary Arimond, Ulla Ashorn, Jaden Bendabenda, Kenneth H. Brown, Emma Kortekangas, Brietta M. Oaks, Eugenia Ocansey, Harriet Okronipa, Anna Pulakka, Jérôme W Somé, Christine Stewart, Robert Stewart, Stephen A. Vosti, Elizabeth Yakes Jimenez

144/1324

CAREGIVER PERSPECTIVES AND FACTORS ASOCIATED WITH UTILIZATION OF A HOME FORIFICATION OF COMPLEMENTARY FOODS PROGRAM

(1)Young, Melissa; (2)Mehta, Rukshan; (3)Gosdin, Lucas; (3)Kekre, Priya; (4)Verma, Pankaj; (3)Larson, Leila; (5)Webb Girard, Aimee; (6)Ramakrishnan, Usha; (4)Srikantiah, Sridhar; (6)Martorell, Reynaldo.

(1)PhD. Assistant Professor. Hubert Department of Global Health. Emory University. USA.; (2)MSW. Hubert Department of Global Health. Emory University. USA.; (3)MPH. Hubert Department of Global Health. Emory University. USA.; (4)MD. CARE-India. Bihar. India.; (5)PhD. Assistant Professor. Hubert Department of Global Health. Emory University. USA.; (6)PhD. Professor. Hubert Department of Global Health. Emory University. USA.

**Background and objectives:** Home fortification of multiple micronutrient powders (MMP) is a globally recommended strat-