SENSORY ANALYSIS OF OLIVE OIL FROM CATA-
MARCA. REGIONAL EXPERIENCE FOR THE TAST-
ING PANEL

Molina, María Sol.

Magister. Chemical engineer. National Institute of Agricultural Technology. National University of Catamarca-Faculty of Health Sciences.

The province of Catamarca, located in the olive-farming region of the Argentinian northwest, produces principally high quality olives from which to extract extra virgin olive oil (EVOO) using a two-phase technology. It possesses varied agricultural and ecological areas which give origin to olive oils with characteristic sensory profiles obtained from different varities grown according to the degree of the ripening process of the olives. Although the characteristics of the product are defined by the combination of agro-nomic and industrial factors, qualified and timely interventionin the fundamental stages of the olive chain of value is a key to define the sensory attributes of the product and to assure the degrees of fruit taste with their different shades of flavor as well as the balance between bitterness and spiciness. The Test Panel method is an effective tool to establish distinguishable features among olive oils from the assessment of their attributes by resorting to the senses of selected and trained tasters. In the commercial classification of olive oils, according to the International Olive Council (IOC), fruit tastes together with the absence of defects determines whether a sample of olive oil is extra virgin or not. The determination of the characteristic and representative attributes of the types of extra virgin olive oil from Catamarca and the region as well as their consistency are necessary elements to differentiate them and give them added value. The Tasting Panel known as "Catadores del Valle" in coordination with the National Institute of Agricultural Technology (INTA) is the official panel recognized by IOC and constitutes a key instrument for the control, monitoring and quality improvements of types of olive oil extracted in the region. This panel was started in the year 2000 as an initiative of the private sector and in coordination with the School for sight-impaired people from Catamarca. The panel has worked without interruption and with the aim of achieving the technical level required internationally in a context of integration and support towards people with different capacities. The results obtained from the analyzed samples show the high quality and the sensory touches of the varities of olive oil produced in the region. They are elaborated mainly with Arbequina base which provides them with delicate fruit flavors with touches of apple, banana and dried fruits. Other typical varities grown in the area are Coratina, Barnea, Frantoio, Camomile and Arauco. They produce olive oils with great personality, from medium to intense fruit flavors which are ideal to intensify or complement other types of oil. All these provide consumers with a great diversity of high quality olive oils with distinctive sensory profiles. The EVOO possesses excellent characteristics of flavor and scent all of which in a context of harmony, complexity and persistence contribute to an appetizing gastronomy.

**Keywords:** Extra virgin olive oil, Sensory Panel Test, Catamarca

OLIVE OIL AS FUNCTIONAL FOOD. SCIENTIFIC
EVIDENCE IN HEALTH

Barrionuevo, Omar T.

National University of Catamarca. Faculty of Health Sciences (UNCA-FCS). Argentina.

Functional food is defined as all food consumed habitually as part of a normal diet, which independent from the provision of nutrients, contain biologically active components with the capacity to affect positively a particular biological activity, reducing the risk of diseases. The component which makes some food functional can be either a macro nutrient with a determined physiological effect, or an essential micro nutrient eaten in a dose above the recommended intake. It can also be a non-essential element of the food or a component without any nutritional value. The strategies of functional food production can be varied but these components will always come in the form of some food. In the case of olive oil (OO) both principal components as well as others which are present in small concentrations have been included in this category. It is important to remark that not all OO, considered to be the Mediterranean Diet fat, are equally beneficial to health. The scientific community has unanimously highlighted the beneficial nutritional effects and the healthy attributes of extra virgin olive oil (EVOO) both for its lipid part and its antioxidants. Among the principal components the most important is oleic acid (C18:1, ω-9) whose healthy properties have been recognized by the Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA). Among the secondary components with bioactive character the phenolic compounds are highlighted by abundant scientific evidence. Nowadays it is also known that the special healthy attributes of OO can be found in the combined and synergic effect between principal and secondary components all of which are present in the fruit, the olives. Consequently, the most recommended olive oil for health will be the one with the highest quality. In this sense, EVOO is the one with the higher potential as a result of the scientific evidence provided by nutritional epidemiology which highlights its importance in relation to the health of its consumers. The beneficiary effects of olive oil as a functional food in dealing with different pathologies would not be merely due to its content of oleic acid but also due to the participation of polyphenols which act as a defense antioxidant mechanism against the constant production of Free Radicals (FR). These are highly unstable and reactive components which attack other cell components causing harm to proteins, lipids and DNA implied in the origin and evolution of chronic degenerative diseases. There is no data about the secondary components with a bioactive nature of the varities of olive oil obtained in Catamarca, which is considered to be the main producer province of OO in Argentina. All this makes it necessary to carry out more research about the phenolic portion present in olive oils from Catamarca so as to be able to design a functional oil enriched with these bioactive components, in the appropriate doses for the prevention of diseases associated to old age and oxidative stress.

**Keywords:** Functional food - Olive oil - Oleic acid - Polyphenols
# CONSUMPTION OF OLIVE OIL IN A HEALTHY DIET

Cornatosky, María Alejandra.

Magister. Universidad Nacional de Catamarca.Argentina.

In a diet fats are the principal source of energy and their bio-
logical properties are defined by the quality of the fatty acids that
constitute them which has a deep influence in health. In the last
decade improvements and recommendations in the field of fats
and fatty acids in human nutrition have been produced. They are
based on a significant body of scientific evidence derived from ep-
idemiological and clinical studies as a result of the growing glob-
al incidence of chronic-degenerative diseases related to changes
in diet and life style which currently constitute the main cause of
mortality and incapacityat world level. The 2008 FAO/WHO Ex-
pert Consultation defined nutritional objectives with minimum
and maximum intakes of total fats and fatty acids in adults. In re-
lation to mono-unsaturated fatty acids (MUFA) found in lots of
items of food, oleic acid (C18:1,ω-9), a major component of olive
oil, is the most recommended to be consumed in any diet due to
its beneficial effects especially in the extra virgin quality. This is
the result of its high oleic content and its contribution in minor
bioactive components such as polyphenols. The studies which
more strongly support the healthy cardio effects of MUFA have
been conducted in the context of a Mediterranean Diet based on
the habitual consumption of vegetables, fruit, legumes, fish, dried
fruit, skimmed dairy products, moderate consumption of red wine
and olive oil as the main source of fat in diet (20% or more in
the total energetic intake). In Argentina, although the availability
and consumption per capita of olive oil has been growing in the
last 20 years, it is still marginal in relation to other seed oils and
compared with the main consuming countries. It can be found in
only 10.5% of homes and it is used mainly as a flavoring (90%) in
middle income segments. From a nutritional point of view virgin
olive oil is the natural juice of olives and is extracted by physical
processes which make it different from the rest of eatable vege-
table oils which are obtained by chemical processes of refining.
Although it is mostly recommended to be used "raw" to preserve
all the organoleptic and nutritional properties derived from the
crushed fruit, it is also adequate to cook at high temperature with-
out decomposing, which means it keeps its chemical structure in
normal conditions. All this makes olive oil suitable for gastronom-
ic preparations such as stir-frys, barbecues, stews or fried dishes.
Our relation with food is complex as it is part of culture, consum-
ers behaviors vary significantly among countries and among seg-
ments of consumers. The popularization of the properties of olive
oil together with a change in habits which lead to a more balanced
and healthy diet is a way to encourage local consumption.

**Keywords:** Mono unsaturated fatty acids – Olive oil – Diet – Health

ANTIOXIDANTS AS BIOACTIVE INGREDIENTS IN
FUNCTIONAL FOODS. A REAPPRAISAL

Nunez Selles, Alberto J.

PhD. Dr Sc. Reserach Director. National Evangelical University,
Dominican Republic.

Nutritional antioxidant supplementation has been considered
largely of secondary importance for human health in medical
practice. However, oxidative stress caused by the body imbalance
of oxygen and nitrogen reactive species (ROS/RNS) may induce
gene-regulatory effects and influence signal transduction path-
ways1. Therefore the use of antioxidants as active ingredients in
functional foods, nutraceuticals and food supplement formula-
tions is demanding increasingly a reappraisal of its effectiveness
not only in order to avoid diseases as part of a healthy life style
together with a balanced diet and physical exercise but as part of
adjuvant therapies in chronic degenerative diseases. Oxidative
stress caused by the body imbalance of oxygen and nitrogen re-
active species (ROS/RNS) may induce gene-regulatory effects and
influence signal transduction pathways. Our previous findings on
the effect of a mango bark extract (Mangifera indica L.) showed a
dose-dependent inhibition of tumor necrosis factor (TNFα) and
nuclear factor κB (NfκB) both in vitro and in vivo indicating that
its antioxidant effect was down-regulated by these factors2. Oth-
er transcriptional factors (JAK 1/2, STAT 3, AKT, MAPK, IKK)
and the VEGF have been also inhibited by mangiferin, the major
component of the mango extract3. It has been described recently
that the Antioxidant Responsive Element (ARE) acts as specific
enhancer of antioxidant enzymes regulation through the tran-
scriptional factor Nfr24. This factor may exert an autoregulatory
effect on mafG and BSV1 transcriptional regulation5. These effects
are underlying the human antioxidant defense pathways and may
explain the potential benefits of antioxidants as bioactive princi-
ples in functional foods and food supplements as well.

Bibliography

1. Núñez Sellés AJ (2016) "Antioxidant Therapies Through Signal Transduction and Gene-Regulatory Pathways" XXV SILAE Congress, 21-25 Sept, 2016, Modena, Italy.

2. Nuñez Selles, Galego Vila D, Rastrelli L. (2015) “Mango Polyphenols and Its Protective Effects on Diseases Associated to Oxidative Stress” Curr Pharmac Biotechnol 16, 272-280.

3. Núñez Sellés AJ, Daglia M, Rastrelli L (2016) “The potential role of mangiferin in cancer treatment through its immunomodulatory, anti-angiogenic, apoptopic, and gene regulatory effects” Biofactors 42(5), 475-491.

4. Kim YC, et al (2001). "Hemin-induced Activation of the Thioredoxin Gene by Nrf2. A differential regulation of the antioxidant responsive element by a switch of its binding factors" J Biol Chem, 276, 18399-406.

5. Jyrkkanen HK, et al (2011). "Novel insights into the regulation of the antioxidant response element mediated gene expres-
sion by electrophiles: induction of the transcriptional repressor BACH1 by Nrf2" Biochem J, 440,167-174.

**Keywords:** Oxidative stress, antioxidants, functional foods, nutraceuticals, antioxidant therapy

## FUNCTIONAL FOODS FOR THE ELDERLY - SPECIAL CONSIDERATIONS

New strategies are needed to face the current panorama in world population fast ageing. Old age generally involves specific situations that interfere in the aspects of food intake and nutrition such as a) decrease of availability of financial resources, making the access to healthy and functional foods more difficult; b) decrease or loss of autonomic decision, influencing choices of what eat and how to prepare it; c) sensory losses (vision, flavor and taste) that interfere with the level of food intake and the amount of added condiments (salt and sugar, mainly); d) physiological losses (masticatory, enzymatic, gastro-intestinal) that lead to nutrient decreased intake, digestion and absorption. The inclusion of functional foods in diet is currently discussed as a strategy to prevent damage to health and prevent or delay the establishment of chronic diseases related to age. However, regarding older people diet, there is still a gap between scientific and technological knowledge that was developed in laboratories and what in fact is applied. One hindrance about the inclusion of healthy and functional ingredients (FI) in the diet of the elderly is the difficulty to change food habits, since the food pattern results of lifelong choices. Within this context, our research group works on two main strategies: improving the acceptability of FI-containing preparations and conducting clinical trials, mainly aiming older people. In studies of acceptability improvement, yellow passion fruit (Passiflora edulis) peel flour - PePF, a very rich fiber ingredient (total fiber content is higher than 65%, db), was used. Men and women (n = 36) with daily fiber intake below the recommended healthy levels (21g for women and 30g for men with more than 50 years old) were selected to perform acceptability tests. The participants middle age was about 69.1±5.6 years old. They were submitted to anamnesis and food survey to identify preparations that were compatible with their eating habits. The two more popular dishes were supplemented with PePF (16g/100g). The final products had acceptability and consumption intention evaluated by an elderly panel. PePF-enriched preparations had a high acceptability index (93.44%) and a high consumption intention (79.9% of the elderly reported that they intend to consume PePF-enriched preparations always or very frequently). According

to Brazilian laws, each portion of developed preparations can be labeled as fiber source food. In the clinical trial, yacon root pulp (Smallanthus sonchifolius) - YRP, containing 65-70% of fructooligosaccharides - FOS (db) was used. The effect of daily supplementation with 100g of YRP for 60 days on the lipid profile, glycemic index and insulinemic index of postmenopausal women (n = 46) aged about 65.7 + 8.5 years old was investigated. Supplementation with YRP pulp did not cause alterations in the lipid profile or glycemic parameters during the investigated period compared with the control group. However, it led to a decrease in body weight and waist circumference. This model of clinical trial with elderly people will be used to evaluate functional effects of PePF added foods.

**Keywords:** Elderly, fibers, functional foods

## COMMUNICATIONS OF FOOD FUNCTIONALITIES

Kimiywe, Judith.

PhD. Associate professor. Department of Food Nutrition and Dietetics. Kenyatta University. Kenya.

Functional foods have potential positive effect on health beyond basic nutrition. The concept of functional foods was first developed in Japan in 1980s after escalating health care costs, the ministry of health initiated a regulatory body, which documented, regulated and approved various foods that had health benefits. Nutraceuticals are dietary supplements that deliver a concentrated form of a presumed bio-active agent from a food, presented in a nonfood matrix, and used to enhance health in dosages that exceed those that could be obtained from normal food. Various clinical trials in Kenya have demonstrated the potential benefits of functional foods in solving common morbidity. Solar dried amaranth leaves blended with maize flour porridge was fed to children aged 24-48 months for 6 months among pastoralist communities. Findings realized significant improvement of nutrients and higher retention of β-carotene, iron and zinc. Another study determined the nutrient composition and contribution of hypochondriac amaranth grain based porridge on nutrition status of 52 HIV children at a comprehensive care clinic. There were positive significant contribution to the nutrition status, CD4 counts and reduced morbidity incidences. An experiment with Spirulina powder in elevation of protein-energy malnutrition and iron deficiency anemia, targeted 240 children aged 6-23 months through a randomized controlled trial. The Spirulina fortified corn soy blend showed faster recovery from PEM and IDA compared to those on CBS alone and the controls. A study on effect of 80 g of peanut supplementation on bio-markers of CVD in 85 HIV free-living adults with dyslipidemia in a randomized crossover clinical trial for 22 weeks period, lowered cardiovascular risk significantly through reduction in total cholesterol, triglyceride and Low Density Lipoprotein Cholesterol. These case studies demonstrate the high potential of functional foods from locally available foods to lower the burden of diseases in Kenya.

**Keywords:** Randomized clinical trials, functional foods, morbidity

<footnote>(1)Chiarello, Marileusa D.; (2)Oliveira, Danielle; (2)Érika, Oliveira;</footnote>

<footnote>(3)Jennifer, Lacerda; (4)Pineli, Livia; (5)Karnikowski, Margo.</footnote>

<footnote>(1)PhD. Food Science. College of Health Sciences. University of Brasilia. Brazil.; (2)MSc. Nutritionist. Gerontology Research Program. Catholic University of Brasilia, Brazil; (3)Chef de cuisine. Gerontology Research Program. Catholic University of Brasilia, Brazil; (4)PhD. Food engineer. Department of Nutrition. College of Health Sciences. University of Brasilia. Brazil.; (5)PhD Pharmacist. Department of Pharmacy. College of Health Sciences. University of Brasilia. Brazil.</footnote>
# THE IMPACT OF FAST-FOOD DIET ON BONE DEVELOPMENT, METABOLISM AND QUALITY

(1)Monsonego-Ornan, Efrat; (2)Zaretsky, Janna; (2)Griess-Fishheimer, Shelley; (2)Travinsky, Tamara; (2)Shahar, Ron.

(1)Institute of Biochemistry and Nutrition Faculty of Agricultural, Food and Environmental Sciences, The Hebrew University, P.O.B 12, Rehovot 76100, Israel.; (2)Institute of Biochemistry and Nutrition, The Hebrew University, P.O.B 12, Rehovot 76100, Israel.

Endochondral ossification in the growth-plates provides a narrow window of opportunity to achieve optimal bone size and quality. Modern western diet has negative health implications; however, its effects on skeleton development have not been explored. We show that young rats, fed exclusively with McDonald's meals suffer from growth retardation due to growth-plates lesions within the tibiae. Bone mineral density decreased significantly, structural parameters of trabecular and cortical bone deteriorated dramatically, as did the mechanical performances of the bones. Supplementations with either multi-vitamins and minerals, or calcium alone resulted in partial rescue of growth-plate and bone phenotypes, but were accompanied by kidneys' calcium deposits. Our findings highlight for the first time, the severe pathology that consuming a fast-food diet does to the skeleton of growing young mammals. Pathologies that extends much beyond the known metabolic effects. These results are relevant to human's health as human bone pathologies corresponds with the rats' phenotypes, and fast-food eating pattern is highly common among children around the world.

**Keywords:** Processed food; skeleton development; chondrocytes; cortical bone;

# LEVERAGING TRADITIONAL CROPS FOR BETTER NUTRITION AND HEALTH – THE CASE OF CHICKPEA

(1)Bar-El Dadon, Shimrit; (2)Abbo, Shahal; (3)Reifen, Ram.

(1)PhD. The Institute of Biochemistry and Nutrition. The Robert H Smith Faculty of Agriculture, Food and Environment. The Hebrew University of Jerusalem. Israel; (2)Prof. The Institute of Plant Science & Genetics in Agriculture. The Robert H Smith Faculty of Agriculture, Food and Environment. The Hebrew University of; (3)MD MSc. The Institute of Biochemistry and Nutrition. The Robert H Smith Faculty of Agriculture, Food and Environment. The Hebrew University of Jerusalem. Israel.

Adequate nutrition in early life is a prerequisite for human capital formation and economic development. Although poor feeding practices is a problem predominantly thought to exist in low income and middle income countries, malnutrition is rapidly rising among developed nations as well. In this context, and in light of scarcity of protein sources, utilization of crops- such as chickpea-as a source of micro and macro nutrients is mandatory in the long route to nutritional improvement.

In this presentation, we outline interesting features of the chickpea crop, in terms of its nutritional value and agronomic potential that may help combat several health issues in both Western countries as well as in many low income sectors in developing countries.

On the global scale, chickpea consumption is steadily increasing in recent years. In developing countries, chickpea brings a variety of taste and texture to the cereal-based diet, as well as high-quality protein, fiber, carbohydrates and minerals, thereby ensuring a balanced diet and improving the nutritional status of the population. In developed countries, chickpea may be an ultimate source of protein for the increasing vegetarian/vegan populations. On top of that, allergenicity issues, content of phytoestrogens, and more are negligible in chickpea.

The chickpea crop should be considered as an outstanding source of protein, the ultimate alternative to soybeans, as well as the next health-food for human consumption.

**Keywords:** Chickpea (Cicer arietinum L.). Protein source. Legumes. Allergy.Malnutrition

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# UPDATE ON ACTIVE PRINCIPLES. ACTIVE FOOD PRINCIPLES AND THEIR RELATIONSHIP WITH HEALTH

## OLIVE OIL: SOMETHING MORE THAN A MONO-UNSATURATED FAT

Barrionuevo, Omar T.

PhD. Biochemist. Argentina.

It is widely accepted that any variety of olives may be used to obtain olive oil; however, the field yields and the quality of the product vary. Each variety of olive produces a different type of oil with its own sensory characteristics that give them their distinctive features. Virgin olive oils are oils obtained from the fruit of the olive tree (Olea europaea L.), by mechanical procedures and by some other physical means in especially thermal conditions so as to avoid the alteration of the oil. It means no other treatments apart from washing, decanting, spinning and filtrate. In this process, solvents, chemical refining and additives are excluded. These olive oils are classified with different denominations according to physicochemical and organoleptic parameters. From a chemical point of view, oil contains a principal or saponifiable fraction, which represents 98-99% of the total weight of the oil, and a minority fraction which represents 2%. The latest innovations in the process and the spreading of extra virgin olive oil (EVOO) culture are based on its quality. There are many studies derived from nutritional epidemiology which support the scientific evidence concerning the importance of EVOO in connection with the health of its consumers. These oils play a central role in the Mediterranean Diet, and its habitual consumption is associated to a lower risk of chronic-degenerative diseases. Among the constituents of the
major fraction, oleic acid (C18:1, ω-9) is the principal nutrient, which besides its energetic function, is attributed the major part of the bioactivity of olive oil. It represents 68-82% of the total amount of fatty acids found in oil. It can be found in its free form, though it maily form part of the oil triacylglycerols. EVOO contains, in it sunsaponifiable fraction, hundreds of minor constituents which are difficult to determine because of their structural complexity and their low concentration; however, they have demonstrated a beneficial effect on people's health. In this group some compound classes are included which are not chemical related to fatty acids, among which polyphenols with a great structural complexity are worth mentioning. The antioxidant potential of these compounds allows them to act as defense mechanisms against oxygen reagent species associated to the steady deterioration of the biological systems, even in good living conditions. Even today the molecular mechanism by which these compounds produce beneficial effects on health is still unknown or difficult to explain.

**Keywords:** Olive oil – Oleic acid – Bioactive compounds – Polyphenols

## UPDATE ON PREBIOTICS

Zuleta, Ángela.

University of Buenos Aires. Argentina.

The human colonic microflora has a central role in health and disease, being unique in its complexity and range of functions. As such, dietary modulation is important for improved gut health. Diet can affect the composition of the gut microflora through the availability of different substrates for bacterial fermentation.

As such, functional food ingredients such as prebiotics could effect a beneficial modification in the composition and activities of gut microflora by increasing positive flora components. The prebiotic approach aims to increase resident bacteria that are considered to be beneficial for human health, e.g. bifidobacteria and lactobacilli.

A prebiotic was originally defined, Dr Robertfroid, in 1995 as a "non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, and thus improves host health".[A more recent definition from FAO, stated that "A prebiotic is a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microbiota that confers benefits upon host wellbeing and health".

The principal concept associated with both of these definitions is that the prebiotic has a selective effect on the microbiota that results in an improvement in health of the host. The definitions arose from observations that particular dietary fibres bring about a specific modulation of the gut microbiota, particularly increased numbers of bifidobacteria and/or lactobacilli, and that ingestion of these compounds was associated with improved host health. Overall, saccharolytic fermentation leads to the formation of end products (SCFA) that are recognised as being beneficial to the host. It is recognised that there are numerous potential new ap-

plications being considered for prebiotic use e.g. prevention and or management of type 2 diabetes mellitus; drug bioavailability; effects on autoimmune diseases and allergy; modulation of pathogenic biofilms.

Common prebiotics in use include inulin, fructo-oligosaccharides (FOS), galactooligosaccharides soya-oligosaccharides, xylo-oligosaccharides, isomalto-oligosaccharides and lactulose.

The majority of studies have so far focused on inulin, FOS and GOS. These saccharides have now a long history of safe use and are generally regarded as safe, There is also a range of new prebiotic compounds emerging, and these include:

gluco- oligosaccharides, levans, resistant starch, xylosaccharides and soy-oligosaccharides. These compounds have been studied to varying degrees in vitro, in animal feeding studies, but rarely in human feeding studies.

Novel compounds new to the human diet fall under the regulatory category of "novel foods" and will require legislated levels of safety and toxicological assessment before they can be included in food products. However, little legislation exists governing the use of the word "prebiotic" itself on functional food products and there is a growing collection of commercially available products which bear the prebiotic label but for which supportive scientific literature is sparse or lacking all-together.

**Keywords:** Key words:colonic microflora, prebiotic, saccharolytic fermentation, bifidobacteria

## VARIATION ON THE CONTENT OF POLYPHENOLS ACCORDING TO THE PRESERVATIVE PROCESS USED

Raimondo, Emilia.

Universidad Juan Agustin Maza. Universidad Nacional de Cuyo. Argentina.

There is studies that show that polyphenols from plants, reduce the oxidative stress at the cellular level, decreasing the incidence of chronic noncommunicable diseases (CNDs), hence the importance of antioxidant intake through vegetables. "A dietary antioxidant is a substance present in food, which significantly decreases the adverse effects of reactive species of oxygen and nitrogen, over normal physiological functions in humans." From here comes the recommendation of daily consumption of, at least, five rations of fruits and vegetables or other products derived directly such as green tea, wine and olive oil. In order to know the content of polyphenols that present the foods in the region, they were obtained directly from the market, both fresh and preserved, or elaborated at the pilot scale: olives, tomatoes, different varieties of beans (Phaseolus vulgaris L.) among others.

It was used the Folin-Ciocalteu technique for its quantification, measuring the absorbance in a UV light spectrophotometer at 760 nm of wavelength. The data obtained were statistically compared. Below are some values found. For example, for olives the highest content of polyphenols was found in green olives, cv. Nevadillo, untreated (2.72 g/kg over dry pulp); this content was decreasing according to the advance of the olive maturation degree, obtain-
ing the lowest value for advanced veraison which was 1.94 g/kg of total polyphenols over dry pulp. For cv. Arauco varied from 2.53 g/kg (fresh) to 1.94 g (preserves). The content of polyphenols of the elaboration of black olives type Californian, from different degree of maturation, was decreasing with the oxidation. For "green" olives it was 2.47 g/kg on the first day, reducing to 1.81 g/kg and finally stabilizing at a value of 1.61 g/kg of total polyphenols, when obtaining bright black color. The content of polyphenols was 420 mg/L for olive oil cv. Arbosana elaborated in Mendoza, Argentina, decreasing to 370 mg/L for the one elaborated in Pelotas, Brazil. The content of polyphenols in fresh vegetables was: tomato (7.32 g/kg), cucumber (3.13 g/kg), pepper (1.46 g/kg), eggplant (1.41 g/kg) and asparagus (1.18 kg). When the tomato was dried, its value increased to 27.93 g/kg. For legumes as dry red beans, its content was 13.38 g/kg, but there was no differences with the salad dressing-type paste obtained from it. For black beans the polyphenol content was 1.5 g/kg, obtaining a similar value for its paste, being significantly lower than for the type red. The french beans did not contain polyphenols. Applying the Student's t-test for a small number of samples and with unknown variances, it was found that there is statistically significant differences between the beans with different colorations.

It was verified that the content of polyphenols changes with the studied variety, the maturation degree of the vegetable, geographical area of cultivation, also varying according to the technological processing used for conservation

**Keywords:** Polyphenols, elaboration process, vegetables, conservation

## LOW-GRADE INFLAMMATION AND FEEDING, IS THERE A CONNECTION?

Asus, Nazarena.

MSc. Nutritionist. Faculty of Nutritional Sciences. Juan Agustín Maza University. Mendoza. University Hospital. National University of Cuyo. Mendoza. Argentina.

Low-grade systemic inflammation has important differences with respect to a classical inflammatory response. It is characterized by an increase in circulating levels of acute phase proteins and cytokines with inflammatory activity, such as C-reactive protein (CRP), the factor of alpha tumoral necrosis (TNF-α) and interleukins (IL) 1², 6 and 17, as well as an increase in the infiltration of immune cells, macrophages and T lymphocytes in insulin dependent tissue. A distinctive characteristic of this inflammatory process is that it exhibits high levels of inflammatory factors and immune cells infiltrated in tissue, but does not show structural alterations or loss in its primary functions.

Low-grade inflammatory status is a pathological characteristic of a wide range of chronic conditions, such as obesity, diabetes type 2, metabolic syndrome, cardiovascular disease, nonalcoholic fatty liver disease, and cancer.

Currently the diagnostic criteria have not been precisely defined, there is no consensus on the markers that represent better

the low-grade inflammation or that differentiate between acute and chronic inflammation or between the various phases of the inflammatory response.

Feeding plays a central role in the regulation of chronic inflammation. The inclusion of 5 portions of fruits and vegetables per day is associated with lower values of CRP, being an importance factor the variety in them. The consumption of nuts and seeds is inversely associated with CRP and IL-6, just as whole grains where there is an inverse association with CRP. Diets of high glycemic index or high glycemic load are associated with low-grade inflammation, but the results are not completely conclusive.

Respect to feeding patterns, the Western diet, rich in red meats, whole dairy products, refined cereals and simple carbohydrates, has been associated with higher levels of CRP and IL-6, meanwhile the Mediterranean diet, rich in whole grains, fish, fruits and vegetables, nuts, olive oil, moderate alcohol consumption and low red meat consumption is associated with lower levels of inflammatory markers as seen with the vegetarian diet and DASH diet.

The modulation of the inflammatory response through diet can be useful in preventing or treating non transmissible chronic diseases, but it is still necessary to know the quantities of nutrients needed, their complex relationships and whether they act equally for all individuals, ages and physiological and pathological states, or well if it could be made recommendations at population level.

**Keywords:** Inflammation, diet, nutrients, foods, adults

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## FUNCTIONAL FOODS AND BIOACTIVE COMPOUNDS ON THE MANAGEMENT OF METABOLIC SYNDROME

### POLYPHENOLS, MICROBIOTA COMPOSITION, INFLAMMATION AND OBESITY

(1)Milagro, Fermin I.; (2)Etxeberria, Usune; (3)Portillo, Maria Puy;

(4)Martínez, J. Alfredo.

(1)Department of Nutrition. Food Science and Physiology. Centre for Nutrition Research. University of Navarra. Pamplona. Spain. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn). Instituto de Salud Carlos III. Madrid. Spain.; (2)Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra. Pamplona. Spain.; (3)Nutrition and Obesity group, Department of Nutrition and Food Sciences, Faculty of Pharmacy. University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Centre. Vitoria. Spain. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn). Madrid.Spain; (4)Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA). Pamplona. Spain. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn). Madrid. Spain.

Polyphenol intake can elicit beneficial effects on human health. For this reason, research on this field has become an increasingly
important area of human nutrition research. The consumption of diets rich in fruits and vegetables is associated with a reduction in the risk of suffering chronic diseases such as cardiovascular events, specific tumors, or neurodegenerative illnesses. The action of gut microbes on polyphenols leading to the production of metabolites with diverse physiological relevance is been analyzed in recent years. In this context, the concept of polyphenols as potential prebiotic candidates is a newly emerging concept.

Gut microbiota plays a key role in host physiology and metabolism. Diet has a major influence on gut microbiota and is able to modify its impact on health, with either beneficial or deleterious consequences. In this context, the supplementation of diets with different polyphenols has evidenced changes in gut microbiota composition that are associated with beneficial effects, including anti-inflammatory actions and an amelioration of insulin resistance.

Within the existing plant secondary metabolites, quercetin (flavonoid), trans-resveratrol and pterostilbene (stilbenes) have been described to exert anti-inflammatory, insulin-sensitizing and antiobesity effects. In rats fed a high-fat-sucrose diet, quercetin prevented body weight gain and reduced serum insulin levels, which was accompanied by a reduction of the abundance of Eubacterium cylindroides and an increase of Bacteroides vulgatus, Clostridium clariflavum and Akkermansia muciniphila. Trans-resveratrol supplementation ameliorated insulin resistance, which was associated with an inhibition of Gracilibacter thermotolerans, Parabacteroides distasonis and butyrate-producing species from Clostridia class (Clostridium aldenense, Clostridium hathewayi, Clostridium sp. MLG661). Pterostilbene supplementation prevented body weight gain and decreased serum cholesterol levels in Zucker rats, which correlated with an upregulation of Odoribacter splanchnicus and Alistipes shahii, but particularly Akkermansia muciniphila.

In summary, the intake of phenolic compounds, either as pure compounds or as part of foods, could be an effective approach to modulate gut microbiota, contributing thus to the amelioration of obesity-related traits such as inflammation, dyslipidemia and insulin resistance.

Etxeberria U, et al. Pterostilbene-induced changes in gut microbiota composition in relation to obesity. Mol Nutr Food Res doi: 10.1002/mnfr.201500906

Etxeberria U, et al. Reshaping faecal gut microbiota composition by the intake of trans-resveratrol and quercetin in high-fat sucrose diet-fed rats. J Nutr Biochem 2015;26:651-60.

Anhê FF, et al. A polyphenol-rich cranberry extract protects from diet-induced obesity, insulin resistance and intestinal inflammation in association with increased Akkermansia spp. population in the gut microbiota of mice. Gut 2015;64:872-83.

Etxeberria U, et al. Impact of polyphenols and polyphenol-rich dietary sources on gut microbiota composition. J Agric Food Chem 2013;61:9517-533.

Neyrinck AM, et al. Polyphenol-rich extract of pomegranate peel alleviates tissue inflammation and hypercholesterolaemia in high-fat diet-induced obese mice: potential implication of the gut microbiota. Br J Nutr 2013;109:802-9.

Martínez JA, et al. Role of dietary polyphenols and inflammatory processes on disease progression mediated by the gut microbiota. Rejuvenation Res 2013;16:435-7.

**Keywords:** Metagenomics, Precision nutrition, Quercetin, Resveratrol, Insulin resistance

COCOA EXTRACT INTAKE WITHIN AN ENERGY RESTRICTED DIET AND METABOLIC SYNDROME FEATURES: CARDIOMETABOLIC RISK AND DEPRESSIVE SYMPTOMS

An excessive body weight contributes to increase the risk of suffering clinical manifestations, such as insulin resistance, dyslipidemia, hypertension, diverse metabolic syndrome features, and depression, among others. The prescription of nutritional strategies as well as lifestyle changes, such as the reduction of energy intake and adherence to healthy dietary patterns, could contribute to combat these metabolic disorders. Nowadays, the intake of plant extracts rich in polyphenols is receiving especial attention in the protection against obesity-associated comorbidities. Thus, cocoa is one of the richest sources of polyphenols with potential benefits on blood pressure, insulin resistance, lipid profile, endothelial dysfunction, oxidative stress, and inflammation. These therapeutic effects have been attributed to bioactive compounds occurring in cocoa, mainly flavanols, which are the most abundant polyphenols in this seed. Furthermore, cocoa also contains other bioactive compounds such as methylxanthines and minerals with additional healthy properties. Phytochemicals from cocoa are usually consumed within chocolate bars or cocoa beverages. However, taking into account the potential benefits of cocoa consumption, it could be used as a functional ingredient to be included in other foods for human consumption. In this way, the consumption for 4 weeks of 1.4 g of cocoa extract (645 mg polyphenols with 415 mg of flavanols) within ready-to-eat meals and under an hypocaloric diet (-15% energy restriction) was able to produce a higher reduction of oxidised low-density lipoprotein-cholesterol (ox-LDL) levels compared to obese subjects following the dietary strategy without cocoa supplementation. Regarding blood pressure, the regular consumption during 4 weeks resulted in a higher reduction of acute systolic blood pressure (SBP) response independently

<footnote><sup>(1)</sup>Zulet, Maria Angeles; <sup>(2)</sup>Ibero-Baraibar, Idoia; <sup>(3)</sup>Abete, Itziar;</footnote>

<footnote><sup>(4)</sup>Martínez, J. Alfredo.</footnote>

<footnote><sup>(1)</sup>Department of Nutrition, Food Science and Physiology; Centre for Nutrition Research; University of Navarra, and IdiSNA. Pamplona. Spain. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn). Instituto de Salud Carlos III. Madrid. Spain.;</footnote>

<footnote><sup>(2)</sup>Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra. Pamplona. Spain.;</footnote>

<footnote><sup>(3)</sup>Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra. Pamplona. Spain. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn). Instituto de Salud Carlos III. Madrid. Spain.;
<sup>(4)</sup>Department of Nutrition, Food Science and Physiology. Centre for Nutrition Research. University of Navarra, and IdiSNA. Pamplona. Spain. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn). Instituto de Salud Carlos III. Madrid. Spain.</footnote>
of body weight loss and also showed an adaptive effect of the acute SBP. Moreover, the intake of cocoa significantly increased the levels of plasma homovanillic acid, which is a marker reflecting the dopaminergic activity in the brain. Interestingly, homovanillic acid was negatively associated with the reduction of depressive symptoms in cocoa consumers, suggesting the possible implication of cocoa on psychological behavior. Finally, it is important to highlight that metabolomics analyses in plasma and urine have suggested an adequate adherence to the nutritional intervention supported by the presence of metabolites derived from cocoa. To sum up, the inclusion of cocoa within a well-designed dietary hypocaloric strategy might contribute to obtain additional benefits to weight loss and body composition, such as improvements in hypertension, oxidative markers, and psychological status.

Ibero-Baraibar I, et al. Cocoa extract intake for 4 weeks reduces postprandial systolic blood pressure response of obese subjects, even after following an energy-restricted diet. Food Nutr Res 2016;60:30449.

Ibero-Baraibar I, et al. An Increase in Plasma Homovanillic Acid with Cocoa Extract Consumption Is Associated with the Alleviation of Depressive Symptoms in Overweight or Obese Adults on an Energy Restricted Diet in a Randomized Controlled Trial. J Nutr 2016. pii: jn222828

Ibero-Baraibar I, et al. Oxidised LDL levels decreases after the consumption of ready-to-eat meals supplemented with cocoa extract within a hypocaloric diet. Nutr Metab Cardiovasc Dis 2014;24:416-22.

**Keywords:** Flavanols, Polyphenols, Homovanillic Acid, Depression, Hypertension

## POTENTIAL HEALTH BENEFITS OF CONJUGATED LINOLEIC ACID FROM NATURAL AND INDUSTRIAL SOURCES. EVIDENCES FROM ANIMAL STUDIES

Conjugated linoleic acid (CLA) is a group of positional and geometrical isomers of linoleic acid recognized by their functional properties. The major contribution of natural CLA is supplied by dairy products and meats where c9,t11-18:2, known as rumenic acid (RA), represents 80-90% of total CLA. On the other hand, industrially synthesized commercial CLA mainly contains a mixture of equimolecular amounts of c9,t11-18:2 and t10,c12-18:2 (mix-CLA).

Nutritional studies in human and experimental animals have demonstrated a variety of beneficial health consequences from

CLA consumption. However, controversial and detrimental health effects have also been reported. The precise actions and the biochemical mechanisms by which CLA-rich foods mediate the metabolic effects remain unclear. Since the specific effects of c9,t11-18:2 and t10,c12-18:2 are different, we have analyzed the effects of CLA from industrial and natural source on different animal models or experimental conditions that share some metabolic disorders observed in the metabolic syndrome. Specifically, parameters associated with the lipid depots and glucose regulations are described.

In normal mice, mix-CLA and RA-rich oil (natural-like CLA) modified the triacylglycerol (TAG) metabolism having different effects depending on the type of CLA and the dietary unsaturated fatty acids (FA) proportions. The reduction of fat in carcass and adipose tissue was higher in the mix-CLA than in RA supplemented diets, independently of the dietary n-9, n-6 and n-3 FA ratio. However, RA showed beneficial effects without hepatomegaly, steatosis, or hypertriacylglyceridaemia. In mice fed high fat (HF) diets, mix-CLA reduced plasma and muscular TAG concentrations. These beneficial effects were associated with a protection against hepatic oxidative stress mediated by an increase in glutathione levels. Nevertheless, the biochemical mechanisms involved in the regulation of lipid levels were related to a reduced hepatic VLDL-TAG secretion and decreased muscle and adipose tissue lipoprotein lipase enzymes, leading to a liver steatosis and dystrophy of epididimal fat pads. Contrary, in a steatosis rat model induced by protein depletion, protein repletion with mix-CLA showed preventive effects on liver steatosis through higher VLDL-TAG secretion and reduced adipose tissue lipid accumulation. In the glucose regulation, dietary mix-CLA supplementation at HF levels partially prevented glycolytic pathway alterations in liver of mice increasing the glycogen synthesis. Glucose utilization was also investigated in isolated skeletal muscle; where in basal conditions dietary mix-CLA improved glucose uptake and incorporation as well as glycogen synthesis via an increase in glucose oxidation. Finally, we have investigated the effect of a functional milk fat (FMF) enriched in RA on glucose and lipid metabolism of rats fed HF diets. Noteworthy, FMF prevented the hepatic TAG accretion induced by HF diets by increasing the hepatic VLDL-TAG secretion and the b-oxidation. In addition, FMF improved the muscle glucose utilization associated with a higher flux through the phosphofructokinase enzyme.

Even though the experimental results in animal models cannot be directly extrapolated to humans, knowledge of the mechanism involved in the beneficial effects of natural or commercial CLA, under different conditions, might be useful for the development of functional foods effective to prevent some metabolic alterations observed in human metabolic syndrome.

**Keywords:** Rumenic Acid - Conjugated linoleic acids - Triacylglycerol regulation - Glucose utilization - Functional foods

<footnote>(1)Bernal, Claudio; (2)Gerstner, Carolina; (1)Fariña, Ana; (3)Sain, Juliana;</footnote>

<footnote>(3)Lavandera, Jimena; (1)Scalerandi, María Victoria; (1)González, Marcela; (4)Antonacci, Liliana; (5)Gagliostro, Gerardo.</footnote>

<footnote>(1)PhD Biochemical. Food Science and Nutrition. Universidad Nacional del Litoral. Argentina; (2)PhD Student. Food Science and Nutrition. Universidad Nacional del Litoral. Argentina; (3)PhD. Food Science and Nutrition. Universidad Nacional del Litoral. Argentina; (4)PhD Student. INTA Balcarce. Argentina; (5)PhD. INTA Balcarce. Argentina.</footnote>
MATERNAL SUPPLEMENTATION WITH FLAVONOIDS AND ANTIOBESITY EFFECT IN THE OFFSPRING OF OBESE FEMALE RATS

Maternal obesity is a risk factor in the development of meta-
bolic diseases of offspring including, obesity, diabetes and meta-
bolic syndrome. This may be due to an influence by different en-
vironmental effects such as maternal feeding during early stages
of life, commonly known as perinatal programming. The use of
animal models in this studies helps to analyse the mechanisms by
which physiological and metabolic changes can promote the de-
velopment of diseases in the adult stage. Dietary supplementation
with flavonoids has been studied regarding the biological prop-
erties and its effect in the prevention of diseases such as obesi-
ty. Therefore, the aim of this study was to determine the effect of
the narirutin and kaempferol-3-O-glucoside on the prevention of
metabolic disorders in the offspring of female Wistar rats fed and
obesogenic diet during perinatal period.

**Material and methods:** Obesogenic group of female rats were fed with a cafeteria diet (372 kcal/100g) and supplemented group (n=2) with cafeteria diet supplemented with kaempferol-3-O-glucoside (15 mg/kg bw) and narirutin (30 mg/kg bw) during perinatal period (7 weeks); a parallel a control group (n=2) were fed a standard diet (335 kcal/100g). After the lactation period (3 weeks), male offspring (control G1 group (n=12), obesogenic G1 group (n=9) and supplemented G1 group (n=9)) were fed standard diet for 91 days. Body weight and food intake were recorded weekly. After the experimental period, animals were sacrificed and serum and tissue samples were obtained.

The obesogenic model was successfully achieved, showing sta-
tistical differences between control group and obesogenic group.
According to the offspring male rats, changes in body weight were
observed in the supplemented group compared to the obesogen-
ic group (p<0.05). Likewise supplemented group showed statisti-
cally significant lower liver weight and lower fat percentage than
the cafeteria group (p<0.05). Food intake (g) and food efficiency
(g/100 kcal) were significantly lowered in male offspring of sup-
plemented female rats. On the other hand, regarding biochemical
measurements, there were no differences in glucose levels, howev-
er significant differences were found in leptin and insulin levels.
Concerning the molecular mechanisms implicated, differences in
the expression of genes involved in inflammation, glucose and li-
pid metabolism were observed in liver and adipose tissue between
obesogenic group and supplemented group.

In this context, the obesogenic diet during perinatal period in
female wistar rats induces metabolic alterations and an increase
dietary intake in their male offspring in adulthood. In addition,
dietary supplementation with flavonoids could prevent the devel-
opment of obesity in the adult offspring.

**Keywords:** Narirutin, kaempferol-3-O-glucoside, metabolic programming, obesity, nutrigenomics

POLYPHENOLS FROM BERRIES INHIBIT INFLAMMATION-RELATED ADIPOSITY

García-Díaz, Diego.

Nutrition Department. University of Chile.

Obesity-associated insulin-resistance is set by a chronic in-
flammatory state established in the adipose tissue. Chilean native
fruits calafate (CA) and maqui (MA) berries present remarkable
anti-inflammatory features. We have been evaluated antioxidant,
anti-inflammatory and insulin-sensitizer effects of these fruits in
an in vitro and in vivo inflammatory setting. We exposed differ-
entiated 3T3-L1 cells to conditioned media (CM) from activated
macrophages that were treated with CA and MA extracts. Extracts
modulated beneficially: metalloproteinase (both MMP-2 and
MMP-9) activity, GSH levels, caspase-3 activity, and inflammatory
markers gene expressions. Furthermore, MA reverted CM specif-
ic IRS-1 phosphorylation, and CA improved insulin-stimulated
glucose uptake. Similar experiences were observed in a in vivo
model (mouse), that were induced to present inflammatory-relat-
ed insulin-resistance by a chronic exposure to high fat diet. Thus,
treatments with extracts of Chilean native fruits were able to block
the development of oxidative stress, inflammation and insulin-re-
sistance in vitro and in vivo.

**Keywords:** Obesity, inflammation, insulin-resistance, polyphenols, chilean native fruits

PS_144/170

PHYTONUTRIENTS IN NUTRITION AND HEALTH:
FROM THEORY TO PRACTICE

QUERCETIN PROTECTS AGAINST ATHEROSCLEROSIS BY INHIBITING DENDRITIC CELL ACTIVATION

**Objective:** Quercetin is a typical flavonol with atheroprotective effects, but the effect of quercetin on dendritic cell (DC)

<footnote>(1)De La Garza Hernández, Ana Laura; (2)Peña Vázquez, Gloria Itzel;</footnote>

<footnote>(2)Treviño de Alba, Carolina; (3)Castro García, Heriberto; (4)Camacho Morales, Alberto.</footnote>

<footnote>(1)PhD. Nutritionist. Universidad Autonoma de Nuevo Leon. Facultad de Salud Publica y Nutricion. Centro de Investigacion en Nutricion y Salud Publica; (2)Nutritionist. Universidad Autonoma de Nuevo Leon. Facultad de Salud Publica y Nutricion. Monterrey. Mexico; (3)PhD. Nutritionist. Universidad Autonoma de Nuevo Leon. Facultad de Salud Publica y Nutricion. Monterrey. Mexico; (4)PhD. Universidad Autonoma de Nuevo Leon. Facultad de Medicina. Departamento de Bioquimica. Monterrey. Mexico.</footnote>

<footnote>(1)Ling, Wenhua; (2)Lin, Weiqun; (3)Wang, Wenting; (4)Wang,
Dongliang.</footnote>

<footnote>(1)PhD. Professor. School of Public Health. Sun Yat-sen University.
China; (2)PhD. Student. School of Public Health. Sun Yat-sen
University; (3)Master of Medicine. Student. School of Public
Health. Sun Yat-sen University; (4)PhD. Professor. School of Public
Health. Sun Yat-sen University.</footnote>
maturation in relation to atherosclerosis has not yet been clearly
defined. Thus, we investigated whether quercetin can inhibit DC
maturation and evaluated its potential value in atherosclerosis
progression in ApoE-/- mice.

**Methods and results:** Quercetin consumption inhibited DC activation, inflammatory response and suppressed the progression of atherosclerosis in ApoE-/- mice. Subsequently, quercetin treatment inhibited the phenotypic and functional maturation of DCs, as evidenced not only by downregulation of CD80, CD86, MHC-II, IL-6 and IL-12 but also by a reduction in the ability to stimulate T cell allogeneic proliferation. Finally, an in vitro study demonstrated that quercetin inhibited DC maturation via upregulation of Dabs, which then downregulated the Src/PI3K/Akt-NF-κB-inflammatory pathways.

**Conclusions:** Our data indicate that quercetin attenuates atherosclerosis progression by regulating DC activation via Dab2 protein expression.

**Keywords:** Atherosclerosis. Dab2. Dendritic cells. Inflammation. Quercetin

A GLOBAL SNAPSHOT OF FRUIT AND VEGETABLE INTAKE AND AVAILABILITY, AND IMPLICATIONS FOR PHYTONUTRIENT INTAKES

(1)Klosner, Alli; (2)Murphy, Mary M.; (3)Barraj, Leila M.; (4)Spungen, Judith H.; (5)Herman, Dena R; (6)Randolph, Keith.

(1)Nutrilite Health Institute. Amway Corporation.; (2)R.D. Exponent, Inc. Washington DC. USA; (3)D.Sc. Exponent, Inc. Washington DC. USA; (4)MS. RD. Exponent, Inc. Washington DC. USA; (5)Department of Family and Consumer Sciences, California State University. USA; (6)Nutrilite Health Institute. Amway Corporation. USA.

In 2004 the World Health Organization (WHO) and Food and Agricultural Organization (FAO)

established minimum fruit and vegetable intake recommendations for adults at 400 g or 5 servings per day. The basis for this recommendation was epidemiological data that showed a strong inverse relative risk for chronic disease morbidity with fruit and vegetable intakes up to this level. Despite this recommendation, there has not subsequently been a global assessment of fruit and vegetable intake. Utilizing WHO World Health Survey data (2002) and FAO food supply utilization data (2012), we evaluated fruit and vegetable intake, fruit and vegetable variety, and intakes of selected phytonutrients in different regions globally. The results show a striking shortfall globally in fruit and vegetable intake relative to the WHO minimum recommendation, and relatively narrow range of variety. According to this assessment, approximately 75% of individuals worldwide fail to meet WHO minimum intake levels. These data strongly support the need to better educate consumers regarding the health promoting and risk reducing effects of fruit and vegetable dietary patterns.

**Keywords:** Phytonutrients, Nutrition, Health,

**Further collaborators:** The present study used data from the WHO and WHS. The study was supported by the Nutrilite Health Institute.

ESSENTIALITY, PHYSIOLOGICAL AND NUTRITIONAL ASPECTS OF POLYUNSATURATED FATTY ACIDS AND THEIR DERIVATIVES: CURRENT TRENDS

(1)Valenzuela, Rodrigo; (2)Valenzuela, Alfonso.

(1)Nutritionist. PhD. Nutrition Department, Faculty of Medicine, University of Chile; (2)Biochemical. PhD. Lipid Center. Institute of Nutrition and Food Technology (INTA), University of Chile (Chile), University of Chile.

Linoleic acid (LA, C18: 2n-6) and alpha-linolenic acid (ALA, C18: 3n-3) are essential polyunsaturated fatty acids (PUFAs) for mammals, including humans, because they lack the enzymatic machinery to synthesize these fatty acids. These PUFAs have important biochemical and physiological functions in the body and are the metabolic precursors of n-6 and n-3 long chain polyunsaturated fatty acids (LCPUFAs). LA is the precursor of n-6 LCPUFAs, including its main metabolic product, arachidonic acid (AA, C20: 4 n-6), which has a relevant role in the development of the nervous and visual system and in the control of vascular homeostasis and inflammatory response. ALA is the precursor of eicosapentaenoic acid (EPA, C20: 5n-3) and docosahexaenoic acid (DHA, C22: 6n-3). EPA participates in the control of vascular homeostasis and the resolution of inflammatory responses. DHA plays a key role in the formation and function of the nervous and visual system, particularly the brain and retina, and in the protection of the central and peripheral nervous system. The synthesis of n-6 and n-3 LCPUFAs derived from LA and ALA occurs mainly in the liver, and to a lesser extent in other tissues, such as the brain. Formation of AA, EPA and DHA occurs through elongation and desaturation reactions of the respective precursors LA and ALA. The synthesis of n-6 and n-3 LCPUFAs requires the participation of enzymes Δ-5 and Δ-6 desaturases, with Δ-6 desaturase being the limiting enzyme of the process. The activity and expression of both enzymes is regulated by hormones such as insulin and estrogens, and by the intracellular redox state. In addition, polymorphisms in the sequences encoding these enzymes negatively regulate the synthesis and tissue levels of n-6 and n-3 LCPUFAs, particularly DHA, affecting physiological processes such as cognitive abilities or cardiovascular health. Another relevant aspect is nonalcoholic hepatic steatosis, a pathology in which there is a reduction in the activity of the Δ-5 and Δ-6 desaturase enzymes, which generates a reduction of the tissue levels of n-6 and n-3 LCPUFAs. These effects would be produced by oxidative stress of nutritional origin and by the development of insulin resistance. Most recently, several investigations have demonstrated the role of eicosanoids, 20-carbon derivatives from EPA and docosanoids, 22-carbon derivatives. Eicosanoids and docosanoids are determinant in the survival of cells against inflammatory processes that compromise its viability, in controlling the inflammatory process and, particularly, in the resolution of inflammation. In this con-
text, the DHA-derived docosanoid neuroprotectin D-1 (NPD-1) shows neuroprotective properties against cerebral aging, neurodegenerative diseases and injuries caused by cerebral ischemia-reperfusion episodes. This work discusses the physiological and nutritional importance of PUFAs, the synthesis of LCPUFAs and the metabolic implications of n-6 and n-3 LCPUFA and its derivatives.

**Keywords:** Essential fatty acid, polyunsaturated fatty acids, n-6 fatty acid, n-3 fatty acid, nutritional importance of polyunsaturated fatty acids

research project (code 11160636). Seeds from E. plantagineum grown in Chile (from an experimental and controlled production in the south of the country) are being collected to extract and characterize its oil, which in turn will be used as source to produce novel structured lipids able to deliver SDA to the human body with a high bio-efficiency.

**Keywords:** Novel lipids, biotechnology, omega-3 fatty acids, stearidonic acid

## SUSTAINABLE ALTERNATIVES TO OBTAIN NEW EDIBLE OILS AND FORMULATES RICH IN POLYUNSATURATED FATTY ACIDS WITH NUTRITIONAL INTEREST

Rincón-Cervera, Miguel Ángel.

PhD. Chemist. Institute of Nutrition and Food Technology (INTA). University of Chile. Chile.

Omega-3 polyunsaturated fatty acids (ω3 PUFAs) are key nutrients because of their multiple roles in the human metabolism. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the most known ω-3 PUFAs due to their beneficial effects for human health. These two ω-3 PUFAs are mainly contained in marine food sources, such as fatty fish. However, fish consumption may be linked to some drawbacks such as low sustainability and high price of the resource (because of overfishing worldwide) and some health concerns (fish may be contaminated with organic and inorganic pollutants such as PCBs, dioxins and heavy metals).

EPA and DHA can be metabolized by the human body using alpha-linolenic acid (ALA) as precursor, which is contained in seed oils from chia (S. hispanica), rosehip (R. rubiginosa) and flaxseed (L. usitatissimum), among other plant-based oils. This fact is becoming ALA-rich oils into an interesting and more sustainable commercial option to provide ω-3 PUFAs. However, ALA is not efficiently converted into longer-chain ω-3 PUFAs such as EPA and DHA because of the low efficiency of the enzyme Δ6-desaturase, which is the responsible to convert ALA into stearidonic acid (SDA), an intermediate ω-3 PUFA between ALA and EPA in the metabolic pathway.

The direct supply of SDA could become a suitable option from a nutritional point of view, because it has been proved that metabolic conversion of SDA into longer-chain ω-3 PUFAs such as EPA is much more effective than when ALA is used as precursor. SDA is mainly available in the seed oils of a reduced number of plants such as Echium plantagineum, which is native from the Mediterranean basin and is being cultivated in several countries in the world because of its seed oil. This species grows wild in Central and South Chile, although it has not been cultivated with commercial purposes yet.

In the symposium, it will be explained the research that we are carrying out with seed oil from E. plantagineum at the Laboratory of Lipids in the Institute of Nutrition and Food Technology, University of Chile, as a part of a currently in force FONDECYT

## ROLE OF N-3 POLYUNSATURATED FATTY ACIDS FROM VEGETABLE SOURCES IN THE METABOLIC SYNDROME

Lombardo, Yolanda B.

PhD, Professor of Biochemistry. Dept. of Biochemistry. School of Biochemistry. University of Litoral. Santa Fe. Argentina.

Excessive food ingestion and the increase in the consumption of high-fat, fructose or sucrose diets characteristic of modern society have been related to the development of visceral adiposity, systemic oxidative stress, impaired glucose homeostasis, insulin resistance, type 2 diabetes, dyslipidemia and hypertension, the major component of the Metabolic Syndrome (MS). Diets can play a major role in the prevention or improvement in this syndrome and its associated pathologies. In addition to other lifestyle interventions, it has been recognized that the adjustments to the quality of dietary lipids such as n-3 polyunsaturated fatty acids (n-3 PUFAs) from marine (fish oil, EPA and DHA) or plant sources [α-linolenic acid (ALA) 18:3 n-3] are also important in the prevention and treatment of the MS by modulating the expression of several genes involved in these chronic manifestations. This presentation highlights recent advances in the understanding of metabolic and molecular mechanisms concerning the effect of dietary whole seeds and/or oils rich in ALA, and focuses on the prevention and/or improvement of dyslipidemia, insulin resistance, impaired glucose homeostasis, diabetes and obesity in experimental animal models, with some extension to humans.

**Keywords:** Alpha linolenic acid. Metabolic syndrome. Dyslipidemia. Diabetes. Obesity.
# ADDRESSING BARRIERS TO EXCLUSIVE BREASTFEEDING: EVIDENCE AND LESSONS LEARNT FROM BABY FRIENDLY COUNTRY PROGRAMS

## SYSTEMATIC REVIEW OF BARRIERS TO EXCLUSIVE BREASTFEEDING (EBF) IN LOW AND MIDDLE INCOME COUNTRIES: EVIDENCE AND PROGRAM IMPLICATIONS

(1)Kavle, Justine; (2)LaCroix, Elizabeth; (3)Stevens, Hallie; (4)Engmann, Cyril.

(1)PhD. Senior Nutrition Advisor. Maternal Newborn Child Health and Nutrition Division. Maternal and Child Survival Program (MCSP)/ PATH. USA.; (2)Consultant. Maternal Newborn Child Health and Nutrition Program. PATH. Washington DC. USA.;

(3)Consultant. Maternal Newborn Child Health and Nutrition Program. Maternal and Child Survival Program (MCSP)/ PATH. Washington DC. USA.; (4)MD. Program Leader. Maternal Newborn Child Health and Nutrition Program. Maternal and Child Survival Program (MCSP)/PATH. Washington DC. USA.

Despite numerous global initiatives on breastfeeding, trend data show exclusive breastfeeding (EBF) rates have stagnated over the last two decades. In low- and middle-income countries (LMICs), only 37% of children younger than 6 months of age are exclusively breastfed, defined as the proportion of infants aged 0–5 months who are fed only with breastmilk and no additional liquids or solids until 6 months of life. Although some countries have made gains in EBF, early initiation and EBF rates in many countries are drastically below global targets. Key challenges to EBF remain unaddressed through infant and young child feeding programming. A recent UNICEF report notes that 43% of new-born babies are fed prelacteal foods or liquids, which can lead to difficulties in establishing breastfeeding. Also, most infants are introduced to other foods or liquids too early, prior to 6 months of age. The objectives of this systematic review were to ascertain barriers to EBF in LMICs according to three domains: 1) Maternal areas: prenatal barriers; 2) Barriers encountered on the first day, including initiating and establishing EBF; and 3) Barriers encountered in maintaining EBF over the first six months of life and to summarize the program implications of these findings. A search of SCOPUS, MEDLINE, CINAHL, and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF in low- and middle-income countries. Following application of systematic review criteria, 48 articles from 14 countries were included in the review. Sixteen barriers to EBF were identified in this review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at child-birth and the initial 24 hours post-delivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breastfeeding and likelihood of practicing EBF. Breastfeeding problems were commonly reported from

cross-sectional or observational studies. Counseling on EBF and the presence of family and/or community support has demonstrated improvements in EBF. Improving the counseling skills of health workers to address breastfeeding problems and increasing community support for breastfeeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breastmilk substitutes, paid maternity leave, and breastfeeding breaks for working mothers require attention in LMICs.

**Keywords:** Barriers, exclusive breastfeeding, systematic review, low and middle income countries, program implications

## DEVELOPMENT AND ROLL-OUT OF NATIONAL BABY FRIENDLY COMMUNITY INITIATIVE (BFCI) GUIDELINES: EXPERIENCE ON ADDRESSING BARRIERS TO EBF IN KENYAN COMMUNITIES

(1)Samburu, Betty; (2)Ahoya, Brenda; (3)Kavle, Justine; (4)Gathi, Constance; (5)Mwando, Rael; (6)Obade, Mary; (5)Akeyo, Florence; (7)Straubinger, Sarah; (8)Wanunda, Evans.

(1)Programme Manage.r Maternal Infant and Young Child Nutrition. Ministry of Health. Nutrition and Dietetics Unit. Nairobi. Kenya.; (2)BA. Nutrition Advisor. Maternal and Child Survival Program (MCSP). PATH. Maternal Newborn Child Health and Nutrition Program. Nairobi. Kenya.; (3)PhD. Senior Nutrition Advisor. Maternal and Child Survival Program (MCSP). PATH. Maternal Newborn Child Health and Nutrition Program. Washington DC. USA.; (4)BA. Nutrition Officer. Maternal and Child Survival Program (MCSP). PATH. Maternal Newborn Child Health and Nutrition Program. Kisumu. Kenya.; (5)County Nutrition Coordinator. Nutrition. Ministry of Health. Kisumu. Kenya.; (6)County Director of Nutrition Services. Nutrition. Ministry of Health. Kisumu. Kenya.; (7)BA. Senior Program Coordinator for Nutrition. Maternal and Child Survival Program (MCSP). PATH. Maternal Newborn Child Health and Nutrition Program. Washington DC. USA.; (8)BA. Nutrition Associate. Maternal and Child Survival Program (MCSP). PATH. Maternal Newborn Child Health and Nutrition Program. Kisumu. Kenya.

**Background and Objectives:** Baby Friendly Community Initiative (BFCI) is a community-based initiative to protect, promote, and support exclusive breastfeeding (EBF) through community support groups (CSGs) and mother to mother support groups. Implemented in western Kenya through the Maternal and Child Survival Program (MCSP) and Ministry of Health (MOH), BFCI offers a platform to identify and address key barriers to exclusive breastfeeding to ensure EBF is sustained for the entire 6 month period.

**Methods:** After development of the National MOH BFCI Implementation Guidelines, Training and Monitoring tools, MCSP and MOH rolled out BFCI. During implementation of BFCI, routine monitoring of infant and young child feeding practices, including early initiation of breastfeeding, introduction of prelacteal
feeding, and early introduction of foods and liquids and exclusive breastfeeding was carried out in Migori and Kisumu counties, Kenya. Following identification of breastfeeding problems, health providers and community workers were supported to document and counsel on breastfeeding problems through the use of a checklist.

Results: BFCI provided a platform to identify key barriers to EBF, including: issues with positioning and attachment, beliefs that “boys need more to eat than girls”, pressure from grandmothers to provide mixed feeding, perceptions of insufficient breastmilk, cultural beliefs hindering EBF (i.e. ‘bad/evil eye’), lack of confidence in mothers’ ability to breastfeed, and lack of sufficient community support structures. BFCI addressed these challenges through continuous medical education sessions for health workers and community health volunteers (CHVs), health education to mothers through multiple channels, inclusive of health facilities, CSGs and CHV home visits, provision of ‘safe’ spaces for breastfeeding at health facilities and within communities, and establishment of CSGs, which allowed for discussions amongst mothers and referral of mothers to health facilities, as needed. Conclusion: Multiple channels are required to address EBF barriers with engagement at both the community and health facility level.

**Keywords:** Exclusive breastfeeding, community, baby friendly, barriers

## PROGRAMMATIC EXPERIENCE ON REVITALIZATION OF THE BABY-FRIENDLY HOSPITAL INITIATIVE (BFHI) IN MALAWI: LESSONS LEARNT ON BARRIERS TO EXCLUSIVE BREASTFEEDING AT FACILITY LEVEL

(1)Guta, Janet; (2)Bwanali, Florence; (3)Nyaku, Albertha; (4)Straubinger, Sarah.

(1)Malawi Ministry of Health; (2)2. BSc. Nutrition Advisor. Maternal Neonatal Child Health. Maternal and Child Survival Program/ PATH. Lilongwe, Malawi; (3)3. MPH. Nutrition Team Lead. Maternal Neonatal Child Health. Maternal and Child Survival Program/ PATH. Washington, DC.; (4)4. BA. Senior Program Coordinator. Maternal Neonatal Child Health. Maternal and Child Survival Program/PATH. Washington, DC.

**Background and objectives:** In Malawi, optimal breastfeeding practices remain challenging as only 61% of babies are exclusively breastfed, according to 2016 Demographic & Health Survey data. Since approximately three-quarters of deliveries are facility-based, it is imperative to support exclusive breastfeeding (EBF) in the immediate 24 hours postpartum in health facilities.

In partnership with the Ministry of Health, USAID's Maternal and Child Survival Project (MCSP), World Health Organization (WHO), and UNICEF worked to revitalize Baby-Friendly Hospital Initiative (BFHI) with linkages to the community-level. BFHI is a global initiative to implement practices that protect, promote, and support breastfeeding and can reduce barriers to and improve rates of early initiation of breastfeeding and sustained EBF.

**Methods:** MCSP spearheaded revitalization of BFHI and addressed barriers to early initiation of breastfeeding and EBF in 15 districts by 1) revising infant and young child feeding (IYCF) hospital-based policies to address barriers to early initiation of breastfeeding and continued EBF, and prevention of mother-to-child transmission (PMTCT) of HIV; 2) adapting the WHO BFHI training course to the Malawi context to address breastfeeding challenges; 3) supporting hospitals on the Ten Steps to Successful Breastfeeding through staff capacity building, and; 4) identifying existing referral linkages between the hospital- and the community-levels to continue breastfeeding support to postpartum women after discharge.

**Results:** MCSP supported capacity building on BFHI and breastfeeding with half of health workers trained in 15 health facilities and 3 centers of excellence. Health facilities developed policies stating commitment to BFHI and to addressing barriers to IYCF, such cessation of EBF before 6 months, poor latching/ positioning, and PMTCT of HIV. BFHI has been able to support early initiation of breastfeeding despite limited space in maternity wards and staff shortages. Facilities identified staff to counsel mothers in waiting areas and postnatal wards on EBF. MCSP oriented 1,400+ community-based promoters to support breastfeeding mothers on EBF barriers. The experience resulted in 13,948 mothers initiating breastfeeding within 1 hour and receiving EBF counseling at discharge.

**Conclusions:** BFHI is a successful approach to addressing barriers to EBF at facility and community levels. BFHI promotes multi-level cooperation to address a range of breastfeeding barriers.

**Keywords:** Baby friendly hospital initiative; exclusive breastfeeding; initiation; health facilities

## PROGRAM IMPLICATIONS FOR ADDRESSING BARRIERS TO EBF: PROGRESS TO DATE AND FUTURE CONSIDERATIONS

Lutter, Chessa.

PhD. Visiting Research Professor. School of Public Health. University of Maryland. USA.

Optimal breastfeeding practices benefit all mothers and children, regardless of where they live or level of economic well-being. Exclusive breastfeeding, in particular, is considered the cornerstone of child survival and health. It not only provides all the nutrients necessary for growth for the first six months of life, but also protection from many childhood life-threatening diseases and some noncommunicable diseases later in life. Breastfeeding is beneficial to a mother's health and contributes to child development, educational achievement, and economic wellbeing. Nonetheless, despite ample evidence that rates can be dramatically improved with a proven set of policies and programs, exclusive breastfeeding for six months is not a normative behavior in most parts of the world, as shown in the systematic review and baby friendly experiences presented in this panel. Why is this so? A key reason is that for too long, breastfeeding has been viewed as a personal issue rather than a collective societal responsibility. For ex-
ample, women give birth in maternity facilities that impede rather
than facilitate immediate skin-to-skin contact and early initiation
and later receive care from healthcare providers who lack basic
knowledge and skills to provide supportive counseling, lactation
management, and information. They face obstacles in the work-
place because of limited or nonexistent maternity protection and
enabling workplace breastfeeding policies and relentless market-
ing by the breast-milk substitute industry. Family, community and
cultural traditions can undermine a woman's decision to breast-
feed. In summary, the world is not as supportive environment for
women who wish to breastfeed and as a result they face daily bar-
riers. To enable women to practice optimal breastfeeding, society
needs to be more supportive and accommodating not the other
way around as has been the case for too long. The key message in
the 2016 series on breastfeeding in The Lancet was that "success
in breastfeeding is not the sole responsibility of a woman – the
promotion of breastfeeding is a collective societal responsibility".
To this end, it called for:

* dissemination of evidence of breastfeeding's fundamental value for all women and children regardless of where they live or level of economic well-being;

* fostering of positive societal attitudes by addressing misperceptions about breastfeeding;

* demonstrating political will by mainstreaming breastfeeding into programs to promote maternal and child health and child development and prevent noncommunicable diseases;

* regulating the breast-milk substitute industry by enacting, monitoring and enforcing the Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly Resolutions (Code); and,

* scaling up and monitoring breastfeeding promotion interventions using proven interventions tailored to patterns of sub-optimal breastfeeding and delivered at scale, and implementing enabling interventions to ensure that maternity and workplace protection are implemented and that all maternity facilities comply with the Baby Friendly Hospital Initiative and the Code.

**Keywords:** Breastfeeding, collective social responsibility, breastfeeding promotion, addressing barriers to exclusive breastfeeding

Track 7: Food Culture Practices and
Nutritional Education

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THE PREDIMED STUDIES: A LEAP FORWARD IN
NUTRITION

RATIONALE AND DESIGN OF THE PREDIMED TRIALS

(1)Martínez-González, Miguel Ángel; (2)Dolores, Corella; (2)Ramon, Estruch; (2)Montse, Fito; (2)Emilio, Ros; (2)Jordo, Salas.

(1)Universidad De Navarra. CIBEROBN. Spain. Havard T.H. Chan School Of Public Health. Boston, USA.; (2)CIBEROBN.

PREDIMED: The selection of the ideal dietary model to prevent non-communicable disease needs to be based on the most robust research designs.

The PREDIMED trial (www.predimed.es) was a primary prevention trial, funded by Instituto de Salud Carlos III, designed to test the long-term effects of the Mediterranean diet (MedDiet) on incident cardiovascular disease (CVD) in men (55-75 years) and women (60-80 years). Participants had no history of previous CVD but were at high risk because of either type 2 diabetes or ≥ 3 classical risk factors. Participants were randomized into one of three diets: 1) MeDiet supplemented with extra-virgin olive oil (EVOO); 2) MeDiet supplemented with nuts; and 3) control diet (advice on a low-fat diet).

Throughout the study (2003-2011), 7,447 participants attended quarterly individual educational visits and group sessions. They received written material with information on key Mediterranean foods and seasonal shopping lists, menus and specific recipes for a typical week. Free (at no cost) allotments of extra-virgin olive oil (1 L per week, including a minimum of 50 mL/day for participants and the rest for family needs) or mixed nuts (30 g/day: 15 g walnuts, 7.5 g almonds and 7.5 g hazelnuts plus extra allocations for the family) were supplied. The primary outcome was a composite of myocardial infarction, stroke or cardiovascular death. The planned duration was 6 years, but the trial was prematurely stopped after 4.8 years of median follow-up for early evidence of benefit of both MedDiets.

PREDIMEDPLUS: Since there are no clinical trials demonstrating that sustained weight loss over >2 years with diet and lifestyle reduce the risk of CVD, we designed the PREDIMED-PLUS Study. This is a randomized, primary cardiovascular prevention trial comparing the effect of two interventions: a)intensive intervention on lifestyle with hypocaloric MedDiet, physical activity and behavioural therapy (intervention group); b)MedDiet following usual care (control group) in participants with metabolic syndrome and overweight/obesity (BMI 27-40 kg/m2, aged 55-75, men or 60-75, women)
Recruitment of participants began in September 2013 in the vanguard centre of Navarra (http://medpreventiva.es/cD5Mp1).

The recruitment was completed on December-2016, in 23 centres. We randomized 6,874 participants. PREDIMEDPLUS is therefore the largest lifestyle and diet trial ever conducted in Europe. We included a 4-week run in period with 3 screening visits before randomization to select the most suitable candidates. In total, 9,677 participants received these screening visits. Participants in the intervention group receive 3 contacts/month during the first year and 2/month during the ensuing years. The control group receives a group session every 6 months. Extravirgin olive oil and tree nuts are provided at no cost to both groups.

The main goal of PREDIMED-PLUS is to get an effective tool based on a hypocaloric traditional MedDiet, physical activity and behavioral therapy strategies to mitigate the priority public health problem of obesity. The primary outcome is the same CVD composite end-point than in PREDIMED-1 and the planned duration is 6 years of intervention plus 2 additional years to collect events.

**Keywords:** Olive Oil, Nuts, Mediterranean Diet, Trial

## THE MEDITERRANAN DIET AND DIABESITY

Salas-Salvadó, Jordi.

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

A considerable body of evidence from prospective studies supports the importance of individual nutrients, foods, and dietary patterns in the prevention and management of metabolic syndrome (MetS) and type 2 diabetes (T2D). The Mediterranean diet (MedDiet) is characterized by high intake of fruits, vegetables, legumes, fish, whole grains, nuts and olive oil; moderate consumption of dairy products and wine, and low intake of red and processed meat and foods with added sugars.

We summarizes the current scientific evidence from epidemiologic studies and clinical trials on the relation between the MedDiet and T2D and the possible mechanisms underlying the reported associations. A meta-analysis of prospective studies showed that greater adherence to the MedDiet was associated with a significant reduction in the risk of T2D and gestational diabetes. Some studies have shown that the MedDiet may be effective in reducing insulin resistance. However, few randomized controlled trials (RCTs) have evaluated the effect of the MedDiet on T2D and MetS management.

Results from the landmark PREvención con DIeta MEDIterránea (PREDIMED) intervention trial showed that participants assigned to the MedDiet had a significant 30% reduction in the risk of T2D and promoted the reversion of MetS and its components, hyperglycemia and central obesity. In addition, some RCTs showed the beneficial effects of the MedDiet compared with other dietary patterns on glycemic control in patients with T2D.

Bioactive components of the MedDiet synergize to affect various metabolic pathways, leading to a reduced cardiometabolic disease risk. The abundance of healthy, nutrient-dense foods that

make up the plant-based MedDiet predicts its bioactivity and potential to beneficially influence metabolic pathways that lead to MetS and T2D, as well as other chronic conditions.

Since there are no clinical trials demonstrating that sustained weight loss over >2years with diet and changes in lifestyle reduce the risk of cardiovascular disease (CVD), we have also designed the PREDIMED-PLUS Study, a parallel group, multi-centre, randomised, primary prevention trial (PREDIMED-PLUS) on men and women aged between 55 and 75 years, with a body-mass-index $≥27$ to $<40$ kg/m2 and meeting $≥3$ criteria for the MetS. The objective of the present research is to compare the cardiovascular effect of two interventions: a) intensive weight-loss intervention on lifestyle program with hypocaloric MedDiet, physical activity and behavioural therapy, b) non intensive care with recommendations on MedDiet following the usual care of medical physicians. The principal end-points are a composite of major hard clinical cardiovascular events, and weight loss and weight maintenance at long term. In October 2017, 6,874 participants have been randomized to the trial. The final results will be available from 2020.

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

**Keywords:** PREDIMED, Mediterranean diet, diabetes, obesity, metabolic syndrome

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

Ros, Emilio.

MD. CIBER Fisiopatología de la Obesidad y Nutrición. Instituto se Salud Carlos III. Spain.

Growing old frequently presents with a plethora of debilitating consequences, among which there are physical disabilities, major organ damage and cognitive decline. The fact that life expectancy has increased throughout the world has raised much interest in factors leading to the presence or absence of aging-associated diseases as major determinants of healthy or unhealthy aging, also named successful or unsuccessful aging. Decades of research on environmental risk factors of cardiovascular diseases (CVD) and other aging-related disorders have firmly established the concept of healthy lifestyles as protective factors. Thus, there is consistent evidence that no smoking, physical exercise, staying lean and adhering to a healthy diet such as the Mediterranean diet account for 80% or more of protection from CVD and diabetes in the general population worldwide. The PREDIMED randomized clinical trial tested calorie-unrestricted Mediterranean diets supplemented with extra-virgin olive oil or mixed nuts against a control diet consisting of advice to reduce dietary fat in older individuals at high risk of CVD for various clinical outcomes: incident CVD (myocardial infarction, stroke or death from these causes) as primary outcome and incident diabetes, metabolic syndrome, peripheral artery disease, atrial fibrillation, congestive heart failure, depression, dementia, major cancers and cataract surgery as prespecified secondary outcomes. Together with neurodegenerative disorders, chronic kidney disease, chronic obstructive pulmonary disease and osteoarthritis, these frequent non-communicable diseases shorten the lifespan and make up unhealthy aging. The results of PREDIMED have shown a beneficial effect of the Mediterranean diets on many of these outcomes: CVD (with a noticeable effect on stroke), diabetes, peripheral artery disease, atrial fibrillation, breast cancer, depression and age-related cognitive decline. PREDIMED has also found a neutral effect of the Mediterranean diets on heart failure and the need for cataract surgery, and other outcomes are still pending analyses of results after extended follow-up. Beneficial effects observed on clinical outcomes can be explained in part by risk factor reduction with the Mediterranean diets: cholesterol, blood pressure, insulin resistance, visceral adiposity, oxidation and inflammation. Nutritional genomic studies in PREDIMED have also shown that adherence to the Mediterranean diets blunts the development of cardiometabolic phenotypes in genetically susceptible individuals, thus providing another mechanisms for the observed reduction of clinical outcomes. From the PREDIMED results up to date, one can reasonably state that the Mediterranean diet is associated with healthy aging. The ongoing PREDIMED PLUS study will eventually extend this observation to the effects of sustained weight loss with energy-restricted Mediterranean diet plus physical exercise.

**Keywords:** Mediterranean diet, aging, cardiovascular risk, non communicable diseases

**Conflict of Interest disclosure:** I have received funds for research through my institution and personal fees for lectures from the California Walnut Commission and am a non paid member of its Scientific Advisory Committee.

# EFFECTS OF THE MEDITERRANEAN DIET ON THE LIPID PROFILE AND LIPOPROTEIN-RELATED MARKERS

(1)Fitó, Montse; (2)Hernáez, Álvaro; (3)Olga, Castañer; (4)Pintó, Xavier;

(5)Estruch, Ramón; (6)Salas-Salvadó, Jordi; (7)Corella, Dolores;

(8)Blanchart, Gemma; (8)Gaixas, Sònia; (9)Arós, Fernando; (10)Serra-Majem, Lluis; (11)Fiol, Miquel; (12)Lapetra, José; (8)Subirana, Isaac;

(13)Martínez-González, Miguel Ángel.

(1)Cardiovascular Risk and Nutrition research group (CARIN);

(2)Pharmacist. Cardiovascular Risk and Nutrition research group (CARIN), Barcelona, Spain.; (3)Medical doctor. Cardiovascular Risk and Nutrition research group (CARIN) Barcelona, Spain.; (4)Medical doctor. Hospital Universitari de Bellvitge de Barcelona, Spain;

(5)Medical doctor. Hospital Clínic de Barcelona, Spain.; (6)Medical doctor. Universitat Rovira Virgili de Reus, Spain; (7)Universidad de Medicina de Valencia, Spain.; (8)Medical doctor. Cardiovascular Risk and Nutrition research group (CARIN), Barcelona, Spain.; (9)Medical doctor. Hospital de Txagurritxo, Vitoria, Spain.; (10)Universidad las Palmas de Gran Canaria, Spain; (11)Hospital Son Espases de Mallorca, Spain; (12)Distrito Sanitario Atención Primaria de Sevilla, Spain; (13)Universidad de Navarra, Spain.

Decreased values of the most relevant HDL function, cholesterol efflux capacity, have been shown to be related to a high incidence of sub-clinical atherosclerosis and coronary events. Similarly, a predictive value of oxidized LDL for cardiovascular events has been reported. With this regard, it is becoming increasingly more accepted that the functionality of HDL and atherogenicity of LDL can be more indicative of the cardiovascular role of these particles than the mere concentration of HDL- and LDL cholesterol.

**Objective:** Our aim was to study the effects of a whole Mediterranean diet (MedDiet) pattern intervention on HDL biological functions and LDL pro-atherogenic traits, in high cardiovascular individuals in the frame of PREDIMED Study.

**Methods:** The PREDIMED Study is a large-scale, multicenter, randomized, controlled, and parallel-group trial with MedDiet interventions (supplemented with virgin olive oil or nuts) versus a low-fat diet control group, on primary prevention of cardiovascular diseases conducted in Spain.

The sub-studies about lipoprotein state and their properties were performed in subsamples of approximately 296 and 210 participants in HDL and LDL subsets, respectively.

Biological samples were obtained for the HDL- and LDL-related biomarkers at the start of the study and 1-year after for the lipoprotein-related analysis.

**Results:** Both MedDiets increased cholesterol efflux capacity relative to baseline. The MedDiet-VOO intervention increased HDL ability to esterify cholesterol, paraoxonase-1 arylesterase activity, and HDL vasodilatory capacity relative to control, and decreased cholesteryl ester transfer protein activity relative to baseline. Adherence to a MedDiet induced these beneficial changes by improving HDL oxidative status and composition. The 3 diets increased the percentage of large HDL particles relative to baseline.

In addition, after the MedDiet-VOO intervention LDL resistance against oxidation increased, the degree of LDL oxidative
modifications decreased, estimated LDL particle size augmented, and LDL particles became cholesterol-rich relative to the low-fat control diet. LDL lipoproteins became less cytotoxic for macrophages only relative to baseline.

**Conclusion:** The MedDiet, especially when enriched with VOO, improved HDL atheroprotective funcions and decreased LDL atherogenicity, in high cardiovascular risk individuals. These traits promoted by a MedDiet could contribute to explaining some of the cardioprotective benefits of this dietary pattern.

**Keywords:** Mediterranean diet, HDL functionality, endothelial dysfunction, olive oil, nuts.

## NUTRIGENOMIC TEACHINGS OF THE PREDIMED STUDIES

Corella, Dolores.

University of Valencia and CIBEROBN. Spain.

**Introduction:** There are many studies that show that the response to the same diet is not equal in everyone. There are several factors (i.e., sex, age, diet, physical activity) that may contribute to that differing response. Great importance is placed on genetic variability in relevant genes for each phenotype studied. Diet is a complex environmental factor as hundreds of macronutrients, micronutrients and other food components are ingested together. Currently, instead of analyzing specific nutrients, more relevance is placed on the study of the whole dietary patterns. On the other hand, numerous meta-analyses of genome-wide association studies have identified new single nucleotide polymorphisms (SNPs) related to cardiovascular risk factors and diseases. However, additional information on how environmental factors modulate the effect of the SNPs on their specific outcomes is scarce. Diet is one of the main environmental factors interacting with genes in determining different genotypes. Therefore our aim was to analyze whether the whole Mediterranean diet (MedDiet) pattern (both observationally measured and intervention with MedDiet) interact with the genetic risk modifying the risk of diseases (both at intermediate and at final phenotype levels).

**Methods:** We have analyzed gene-MedDiet interactions in more than 7,000 high cardiovascular risk participants (aged 55-80 years, who fulfilled at least one of two criteria: T2D; 3 or more cardiovascular risk factors) in the PREDIMED (PREevención con DIeta MEDiterranea) trial both at baseline and after follow-up. We have focused on intermediate and on final cardiovascular disease phenotypes after 4.8 y of median follow-up. Among genetic factors we have selected those SNPs more relevant in determining each analyzed phenotype. We also constructed genetic risk scores (GRS).

**Results and Discussion:** We have found several gene-diet interactions between the MedDiet intervention on stroke incidence (involving the TCF7L2 and LPL genes) and myocardial infarction (MLXPL). Likewise, we have detected several gene-MedDiet interactions on plasma lipids and glucose involving several genes: SORT1, TRIB, , MYLIP, CITED2, CAPN3, KLF4, TRPS1, PLEC1, PDE3A, CTF1, PGS1 and ERGIC3, among others. Also, we have detected gene-diet modulations in determining obesity and dia-

betes, particularly including CLOCK genes and taste genes. Conclusions: MedDiet intervention as well as specific dietary patterns modify the effects of relevant SNPs and GRS on cardiovascular outcomes and intermediate phenotypes.

**Keywords:** Nutrigenetics, genes, mediterranean diet, cardiovascular, obesity

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## TOWARDS GLOBAL LEADERSHIP IN NUTRITION

### NUTRITION LEADERSHIP IN ACADEMIC RESEARCH: THE CHALLENGE OF CROSS-DISCIPLINARY COLLABORATION

Haddad, Lawrence.

Executive Director GAIN.

Cross disciplinary collaboration in nutrition research is frequently held up as desirable. It is difficult enough outside of an academic setting, but within the academy it is even more challenging. The presentation examines (1) why this type of collaboration is so desirable to help prevent malnutrition, (2) why it is challenging within an academic setting, and (3) what, if anything, can be done to incentivise greater amounts of high quality cross disciplinary collaboration to advance nutrition status.

**Keywords:** Cross-disciplinary academic

### GLOBAL NUTRITION LEADERSHIP: PERSPECTIVES FROM THE CORPORATE SECTOR

(1)Martins, Fernanda; (2)Martins, Fernanda; (3)Leroy, Jef; (4)Verstraeten, Roos; (5)Lartey, Anna.

(1)Msc. Nutritionist. Unilever.; (2)Msc Nutritionist. Unilever. The Netherlands.; (3)IFPRI; (4)IFPRI. Belgium.; (5)FAO. IUNS.

Since the foundation of the first Nutrition Leadership Program in Europe in 1994, Unilever has been involved in training, building and maintaining a global network of nutrition leaders. Currently, this network consists of more than 1300 nutritional professionals in Europe, Africa and Asia.

The need for such a network has surfaced as nutrition professionals in academia, industry, and the public sector are generally very strong in their field but also require the skills to collaborate and thus to address nutrition-related public health problems in an impactful way. The Nutrition Leadership Programs (NLP) has helped provide the leadership skills such as communication, strategic influence and interpersonal skills required to do so.

From an industry standpoint, the NLPs are critical for:

* the development of future leaders that have a broader understanding of the nutrition agenda and are able to effectively collaborate across cultures
* building understanding that each actor in the field of public health has their role to play to combat nutrition related challenges (academia, industry, governments and NGOs)

* access, via employee participation and sponsor representation, to an inspiring and strong global network of (future) nutrition leaders

Based on the data from career development of NLP alumni it is evident that this program is an effective tool in nutrition leadership development across regions. The need to train nutrition professionals in leadership skills and the ability to collaborate effectively across stakeholders to drive the public health agenda forward has not diminished in the time since the first NLP was founded. As a matter of fact, increasing business across regions has identified the need for leadership at a global level. We will discuss how connecting regional NLPs into a global NLP could benefit corporate organizations in driving an aligned public health agenda at the global level.

**Keywords:** Nutrition leadership. Leadership program

**Conflict of Interest disclosure:** Fernanda Martins is Nutrition&Health Manager at Unilever, a manufacturer of Food and Beverages products and sponsor of the ENLP and ANLP.

## THE NEED FOR GLOBAL NUTRITION LEADERSHIP TO MEET THE SUSTAINABLE DEVELOPMENT GOALS

Lartey, Anna

President of the International Union of Nutritional Sciences (IUNS). Director of Nutrition at the Food and Agriculture Organization of the United Nations (FAO). Rome. Italy.

In 2015, the world received a broad set of universal, ambitious and sweeping set of goals. These are considered a transformative agenda that must leave no one behind. Although nutrition is explicitly mentioned in Goals2, at least 12 out of the 17 goals cannot be achieved without addressing nutrition. The current nutrition situation where 800 million people are undernourished, two billion are micronutrient deficient and 159 million children under five years are stunted, but at the same time 1.9 billion are overweight or obese, calls for a different way of doing business. In response to this, countries are putting in place nutrition policies and strategies to be able to achieve these targets. However, the complexity of the nutrition problem requires multi-sectoral actions involving different stakeholders. The training given to nutrition professionals provides scientific content. However, in a multi-sectoral environment, new skills sets are needed, such as the ability for leading change, team building, effective communication, networking and negotiation skills, to effectively deliver on nutrition and to keep nutrition on the global agenda. Taking advantage of the SDG, the need for a Global Nutrition Leadership Program that would function and deliver effectively within a multi-sectoral environment is needed. Region-based Nutrition Leadership training programs aim to fill this gap. However, to have a stronger voice at the global table, regional Nutrition Leadership Programs should

join forces under the umbrella of a Global Nutrition Leadership Program to develop a harmonize approach of building leadership skills for early to middle career nutritionists.

**Keywords:** Nutrition leadership. SDG. multisectoral

## FINDING SYNERGY BETWEEN INTERNATIONAL LEADERSHIP DEVELOPMENT INITIATIVES: PERSPECTIVES FROM THE NUTRITION LEADERSHIP PROGRAMMES

There is growing recognition that to address today's nutritional problems there is a need for effective leaders in nutrition across sectors (academic, corporate, governmental and non-governmental), and at all career levels (junior, mid-career and senior). This requires strong leadership skills to build transdisciplinary alliances, identify evidence gaps, seize opportunities for action, and to effectively communicate to varied audiences about nutrition at the individual, organizational and system levels.

Regional Nutrition Leadership Programs (NLPs) are now well established in Europe, Africa, South-East Asia, Middle East, Latin-America, and Oceania. Interest has been expressed by the SUN movement and other agencies in developing leadership capabilities in other (sub-)regions. Leading change in nutrition is challenging, and requires a unique set of values, attitudes and orientations in addition to excellent technical, facilitation, strategic, and inter-personal skills. By creating awareness and developing these skills at an early- or mid-career stage, the different NLPs seek to increase the capacity of nutrition professionals to lead from where they are at all levels in the system.

Representatives from different NLPs have joined forces to build the functional capacity necessary to deal with the global nutrition challenges common to so many regions of the world. In keeping with the region-led approach of the NLPs, the initial emphasis is on supporting and strengthening existing NLPs whilst creating a common global purpose across NLPs and forging linkages between them. We will share details of this new initiative, which includes as a first step a detailed mapping of the global nutrition leadership landscape and a critical assessment of the potential added value that inter-regional collaboration could provide.

**Keywords:** Nutrition Leadership Programs, Global nutrition, leadership

**Further collaborators:** A large group of individuals involved in leadership development globally, including the different NLPs.

<footnote>(1)Verstraeten, Roosmarijn; (2)Jerling, Johann; (3)Leroy, Jef.</footnote>

<footnote>(1)PhD. Nutritionist. Independent researcher and consultant. Belgium; (2)Prof. PhD. Centre of Excellence for Nutrition. North West University. South Africa.; (3)PhD. Senior Research Fellow. Poverty, Health, and Nutrition Division. International Food Policy and Research Institute. Washington DC.</footnote>
OVERVIEW OF CURRENT COURSE CONTENT & LESSONS TO BE LEARNED

Ellahi, Basma; (2) Jafri, Ali; (3) Mukantwali, Christine.

(1)PhD. Faculty of Health and Social Care. University of Chester.
UK.; (2)PhD. University of Casablanca. Morocco; (3)PhD. Rwanda
Agriculture Board. B.P 5116. Kigali. Rwanda.

The eNutrition Academy (eNA) initiative, focussing on the
learning needs for Africa, has been developed by global and re-
gional nutrition professional bodies (International Union of Nu-
tritional Sciences, Federation of African Nutrition Societies, Af-
rican Nutrition Society, American Society of Nutrition, Nutrition
Society UK and Ireland). The aim is to strengthen nutrition capac-
ity in Africa using an electronic learning platform in response to
identified gaps in training resources in Higher Education Institu-
tions (HEI).

Two units of study on the subject of dietary assessment were created (co-authors BE and RA) and developed into eLearning units with support from the web host, Cambridge University Press. These are open and free access units. The unit content is stand-alone but the development of each unit followed a similar format and incudes text material, access to free learning resources, video clips and interactive online exercises. The authors used additional learning materials, produced by colleagues African group members, to supplement the content in order to ensure a context specific approach. This also encouraged a higher level of engagement and adoption of the material. A third unit to complement the dietary assessment units was developed by our sub-group from across Africa and is currently undergoing review before being developed into online content.

An evaluation form was also created by the sub-group mem-
bers which explored learner satisfaction with the material and the
on-line features. The two units developed to date were evaluated
by nutrition students and professionals in Africa. Training based
on the experience was provided for other African colleagues to
support current and on-going eLearning production. The pres-
tation will discuss the findings of the evaluation to inform fu-
ture developments.

**Keywords:** Dietary assessment, online learning, evaluation, development

MAPPING OF FREE AND OPEN-ACCESS ELEARNING RESOURCES IN HUMAN NUTRITION

(1)Aryeetey, Richmond; (2)Grace, Marquis.

(1)PhD. Senior Lecturer. University of Ghana School of Public Health. Legon. Ghana; (2)PhD. Nutritionist. School of Human Nutrition. McGill University. Quebec. Canada.

Capacity building and leadership have been recognized as key ingredients for delivering effective actions in nutrition and health, and particularly within the scaling up nutrition framework. The eNutrition Academy (eNA) initiative has been developed by global and regional nutrition professional societies/federations (International Union of Nutritional Sciences, Federation of African Nutrition Societies, African Nutrition Society, American Society for Nutrition, The Nutrition Society [UK]). It aims to strengthen nutrition capacity in Africa using an electronic learning (eLearning) platform. The eNA is an innovative response to the identified gaps in pre-service training resources in higher education institutions (HEI) in sub-Saharan Africa. The current study maps the typology and characteristics of existing eLearning resources which are openly and freely accessible to African HEIs. This rapid mapping exercise relies on an online search of existing eLearning resources, performed between January and May 2017 by the author as well as a cross-section of nutrition students and faculty in Africa. The search strategy was guided by the following search terms: nutrition, food systems, eLearning, course, open-access. Two independent reviewers used a template to extract characteristics of the identified eLearning platforms, including category of sponsors, content, organization or content, level of interactivity and target audience. This presentation will provide evidence on the 17 identified eLearning resources in nutrition and the gaps in their content and their delivery approach. The findings will form a basis for developing appropriate content delivery of nutrition training through the eNA.

**Keywords:** eLearning, Nutrition, Africa, Training, Higher education.
STRENGTHENING SYSTEMS FOR ESTABLISHING
INTEGRATED HUMAN MILK BANK PROGRAMS
AS ESSENTIAL NEWBORN CARE THROUGH
GLOBAL LEARNING EXCHANGES: A BEST PRAC-
TICE FOR ENSURING OWNERSHIP

(1)Israel-Ballard, Kiersten; (2)Mansen Amundson, Kimberly; (3)Nguyen Quynh, Nga; (4)Sachdeva, Ruchika; (5)Muiruri, Juliana.

(1)DrPH. Maternal, Newborn, Child Health and Nutrition. PATH. United States.; (2)MSPH. Dietitian. Maternal, Newborn, Child Health and Nutrition. PATH. United States.; (3)MD. Maternal, Newborn, Child Health and Nutrition. PATH. Vietnam.; (4)MSc. Nutritionist. Maternal, Newborn, Child Health and Nutrition. PATH. India.; (5)BsC. Maternal, Newborn, Child Health and Nutrition. PATH. Kenya.

**Background and objectives:** Human milk is essential for all infants to ensure optimal growth and development. For preterm, low-birthweight infants unable to access sufficient breastmilk from their own mothers, pasteurized donor milk from a human milk bank (HMB) is recommended by the World Health Organization. HMB, when integrated with skin-to-skin, and lactation support programs, increases access to human milk, influences the culture of care to advocate for all infants to receive human milk. HMB expansion is limited due to lack of global guidance or quality standards to ensure safety. The aim of this work was to establish a systematic approach for building local technical capacity; a best practice of this approach is conducting learning exchanges to established HMB programs with the goal of developing a mechanism for mentorship and transferring skills for new HMBs.

**Methods:** Three HMB learning exchanges were facilitated between June 2015 and March 2017 to foster multinational collaboration. This included delegations from India to Brazil, Vietnam to Scotland, and Kenya to South Africa. Multi-disciplinary teams attending each exchange included ministry of health representatives, newborn and nutrition technical leaders, and nursing and midwifery experts. Focus was on specific needs from each region to ensure that the experience fulfilled pressing concerns. HMB champions hosted in-country site-visits. Approvals were obtained from the host ministry of health authorities to promote sustainable relationships.

**Results:** Each resulted in increased local ownership and capacity to adapt and strengthen systems in their own setting, including establishing local guidelines, operating procedures and policies. Various HMB models were explored in public and private sectors, exposing each team to best practices in HMB processes, and optimal integration with newborn and nutrition practices. Critical areas of learning included the importance of robust policy and practices to ensure sustainable, ethical, quality, and safe donor human milk.

**Conclusions:** In the absence of global guidance on HMB, learning exchanges play a critical systems strengthening role for

ensuring that evidence-based best practices are integrated into new programs. Additional opportunities to share knowledge and expand best practices are lacking. Global HMB guidance and quality standards are needed as part of ensuring that infants worldwide have access to safe human milk.

**Keywords:** Human milk bank, breastfeeding, preterm

INDIGENOUS PEOPLES' FOOD SYSTEMS: GENDER ROLES, BIODIVERSITY AND FOOD SECURITY – A NEW PUBLICATION

Kuhnlein, Harriet.

PhD. Founding Director. Centre for Indigenous Peoples' Nutrition and Environment. McGill University. Canada.

It is with pleasure that in this session we release our publication titled "Indigenous Peoples' Food Systems: Gender Roles, Biodiversity and Food Security, co-edited by Harriet Kuhnlein and Thingnganing Longvah. We are grateful to the journal, Maternal and Child Nutrition (Wiley), for this free access publication venue, and to the International Union of Nutritional Sciences (IUNS) for supporting this effort.

The IUNS Task Force on Traditional, Indigenous and Cultural Food and Nutrition (2010-2017) has evolved from earlier task forces within the Union that addressed Nutrition and Anthropology (1986-1994) and Indigenous Peoples' Food Systems and Nutrition (2001-2009). Major recent free access publications from the Task Force describe the methodology and process of documenting food systems of 12 diverse cultures of Indigenous Peoples, and how their biodiverse food systems are used and promoted to benefit health status of rural indigenous communities. Our current effort, released today, describes how gender roles and the right to food for several cultures of Indigenous Peoples can be fostered to protect their unique food resources and traditions for their food security benefits, especially for women and children. In particular, aspects of societal maternal or paternal lineality and locality, division of labor, spirituality, and decision-making are described to recognize the impact gender roles have on leadership process, and dynamics of family food access, availability and use. Indigenous Peoples' food systems from cultures in Ecuador, Nigeria, Thailand, India, Canada, Japan and Morocco are included. Perspectives from these traditional and transitional rural indigenous cultures give important insights on how gender roles with indigenous world views affect use of local food biodiversity and food security at family and community levels. We avoided gender-based stereotypes and sought local interpretations, customary laws and norms impacting ownership and inheritance of resources and the related decision-making that is important for maintaining biodiversity, food security, and well-being. Articles based in these local
cultures give descriptions of local food biodiversity and patterns of use; some give detailed descriptions of nutritional status of women and children; and attention is given to historical changes in environmental circumstances and cultural norms affecting food and nutrition security.

We recognize all Task Force members for their contributions to this publication, and we thank Bioversity International and the Indigenous Partnership for Agrobiodiversity and Food Sovereignty for the inspiration to conduct this research that was first discussed in 2015 at the Indigenous Terra Madre in Shillong, India.

**Keywords:** Indigenous Peoples, food systems, biodiversity, gender, traditional food

## NUTRITIONAL DIMENSIONS AND POTENTIAL OF INDIGENOUS FOOD SYSTEM IN NORTHEAST INDIA

Northeast India, home to more than 200 diverse tribes with distinct cultural, linguistic, religious and historical background is considered one of the most diverse regions of the world. The paper presents the indigenous food system in Northeast India, the diversity of the food resources, their nutritional attributes and the impact of their use on food and nutrition security among indigenous tribes.

Wide variety of wild species and interspecies still constitutes the bedrock of the indigenous food system. Several studies on the food system of the different tribes in Northeast India revealed that the indigenous food count can be anywhere from 250 to 748. Majority of these are collected from the wild however, the current usage is much lesser than documented. The indigenous tribes of Northeast India being owners of the land have access and control with customary laws protecting the forest reserves. About 10 – 15% of the wild foods from forests find market and form source of income. Traditionally local crops, ethnic vegetables and indigenous fruits are collected by women folk either from the forest areas, conserved in shifting land or indigenous kitchen gardens. This is demonstrated by the fact that many edible wild species are in various stages of domestication as a result of human selection. The most commonly harvested wild food are green leafy vegetables, roots & tubers, fruits, flowers, seeds, spices, insects, snail, crab, small fishes and game animals. The indigenous food system in Northeast India also boast of rich agrobiodiversity with several landraces. Several landraces of rice, specific to tribes have been documented that have better nutritional attributes such as low glycemic index normally

not seen in high yielding or hybrid rice thus reflecting in low incidence of diabetes in the region. Traditional plants are often used as both food and medicine and this connection must be noted. For example, Clerodendrum colebrookianum leaves popularly used in Northeast India minimize high blood pressure and perhaps the use of such vegetables is the reason for lower prevalence of hypertension and diabetes in the region. Wild foods remain important from both cultural and nutritional perspective manifesting in lower rate of child undernutrition in northeast India as compared to the rest of India.

Traditionally wild foods are consumed in various combinations along with cereals and vegetables to meet the food and nutrient needs and form a significant portion of the diet but their contribution to the household food supply vary according to the region and tribe. In view of the importance of wild foods resources in the food system of the indigenous people, systematic documentation and nutrient characterization of important food source is required. This will help in efforts to capitalize on the health benefits of indigenous food systems and integrate it into contemporary food systems to be able to fully support health and nutrition of the population in a sustainable manner.

**Keywords:** Indigenous food system, Northeast India

## GENDER ROLES, FAMILY RELATIONSHIPS, AND HOUSEHOLD FOOD AND NUTRITION SECURITY IN THE OHAFIA MATRILINEAL SOCIETY IN NIGERIA

**Objective:** Information on the nutritional status and household food security of the Ohafia matrilineal society are scarce. This study examined gender roles, family relationships, food security, and nutritional status of households in Ohafia, Nigeria.

**Methods:** A cross sectional descriptive study was conducted. Multistage sampling technique was used to select 287 households from three villages: Akanu, Amangwu, and Elu. Qualitative and quantitative data collection methods were adopted, namely, focus group discussions and questionnaires. Anthropometric measurements (height and weight for mothers and children, and mid upper arm circumference for young children) were taken using standard techniques. The body mass index of the mothers was calculated. All nutritional indices were compared with reference standards. Food insecurity was assessed using the Household Hunger Scale (HHS) and Dietary Diversity Score (DDS), then, analyzed using the Statistical Product for Service Solution (SPSS®) version 21. Data analysis used descriptive statistics.

<footnote>(1)Longvah, Thingnganing; (2)K., Venkaiah; (2)Indrapal I, Meshram;</footnote>

<footnote>(2)VSS., Prasad; (3)Roy, Phrang; (4)Kuhnlein, Harriet.</footnote>

<footnote>(1)National Institute of Nutrition, Jamai Osmania PO, Hyderabad - 500 007, TS, India; (2)National Institute of Nutrition, Jamai Osmania PO, Hyderabad - 500 007, TS, India; (3)Indigenous Partnership for Agrobiodiversity and Food Sovereignty, c/o Bioversity International, Rome, Italy; (4)Centre for Indigenous Peoples' Nutrition and Environment (CINE), McGill University, Montreal, Canada.</footnote>

<footnote>(1)Ene-Obong, Henrietta; (2)Onuoha, Nne Ola; (3)Eze, Eme Paul.</footnote>

<footnote>(1)BSc, MSc, PhD. Department of Biochemistry (Human Nutrition & Dietetics Unit). Faculty of Basic Medical Sciences. University of Calabar. Calabar. Cross River State. Nigeria.; (2)BSc, MSc, PhD. Department of Home Science Nutrition and Dietetics. University of Nigeria. Nsukka. Enugu State. Nigeria.; (3)BSc, MSc. Department of Home Science Nutrition and Dietetics. University of Nigeria. Nsukka. Enugu State. Nigeria.</footnote>
**Results:** Most (91.2%) of the respondents were female. The matrilineal system known as “ikwu nne” or “iri ala a nne” (inheritance through mothers’ lineage) is still in place, but is changing. One important benefit of the system is the access to land by women. While women participated actively in agriculture, food preparation, and care of family, the men were moving to off farm activities. High prevalence of household food insecurity (66%) and signs of malnutrition including moderate to severe stunting (48.4%) and wasting (31.7 %) in children, household hunger (34.5%), and overweight (27.5%) and obesity (19.2%) among mothers were observed. Conclusion: Despite women access to land, malnutrition remains a serious problem in these communities. These communities urgently need gender sensitive interventions.

"A member of the Task Force on Traditional, Indigenous and Cultural Food and Nutrition"

MATRILINEAL SYSTEM, HOUSEHOLD FOOD SECURITY AND NUTRITIONAL STATUS OF WOMEN AND CHILDREN AMONG THE OHAFIA IBOS OF SOUTH-EASTERN NIGERIA

(1)Ene-Obong, Henrietta; (2)Onuoha, Nne Ola; (3)Eze, Eme Paul.

(1)BSc, MSc, PhD. Department of Biochemistry (Human Nutrition & Dietetics Unit). Faculty of Basic Medical Sciences. University of Calabar. Calabar. Cross River State. Nigeria.; (2)BSc, MSc, PhD. Department of Home Science Nutrition and Dietetics. University of Nigeria. Nsukka. Enugu State. Nigeria.; (3)BSc, MSc. Department of Home Science Nutrition and Dietetics. University of Nigeria. Nsukka. Enugu State. Nigeria.

**Objective:** Women occupy a central role in subsistence agriculture, being responsible for about 80% of agricultural production. However, gender disparity in access to agricultural resources and services count against their productivity and consequently on the food and nutrition security of their household. It has been shown that when women have access to or own land they allocated much of their household income to food and therefore have more healthy children. In patriarchal societies, rules of inheritance favour male rather than the female in terms of land allocation. Nigeria is basically a patriarchal/patrilineal society; however, a few matrilineal societies exist in different parts of the country, one of which is the Ohafia Ibos of South-eastern Nigeria. The Ohafia Ibos operate a system where inheritance is through mothers' lineage (translated into the local dialect as "iri ala a nne"). Researchers have examined the socio-political implication of the matrilineal descent system among the Ohafia Ibos. This paper focuses on the origins, features, food and nutrition security, and nutritional status of women and children in matrilineal Ohafia communities.

**Methods:** A cross sectional descriptive study was conducted. Multistage sampling technique was used to select 287 households from three villages: Akanu, Amangwu, and Elu. Qualitative and quantitative data collection methods were adopted, namely, focus group discussions (FGD) and questionnaires. Anthropometric measurements (height and weight for women and children, and

mid upper arm circumference [MUAC] for young children) were taken using standard techniques. The body mass index of the mothers was calculated. All nutritional indices were compared with reference standards. Food insecurity was assessed using the Household Hunger Scale (HHS) and Dietary Diversity Score (DDS), then, analyzed using the Statistical Product for Service Solution (SPSS®) version 21. Data analysis used descriptive statistics.

**Results:** The origin of the matrilineal system in Ohafia is based on oral tradition. The system is still in place but is changing. Although the matrilineal system allows women to inherit and have access to land, men are the household heads and preside over land matters. While women are actively engaged in agriculture, food preparation, and care of family, the men are moving to off farm activities. Indigenes perceive the matrilineal system to have some merits and demerits which have had significant impact on the lives of the people. Despite the rich biodiversity, high prevalence of household food insecurity (66%) and hunger (34.5%); malnutrition, including moderate to severe stunting (48.4%), wasting (31.7 %), and severe malnutrition (11.5%; MUAC < 11.00 cm) in children; and overweight (27.5%) and obesity (19.2%) among mothers were observed.

Conclusion: The matrilineal system and women access to land did not appear to shield these communities from household food insecurity and the double burden of malnutrition among women and children. While a detailed study of the intervening variables is recommended, these communities urgently need gender sensitive interventions.

**Keywords:** Matrilineal system, food and nutrition security, malnutrition, women and children, Ohafia

SUPPORTING INDIGENOUS CULTURES AND HONORING POSITIVE GENDER ROLESTHROUGH WOMEN'S GROUPS IN TUNGURAHUA, ECUADOR

(1)Roche, Marion; (2)Ambato, Lorena; (3)Sarsoza, Julieta; (4)Kuhnlein, Harriet V.

(1)PhD. Senior Technical Advisor Adolescent and Women's Health & Nutrition. Nutrition International. Ottawa. Canada.; (2)BSc. Community Nutritionist. Chimborazo & Tungurahua. Area Development Programs. World Vision Ecuador. Ecuador.; (3)MD. Health Advisor. World Vision Ecuador. Quito. Ecuador; (4)PhD. Centre for Indigenous Peoples' Nutrition and Environment. School of Dietetics and Human Nutrition. McGill University. Canada.

Across Latin America, there have been improvements in undernutrition in recent decades, but these improvements have not been equal for Indigenous Peoples. They do not experience the same health and access to healthcare as non-Indigenous people, resulting in physical and cultural health consequences for the individual and the collective group. Traditional food systems of Indigenous Peoples, including wild leafy greens, can provide nutritional
value to diets and also support cultural aspects of food security. This study focuses on women in the maternal land of Tungurahua and their connection with culture and the food system through a food-based community nutrition intervention. Building upon the Quichua concept of mink'a—a system of community collaboration for the common good, mothers' cooking clubs were organized. The community nutrition intervention promoted the reintroduction of local foods through community cooking clubs and recipe competitions at local fairs. A positive deviance approach identified the local foods to be included in the intervention recipes, which were prepared in mothers group sessions under the guidance of a mother that was selected and trained as a guide mother. Two leafy greens were among the key foods identified to be widely available, but used by only a few households. Mothers met for 12 days consecutively to learn the recipes and prepare a meal together with other mothers at the house of a guide mother. An elder supported each of the mothers groups with traditional knowledge and Quichua language. We assessed the social, cultural, and nutritional potential of the mothers' club intervention to increase the consumption of local foods and the potential to improve children's diets with local foods. Key informant interviews and focus groups were conducted with 54 mothers and 16 elders to identify perceptions of the intervention and traditional foods. Social and cultural dimensions, including gender, were identified through content analysis. The nutritional contribution of the leafy greens was estimated through semi-quantitative food frequency questionnaires conducted with 160 participant mothers and 98 mothers living in nearby communities without the intervention that served as a comparison group. The use of local foods was a source of pride for mothers and elders. Non-food uses of the nettle proved an initial barrier to acceptance; however, peer support within mothers' groups enabled increased consumption. The greens were estimated to contribute an additional 8% vitamin A, 7% iron, 12% vitamin C, and 27% folate to children's recommended dietary intakes. By promoting wild leafy greens, mothers' groups improved food security and the cultural and nutritional value of their diet. Additionally, mothers' cooking clubs increased self-efficacy and cultural identity for Quichua women, offering a highly acceptable nutrition intervention model, honoring both gender roles and culture.

**Keywords:** Quichua. Community Intervention. Mothers' Groups. Culture. Traditional Foods.

**Conflict of Interest disclosure:** Julieta Sarsoza and Lorena Ambato worked for World Vision Ecuador at the time of the study, but did not influence data collection or interpretation.

NUTRITIONAL STATUS, FOOD INSECURITY AND BIODIVERSITY AMONG THE KHASI IN MEGHALAYA, INDIA

(1)Kuhnlein, Harriet; (2)Chyne, Daniella A.L.; (3)Longvah, Thingnganing.

(1)PhD. Founding Director. Centre for Indigenous Peoples' Nutrition and Environment. McGill University. Canada.;

(2)Research Scientist. National Institute of Nutrition. Hyderabad. India.; (3)PhD. Director. National Institute of Nutrition. Hyderabad. India.

Tribal communities in India are 8.6 % of the national population- an estimated 104 million people. The Khasi in Meghalaya State is among the largest tribal cultures and is well-known for unique matrilineal and matrilocal patterns. Women head households and enjoy positions of importance and dignity as preservers of clan, family and lineage. The youngest daughter is the receiver and custodian of intergenerational property transfer and the maternal uncle is head of family with executive management toward children, including behavioral discipline. The West Khasi Hills (WKH) district population is mostly Khasi, and is known for rich biodiversity and extensive rainfall, with sacred forests considered storehouses of genetic ecosystem resources; however, deforestation is widespread and high rates of childhood undernutrition and anemia are known in the State. The research purpose was to establish Khasi nutritional status and food biodiversity in the region to help determine priorities for food security using local natural resources.

A random sample of 600 households was determined in 20 villages for index child and mothers; anthropometry, dietary and food security interviews, and finger prick blood samples were taken; and environmental conditions recorded. Literacy was 77% for women and 67% for men, with 21% completing grade 12. Household income was low, 45% had safe drinking water, and 77% had sanitary latrines. Due to extensive missing nutrient data, food group analysis was conducted and compared to the Indian RDI. Cereals & millets, roots & tubers were consumed by more than 50% of individuals exceeding 70% RDI. White rice from the public distribution system was consumed by more than 95% of adults 2-3 times per day; leafy vegetables (GLV), milk, and fat intakes were poor; and overall dietary diversity was low. Moderate food insecurity existed in 63% of households, with 19% food secure. Colostrum was routinely given; exclusive breast feeding usually ceased at 6 mo, with breast feeding continuing until about 2 yr. Children's food intake by gender was similar with wide variation. Children's weight and height were close to 2006 WHO standards in early months, but growth faltering began around the third month. Underweight (31%), stunting (57%) and wasting (10%) existed for children <5 yr, with undernutrition higher among boys than girls. BMI ≤18.5 for women was 19% and 8% had BMI ≥ 25. Anemia was present for 68, 70, 86 and 83% of 1-5 year children, pregnant, lactating, or non-pregnant-or-lactating women, respectively. Women's hypertension was 15% and glucose intolerance was 0.7%.

The Khasi local food system has 372 differentiated species/varieties, many uncultivated and without scientific identification or nutrient data. Of 31 wild GLVs, only 10 were consumed by >50%
of households 1-2 times/wk; 52 wild fruits were known, but only 5 varieties regularly consumed. Environmental protection, agrobiodiversity, food composition research, and food and nutrition education can be strengthened to improve health in this unique society.

Sincere appreciation is expressed to staff at the National Institute of Nutrition, Hyderabad, and the Northeast Slow Food and Agrobiodiversity Society, Shillong.

**Keywords:** Indigenous Peoples, Khasi, nutritional status, bio-biodiversity, food security

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## AFRICAN GRADUATE NUTRITION STUDENTS NETWORK (AGSNET) SYMPOSIUM AT ICN, 2017

> **"I CANNOT SIT HERE AND EAT ALONE WHEN I KNOW A FELLOW GHANAIAN IS SUFFERING; WE WERE NOT BROUGHT UP THAT WAY": PERCEPTIONS OF FOOD INSECURITY AMONG GHANAIAN MIGRANTS**

(¹)Osei-kwasi, Hibbah Araba; (²)Nicolaou, Mary; (³)Powell, Katie;

(³)Holdsworth, Michelle.

(¹)PhD student and Research Associate. University of Sheffield. Public Health Section. Sheffield. UK; (²)Department of Public Health. Academic Medical Centre. University of Amsterdam. Amsterdam. The Netherlands.; (³)University of Sheffield. Section of Public Health. Sheffield. UK.

**Background:** In the UK, ethnic minority groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored the influence of social and economic factors in shaping dietary practices among Ghanaians living in Greater Manchester to get an insight into perceptions of food insecurity among participants.

**Methods:** A qualitative study of adults aged ≥25 years (n=31) of Ghanaian ancestry living in Greater Manchester using face-to-face interviews. Participants varied in socioeconomic status, gender and migration status. Interviews were transcribed verbatim and analysed thematically.

**Results:** This study shows that most people can manage on limited resources and from the social support within the community, however people opt for 'belly food', which tends to be unhealthy and do not prioritize their own health. Food insecure household were perceived to be reluctant to make use of food banks for the fear of gossip and pride, paradoxically, this reluctance does not extend to close network. The church and other social groups formed a trusted base in which people operate; support given through these channels is more acceptable than through the "official context".

**Conclusions:** This study suggests that food security within the Ghanaian community could be enhanced through supportive networks within the community. The churches and other social organisations such as the Ghana Union might be a means through which formal support may be mediated. If the churches and social groups can target the most deprived, there is the need for research to find out whether the resources of the church are sufficient to meet their needs, as effective interventions depend on being able to effectively target the vulnerable. Future survey-based research is needed to better assess the accessibility and utilization pillars of food insecurity given that perceptions data may not suffice to capture the physical and utilization component of food insecurity. There is also the need to explore the implications of food management and coping strategies for dietary quality and health among this population.

**Keywords:** Food insecurity, Social networks, Ghanaians, Dietary practices, Migrants

## BODY COMPOSITION IN PRE-PUBERTAL MOROCCAN CHILDREN USING ISOTOPE DILUTION: DEVELOPMENT AND VALIDATION OF BIOELECTRICAL IMPEDANCE ANALYSIS EQUATIONS FOR PREDICTION TOTAL BODY WATER AND FAT-FREE MASS

(¹)El Harchaoui, Imane; (²)Baddou, Issad; (³)El Menchawy, Imane;

(²)Benjeddou, Kaoutar; (²)Saeid, Naima; (⁴)Belghiti, Hakim; (⁵)El Kari, Khalid; (⁵)El Mzibri, Mohammed; (⁵)El Hamdouchi, Asmaa;

(⁶)Aguenaou, Hassan.

(¹)PhD Student. Joint Unit of Nutrition and Food Research. Ibn Tofail University - Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco; (²)PhD Student. Joint Unit of Nutrition and Food Research. Ibn Tofail University-Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (³)MD. Joint Unit of Nutrition and Food Research. Ibn Tofail University-Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (⁴)MD. Nutritionist. Hôpital Militaire d'Instruction Mohammed V. Rabat. Morocco; (⁵)PhD. Researcher in Nutrition. Joint Unit of Nutrition and Food Research. Ibn Tofail University-Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.; (⁶)PhD. Professor. Joint Unit of Nutrition and Food Research. Ibn Tofail University-Centre National de l'Energie des Sciences et des Techniques Nucléaires. Morocco.

**Background/Objectives:** Body composition is important as a marker of both current and future health. Bioelectric impedance analysis (BIA) is a simple and accurate method for estimating body composition, but requires valid equations obtained from calibration studies to derive total body water (TBW) and fat free-mass(FFM) from electrical impedance. Equations for estimating FFM and TBW using this tool, with appropriate cross-validation, have been developed in Moroccan adolescents and adults. However none of the previous studies included Moroccan children.
The aim of our study was to examine the validity of published BIA-FFM and BIA-TBW equations available in the literature in the population of study and if needed to develop a new FFM-BIA and TBW-BIA equations using deuterium dilution as the reference method.

**Subjects/Methods:** Data were collected from 247 healthy children aged 8-11-year-old. Children were sorted by gender and age group and assigned into development and validation subgroups. The deuterium dilution was used as reference for estimating TBW and FFM. The accuracy of previous published equations was tested using Bland and Altman approach, proportional bias, pure error and effect size. BIA new equations were developed using linear regression and cross-validated using Bland and Altman approach.

**Results:** The previous published equations tested, showed a significant absolute and proportional bias indicating that these equations would provide biased values in estimating TBW and FFM. The above the mentioned biases detected, emphasizes the need for the development of specific equations to predict TBW and FFM with a low standard error in pre-pubertal Moroccan children.

The new equations derived provided non-significant proportional bias values, and better agreement than other tested equations. Bias and pure error values were 0.05 and 0.761 for boys and -0.12 and 0.921 for girls, for TBW equation. For FFM equation, bias values were 0.09 and -0.14, and pure errors were 1.00 kg and 1.17 kg for boys and girls, respectively.

**Conclusions:** The new prediction equations for TBW and FFM developed in our study are the most accurate to estimate TBW and FFM in Moroccan pre pubertal children aged 8-11 years. Further studies are needed to examine the validity of those new equations in a large sample on children.

**Acknowledgments:** This study was performed with the support of the IAEA. (Project RAF 0642).

**Keywords:** Keywords: Body composition; Bioelectrical impedance; Prediction equation; Total body water; Fat free mass; Moroccan children.

a special combination of values, attitudes, orientations and behaviours in addition to their excellent technical skills.

The African Nutrition Leadership Programme (ANLP) has hosted a series of leader development events since 2002 and has built a Pan-African network of more than 380 leaders in 35 African countries working in multiple nutrition-related sectors. The ANLP's focus is on the development of the individual's leadership capabilities. Since 2010 the ANLP has also developed a number of needs-based leadership development programmes for multi-sectoral teams and organisations at national and subnational level who contribute towards scaling up nutrition interventions. Programmes have been hosted in Kenya, Rwanda, Uganda and Zambia with more being developed for implementation in the near future. Recognising the urgent demand, the ANLP has started developing a larger group of master trainers to facilitate the scaling up of leadership capacity building across the continent.

Leader development is also of importance to enhance the employability of science graduates. The NWU has developed a personal development programme which includes aspects of self awareness, contextualizing your behavior in the workplace and conflict resolution among others. The programme has been piloted in a cohort of graduate interns and the second cohort are now engaged with the programme. The self-awareness created set participants up for a process of life-long learning and growing. In addition the need has been identified and programme initiated to embed leadership development in the dietetics curriculum to ensure that we develop a workforce that have the ability and the necessary orientations and values to stand up and lead from where they are.

These programmes are examples of ongoing capacity development initiatives that are African-led and that impact the functional capacity of our nutrition workforce.

**Keywords:** Leadership, capacity building, Africa, change, ANLP

**Further collaborators:**

Extended team of ANLP volunteer facilitators and thought leaders.

## DEVELOPING TRANSFORMATIONAL NUTRITION LEADERS IN AFRICA

Most African countries are burdened by undernutrition and all indications are that we are set to be particularly hard-hit by the growing burden of overnutrition. Despite significant investments, progress to optimize nutritional status is variable.

Nutrition in Africa is about change – it is a multisectoral process that has to lead. Leaders are change agents and are required throughout the whole system at all levels. Effective leaders develop

## THE IMPORTANCE OF COACHING AND MENTORING, POST NUTRITION EDUCATION FOR SUSTAINED BEHAVIOUR CHANGES - THE USAID SOLID APPROACH

Tillekeratne, Visakha.

President. Nutrition Society of Sri Lanka.

The approach of “coaching and mentoring following nutrition education” was the nutrition component of the USAID Supporting Opportunities in Livelihood (SOLID) project implemented

<footnote>(1) Jerling, Johann; (2) Den Ouden, Simone; (3) Conradie, Cornelia;</footnote>

<footnote>(1) Dolman, Robin.</footnote>

<footnote>(1) PhD. Centre of Excellence for Nutrition. North-West University. Potchefstroom. South Africa.; (2) BComm. Centre of Excellence for Nutrition. North-West University. Potchefstroom. South Africa.;</footnote>

<footnote>(3) MSc. Centre of Excellence for Nutrition. North-West University. Potchefstroom. South Africa.</footnote>
in three provinces in the dry zone of Sri Lanka. Over 2000 farm families who were part of a livelihood improvement program supported by USAID were trained on the basics of nutrition with the targeted objective of "farmers improve the quality of their diet by including more fruits and vegetables and high quality proteins in their diet". The training component was designed in consultation with the families themselves and government service providers. A 3 stage approach was used culminating with a 5 hour practical training program done using interactive methodologies and cooking. A written pre-evaluation of 24 hour recall was done coupled with a post evaluation immediately after the training, in the written form of "what am I planning as my diets in the next 24 hours. The pre and post evaluation forms were compared for increases in dietary diversity in the number of food groups as well as the percentage of participants increasing their knowledge on diversity. Follow up, mentoring and coaching was done in three intervals post training through household visits and recording observations of households randomly selected. The visits were not announced. The food diary provided as part of a nutrition manual for the family was perused as well. 67% of those targeted for training had improved their knowledge immediately post training. 61% of those visited through random selection had improved their nutrition related behaviours with respect to dietary diversity, reduction of fat, salt and sugar in the diet, increase of fresh food and improved home gardens. The conclusion is that there seems to be fairly quick improvement in nutrition related behaviour if targeted participants are closely tracked and corrected. It is important to deliver nutrition improvement programs within livelihood initiatives.

**Keywords:** Pre post evaluation, dietary diversity

## NUTRITION BEHAVIOR CHANGES AMONG CHILDREN, MOTHERS AND COMMUNITIES!

Aghi, Mira.

PhD Behavioral Science, Healis Sekhsaria Institute of Public Health. India.

How do we change the eating behaviors of children, the feeding behaviors of their mothers and the understanding of communities to optimize wellbeing through nutrition? Wellbeing does not imply more food but the right food eaten at the right time, in a quantity commensurate with the person's activity. In the case of deprived communities it implies eating enough of whatever they have to avoid hunger.

As interventionists we have to understand that behavior change requires four elements coming together in synergy. 1. Knowledge which is likely to come from education. The education for its proper and desirable impact should be driven by the users based on their perceived needs, 2. Motivation for change of behavior in this case eating and feeding practices, 3. Skills required for the change and 4. Enabling environments which make change possible and sustainable.

The mantra is conducting relevant formative research to design the education which is easily understood and is interesting to

the user. The education content should be relevant and applicable and at the same time credible and scientifically sound. It should be respectful to the sensibilities of all members of the community so that there are no barriers on that account. The education should adopt formats which motivate the users so that they want to acquire skills to modify their behaviors and change their environments. The skills should be imparted by participatory methodology which makes learning easy.

The enabling environments are at several levels like the family, friends, community and the country. They all contribute to change of behavior.

A short video from Meena Communication Initiative Meena of UNICEF would demonstrate this dynamics.

**Keywords:** Knowledge, motivation, skills, enabling environments, interventionist

## IMPROVEMENT OF NUTRITION OF CHILDREN WITH MOTHERS EMPOWERMENT THROUGH MOTHER SUPPORT GROUPS

Even though most health indicators for Sri Lanka are satisfactory when compared to other countries of the region, indicators related to nutritional status of under five children are not in keeping with the other health indicators. To improve the nutritional status indicators further, UNICEF in collaboration with the Ministry of Health planned to implement alternate measures. The program aimed at focusing on applying several innovative activities by groups of mothers formed as a Mothers Support Groups (MSGs) ) aimed at improving the nutritional status of under five children.

Programme was implemented in 5 districts out of 25 through the public health midwife (PHMs) of the respective areas. Well motivated mothers having children under five years and who had leadership qualities were invited to a 'cluster meeting' to be held at a place convenient for the mothers. About 10-15 mothers formed a 'cluster'. The facilitators undertook the training of mothers. During the training, the concepts of health and nutrition, wellbeing and concept of nutrition promotion were focused on. Mothers were motivated to initiate the program at community level. These trained mothers shared the information with other mother's having a child/children below five years of age. These groups had regular meetings, some of them meeting once a month and some, more frequently. At these meetings they discussed the nutritional status of their children and the possible contributory factors. As a group, they discussed possible solutions to the problems identified. PHM provided relevant advice when necessary and mothers were guided to enumerate the probable solutions. Mothers developed innovative activities and relevant indicators to assess the progress. Several innovative activities conducted by mothers were; happy calendar, brain calendar, five sensation stimulation book,

<footnote>(1) Jayatissa, Renuka; (2) Jayakody, Gamini; (3) Fernando, Dulith.</footnote>

<footnote>(1) Department of Nutrition, Medical Research Institute, Sri Lanka;</footnote>

<footnote>(2) UNICEF, Colombo; (3) Emeritus professor.</footnote>
hapana calendar, baby room, play house, nutrition calendar, collective feeding, weight chart, sapa and moda malla, daily expenses reduction chart, unnecessary food and beverages reduction chart, buddhi kataya, vibhaga pohora etc. After 6 months, impact was assessed.

There were 2000 MSGs were formed. It was observed evidence of weight improvements, gains in development, current wellbeing of child and family, better money and time management in families. In many of the families, the reduction of money spent on tobacco smoking and alcohol, as well as on food items that are not nutritious, was seen as a positive impact of the program. "Active" mothers from one MSG to visit another village and assist the mothers in that village to establish a mothers group and provide guidance to carry out the activities were used. The 'mini-symposia' were conducted to share success stories and plans made to further spread of the approach. Successful groups also worked out further targets, to broaden the scope of their own activities.

In conclusion linking in MSGs with the formal health system, in promoting nutrition is likely to improve the nutritional status of children thereby benefitting the community in a multitude of ways.

**Keywords:** Mother support groups, nutrition promotion, community empowerment, children under five

**Further collaborators:** Plan international

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# DEVELOPMENT OF TRAINING AND RESEARCH IN NUTRITION AND DIETETICS IN FRANCOPHONE AFRICAN COUNTRIES

## NUTRITION AND DIETETIC TRAINING AND RESEARCH IN AFRICAN FRENCH-SPEAKING COUNTRIES: WHERE ARE WE TODAY?

Kana Sop, Marie Modestine.

University of Douala, Faculty of Douala, Department of Biochemistry PO BOX 24 157 Douala.

**Background and objective:** More than half French-speaking people live in Africa. Sixteen of Francophone Sub-Saharan African countries (more than 21), are least-developed countries. As indicator of chronic undernutrition double by increasing prevalences of obesity, 40% of children are wasted. The main strategies of support are research and training. French speaking African countries are limited by language to access to quality training, research and scientific exchange. The objective of this work is to investigate on gap, strength and opportunities of training and research on nutrition and dietetics in Francophone African countries.

**Methods:** We use an inventory of available online resources in French and in English (websites, platforms), In-depth interviews with stakeholders.

**Results:** There are very few scientific and research support available in French. French speaking are very poorly trained in

nutrition and dietetics and related discipline. Few International Courses (PLAN in Morocco, FINSA in Benin) and related masters are available, but not really accessible for every one willing to learn. FAO is also developing online ENAF course for French speaking countries. Very limited programs are available in French. French speaking apply as well in English programs either for training or research, but are not really competitive in front of their English mate. Their application are usually rejected. There is a great lack of human capacity in the field and at the point of decision, they are absent. Refreshing courses are not sufficient to build sustainable skill in and nutrition and dietetic.

**Conclusion:** French resources on malnutrition are insufficient constituting a barrier to effective implementation of nutrition and dietetic programs in French-speaking countries of Africa. In order to develop a comprehensive framework to strengthen human capacity for nutrition and dietetic training and research, we appeal for a "Inter-country Institute of Applied Nutrition and Food Science in Francophone Sub-Sahara Africa (IANFA)" , where training and research programs will be fully implemented in French for effective nutrition interventions and relevant human capacity building.

**Keywords:** Training and Research, Nutrition and Dietetics, Francophone African Countries

## OVERVIEW OF NEEDS AND OPPORTUNITIES IN NUTRITION TRAINING: A RAPID SITUATION ANALYSIS IN BURKINA FASO

(1) Kangambega, Marcelline Tebkieta; (2) Belahsen, Rekia.

(1) MCs. Nutritionist. Food Control and Applied Nutrition Department. National laboratory of public health. Burkina Faso.; (2) PhD. Professor. IUNS Past Secretary General. Training and Research Unit. Nutrition and Food Sciences. Chouaib Doukkali University. School of Sciences El Jadida. 24000 Morocco. Professor.

**Background and objectives:** In Burkina Faso, the nutritional disorders remain a major health problem. The prevalence of chronic and acute malnutrition was respectively 30.2% and 10.4% among children under five. A survey conducted in 2013 showed that the prevalence of high blood pressure and diabetes was respectively 17.6% and 4.9%. More than 75% of the survey participants have a low rate of HDL cholesterol2.

The nutritional disorders is a concern for the country and the national nutrition policy was developed to address the key issues that require technical and operational skills. This raise the following question: Does the training opportunities in the field of nutrition are in line with the needs for strengthening the control of nutritional disorders in Burkina Faso?

The purpose of this work is to highlight the needs in nutrition training, the existing opportunities and the measure developed to meet these needs in Burkina Faso.

**Methods:** A documents analysis and interview with key informants were used to conduct this situation analysis.
**Results:** The analysis of nutritional key problems identified by the national nutrition policy3 suggests the following needs:

- Nutrition education of parents, children, teachers and others key stakeholders involved in the valuation of local food products;

- Training in nutrition and promotion of nutrition at universities, public health schools;

- Capacity building of all the key stakeholders involved in the diagnosis, the treatment and prevention of nutritional disorders.

Regarding the opportunities of training in nutrition in Burkina Faso, progress has been achieved:

- Nutrition was included in the curricula of primary and secondary schools;

- Training and refresher training in nutrition at universities and health schools;

- Refresher training for health professional;

- Training of community health workers in nutrition (integrated management of childhood illness);

However, most of these trainings address the nutrition issues in general terms.

**Conclusions:** Progress was done in responding to nutrition training needs in Burkina Faso. However, some efforts are required for focusing more specifically on nutrition issues in the training programs and for strengthening the capacities of all the stakeholders giving the multi-sectoral nature of nutrition.

However, ensuring the safety and quality of the GE food for intended nutritional compliance is a pre-market challenge. In the world there are many GM crops like Maize, Cotton, Soybean that are in use for the last decade in several Countries. In India the success story of Bt Cotton which occupies 80% of the crop, has not only boosted the economy of farmer and country but given a scope to introduce new crops like GM. Mustard, Bt Brinjal, Bt Okra, Bt. Rice etc., The data generated in our laboratories mentioned crops have demonstrated nutritional equivalence and their safety with the native crops. This has led to harmonize the protocols (to evaluate allergenicity, acute and chronic toxicity, compositional and nutritional equivalence) for pre-market safety assessment

In the current scenario in India, sub-clinical vitamin A deficiency is increasing rapidly. Therefore, the potential strategy of developing GE crop with enhanced beta carotene content has been recognized to combat the vitamin A deficiency. This approach needs to be strengthened to counter micro nutrient deficiency so as to fight the hidden hunger. Identifying the delivery of such micro nutrients through GE foods. This requires the evidence based support involving Scientists, Academia, Regulators and Civil Societies.

**Keywords:** Genetically Engineered (GE) foods, Recombinant DNA technology, Benefits of GE foods, Sub-clinical vitamin A deficiency.

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# THE PAST AND FUTURE OF ASIAN FOOD CULTURE AND NUTRITION SECURITY: STRENGTHS AND WEAKNESSES

## GENETICALLY ENGINEERED (GE) FOODS TO MEET NUTRITIONAL & FOOD SECURITY CHALLENGES IN INDIA

(1)Bharatraj, Dinesh Kumar; (2)Siruguri, Vasanthi.

(1)Sr.Deputy Director, Coordinator - PCT, HOD Drug Toxicology Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana State, India; (2)Deputy Director, Food Toxicology Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana State, India.

The advances in Biotechnology is gaining wide acceptance specially in relation to early diagnosis of disease profile, development of therapeutic agents, vaccines, foods, improved agricultural productions etc. The rapid development of Genetically Engineered (GE) foods using recombinant DNA technology from different species of organism like Microbes, plant and also animal is considered to be most advanced technology. The potential benefits of GE Foods are (i) Reduced use of pesticides, Herbicides, (iii) Enhanced nutrition, (iv) Enhanced shelf life, (v) Enhanced resistance to drought and other abiotic stresses etc., The role of GE foods in alleviating global macro and micro nutritional deficiencies is being recognized.

## FOOD AND NUTRITION SECURITY OF INDONESIA

Hardinsyah, Ridwan.

Professor in Nutrition at Department of Community Nutrition. Faculty of Human Ecology. Bogor Agricultural University. Indonesia. President Food and Nutrition Society of Indonesia.

This paper is intended to reveal the food culture and nutrition security of Indonesians, the largest tropical archipelago country in Asia. This was done through analyzing secondary data on poverty, food intake and review of the literature on food habits and nutrition status of Indonesian from the last two decades. During the last two decades, Indonesia enjoyed annual economic growth between 5 to 6.5% following by reduction of the percentage of poor people from 23.4% to 11.0% and underweight children from 31,6% to 19.6%, and anemia among pregnant women from 50.9% to 37.1%. Mayor food groups on the current Indonesian diets are similar to the traditional diet. The differences are the current diet is more from food away from home, contains more variety of foods and beverages contain more fat, sugar and sodium content. Meanwhile the intake of fruit and vegetables relatively not much change. Current Indonesian diet consists of rice as the first staple food and wheat flour products like noodle and bread as the second. Fish, egg, chicken, tempe and tofu are the side dishes commonly consumed that are usually fried. Vegetables and fruit commonly consumed are spinach, swamp cabbage, cabbage, banana, papaya, orange and water melon. Coconut milk and palm oil now are commonly used for cooking; and onions, chilies, herbs,
salt and sugar are commonly used as spices in cooking. The five
most Indonesia's favorite foods are rendang, satay, nasi goreng,
soto and bakso are seasoned with that spices. It is common that
Indonesians consume chili sauce (sambal), soybean sauce (kecap)
and crackers (kerupuk) as an appetizer. Food habits vary in differ-
ent regions and ethnics. Percentage of household food expenditure
for prepared food increased significantly from 12.5% to 28.08% in
which mostly fatty, sugary and salty foods. In addition, currently
there are about 1500 western fast food outlets in urban Indonesia,
which showed changing in food culture partly. Inline with chang-
ing in food culture, accompanied by improvement in economic
and access to food, obesity prevalence is increasing in Indonesia
especially among women, which is increased from 23.8% in 2007
to 32.9% in 2013, while the problems of underweight, stunting and
anemia among children are still prevalent. In the last two decade
the main cause of death was upper respiratory infections, but now
is cardiovascular diseases. This implies that Indonesia is now fac-
ing a double burden of nutrition and health transition, which
requires more innovative and comprehensive policy programs for
preventing double burden of nutrition in Indonesia.

**Keywords:** Food culture, health transition, Indonesia culture, nutrition security

## FOOD CULTURES AND NUTRITION SECURITY IN
MALAYSIA: ISSUES AND CHALLENGES

Noor, Mohd Ismail.

PhD. Nutritionist. Faculty of Hospitality. Food and Leisure
Management. Tayloy's University, Subang Jaya 47500. Selangor.
Malaysia.

Malaysia is a multi-racial country and each ethnic groups has
its own unique food culture. For centuries, it has been a melting
pot of different cultures and the interaction and integration among
the various ethnic groups making Malaysia unique as compared
to other countries. It's often said, culture enriches life however
local food cultures may have its own strengths and weaknesses
in its ability to meet nutritional and health needs of the popula-
tion. In addition, religion can influence food purchasing decision
and eating habits. Over the last few decades Malaysia's national
per capita income increased more than 25-folds from US$402 in
1970 to US$10,796 in 2014, a sizeable new middle income class has
emerged, an impressive achievement but not without a cost! The
increasing globalization of food systems, have resulted in a pop-
ulation shift from minimally processed diets rich in staple foods
of vegetable origin to diets high in meat, vegetable oils, refined
sugars, sodium, processed and ultra-processed foods, a significant
contributor to the current and future disease burden associated
with obesity and diet-related NCDs in Malaysia. From a public
health perspective, the role of processed foods in nutrition tran-
sition is receiving greater scrutiny in some while others will con-
tinue to increase without policy intervention. The "mushrooming"
of fast food outlets and supermarkets, aggressive advertising and
marketing of cheaper industrialized products, have led to a dra-

matic rise in consumption of low nutritional quality, energy-dense,
ultra-processed food and drinks, and fried snacks and sweets. The
presence of “24-hour” food outlets combined with increasingly
sedentary lifestyles, is a “recipe for disaster” for Malaysians, rated
the highest in obesity prevalence in SEA region. A recent study
(EIU, 2017) revealed total cost of obesity estimated to be between
10% and 19% of national healthcare spending. There is however
renewed interest in health promoting “healing” foods and nutri-
tional re-profiling of traditional diets to provide healthier food
options for the future generation. Enhancing food security and
reducing under-nutrition have been pledged since 1948 through
the Universal Declaration of Human Rights. Malaysia is not like-
ly to face food shortages but food security, especially for our sta-
ple food, rice. The food import bill in 2015 was RM45.4(US10.5)
bn, with exports of RM27(US6.2)bn, with a trade deficit of over
RM18(US4.2)bn. Malaysia was ranked at the 35th spot in the
Global Food Security Index 2016 rankings with Singapore at third
spot and highest ranked country in Asia, followed by Japan (22),
South Korea (28) and China (42). Climate change is a globally im-
portant environmental issue that impacting our economic future
and livelihoods and various policies are adopted to mitigate this
phenomenon. The National Plan of Action for Nutrition Malaysia
III (2016-2025) goes beyond improving household food security
whereby element of nutrition security is given greater emphasis in
line with ICN2 declaration and SDGs in the next decade.

**Keywords:** Food cultures, food security, Malaysia

## EXPERIENCE IN REDUCING STUNTING IN
VIETNAM: NUTRITION POLICY, PROGRAMS
AND COMMUNITY NUTRITION INTERVENTION

Hop, Le Thi.

Vietnam Nutrition Association, Vietnam.

Nutrition policy and nutrition programs: During the 1980th,
after a long devastated war and the pressure of high demograph-
ic rate, the nutritional status of Vietnamese, especially of chil-
dren and mothers was very poor. Since 1980, when the National
Institute of Nutrition of Vietnam was established and started to
conduct several nutrition epidemiological studies, providing the
scientific evidences of malnutrition rate and its main causes. In
1985, the rate of underweight was 51.5% and the rate of stunting
was very high (59.7%). The network of nutrition has been set up in
the whole country; Control of PEM and vitamin A deficiency has
become national programs.

In 1995, the Prime Minister ratified the NPAN 1995-2000,
where the Government asked authorities at all levels to integrate
nutrition goals, reduction of malnutrition, into their local so-
cio-economic development plans. The National Nutrition Strate-
gy (NNS) 2001-2010 was officially ratified by the Government in
February 2001; the overall goal was to improve nutritional status
of children focusing mainly on underweight reduction. Then the
second NNS for the period 2011-2020 was approved in February
2012 with the general objective to improve the diet of Vietnamese
population and focus on reduction of stunting and control of over-
weight and obesity.

The main nutrition interventions/projects up to 2010 were the
national PEM control program, PAM project, High dose Vitamin
A supplementation for children, Fe-folic supplementation for
pregnant women and weekly Fe supplementation for adolescent
girls... With purpose to reduce stunting among <5 children, be-
sides malnutrition control program, the Food fortification projects
(ILSI, GAIN projects), multi-micronutrient supplementation to
the poor and disadvantaged areas, school nutrition project... were
also developed and carried out during period 2011-2020.

The main intervention strategies in Vietnam were the preventive
orientation- nutrition throughout the lifecycle; Prioritizing high risk
groups and disadvantaged areas; and community-based and mul-
ti-sectoral approach in implementation of nutrition activities.

The Vietnam food-based Dietary Guidelines were developed for
each 5 - 10 years (FBDG for period 1995-2000, 2001-2005, 2006-
2010 and 2011-2020, as nutrition education tools.

Building up capacity for nutrtn has received high attention.
Nutrition and food safety departments have been set up in sever-
al medical, agricultural universities. Since 1994, the MSc. training
of community nutrition and in 2005 the Ph.D training in Nutrtn
were implemented.

Success and challenges: Child malnutrition (underweight, stunting) prevalence as well as micronutrient deficiency has been remarkably reduced. However, Vietnam started facing with double burden of malnutrition (stunting is still high and overweight and obesity is increasing very fast).

**Keywords:** Nutrition policy, programs, intervention, stunting,
Vietnam

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UNDERSTANDING DIETARY PATTERNS: A STEP TO-
WARD DEVISING A GLOBAL NUTRITION STRATEGY

PHYSIOLOGY AND PSYCHOLOGY UNDERLYING
FOOD CHOICES

Drewnowski, Adam.

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

The simple question of why people eat the foods they do re-
quires answers that are both complex and interdisciplinary. Taste,
cost, convenience, health, and variety are commonly cited as the
main drivers of individual food choice. Collective food choices are
also an expression of social identity, deeply embedded in religion
and culture. Finally, food systems operate within a social, econom-
ic, and political space. Food availability – and hence food choices
- can be influenced by myriad factors, from political upheavals to
catastrophic weather vents, global warming, and climate change.

First, the sensory response to foods involves complex metabol-
ic and neurochemical responses that may involve opioid peptides

and dopamine. Beginning in infancy and childhood, food choices
are driven by biological factors that favor foods that are both palat-
able and rich in calories. Whereas bitter-tasting foods are generally
avoided by infants, children, and by pregnant women, sweet and
umami ("delicious") tastes are sensory markers for dietary ener-
gy and nutrients. Early food choices are shaped by the desire for
sweetness, calories, and variety. Food cravings in later life tend to
center around foods and are energy-dense, salty, or sweet.

Second, economic factors, including the cost of foods can de-
termine food choices as the individual or population level. The
economic development of low-and-middle income countries
(LMIC) has been accompanied by the nutrition transition. Cereal-
and tuber-based diets (rice, corn, wheat, potato and cassava) are
being replaced by more diversified diets containing more animal
products, more processed foods and more added sugars and added
fats. Whereas the percentage of calories from added sugars and
animal and vegetable fats can vary widely, depending on country
incomes, protein content of the diets remains relatively constant
at 12-14%

However, plant proteins are often replaced by animal proteins
from milk and dairy products or from meat, poultry, or fish. This
component of the nutrition transition, called "protein transition",
is very much dependent on perceptions, attitudes and on social
and cultural norms. For example, populations in SE Asia derive
up to 70% of energy from rice, with additional energy from leafy
greens, other vegetables and some fruit. The consumption of meat
and fish is low, as is the consumption of milk, whereas the con-
sumption of yogurt and cheese is virtually non-existent. The diet is
deficient in calcium, iron, and zinc and protein quality and amino
acid balance are questionable. By contrast, countries in South Asia
have increased milk consumption but for a variety of reasons con-
sume little pork or beef.

Ongoing studies on the drivers of protein selection in SE Asia LMICs are directly in line with the WHO and FAO policies. One goal of the global nutrition strategy is to supply LMIC populations with high-quality protein foods that are nutrient rich, affordable, sustainable, and appealing.

**Keywords:** Sweet taste, energy density, food patterns, cost, af-
fordability, protein transition, protein quality.

**Conflict of Interest disclosure:** AD has received grants, con-
tracts, and honoraria from public agencies, private industry, pri-
vate foundations, and commodity groups for projects involving
nutrient profiling, diet quality assessments, and health outcomes
# METHODS TO COLLECT AND COMPARE DATA ACROSS GEOGRAPHY

Fisberg, Regina.

PhD. Nutritionist. Department of Nutrition. School of Public Health. University of São Paulo.

The wide use of dietary data for researches relating diet to health and disease or in public policies planning requires that the collection of dietary information be increasingly accurate. New technologies have been developed to facilitate the food intake assessment, such as the use of internet, computers, tablets and smartphones. Although several techniques are still under development, especially in Latin America, many progresses have already been made, providing a range of possibilities for assessing food intake in both individuals and population groups.

Online platforms can help researchers determine the best way to assess diet for any study in which estimates of group intakes are required, since there is no perfect measure of diet. Understanding the key features of self-report instruments and the benefits and drawbacks of potential approaches to collecting and analyzing dietary intake data can help the researcher to make the best choices given the research question and resources.

Another possibility for the researchers is to be part of a network of cooperation with other researchers. Dietary data from several places can be compiled to provide food and nutrient intake data from countries around the world. Continuous collaborative networks are formed for gathering, validating and disseminating data on food intake of the main foods and nutrients for individuals by age, sex, household region, educational level and geocoding. These data enable to describe the global nutritional transition, ranging from nutritional deficiencies to overfeeding.

Several initiatives have been developed for customization and standardization at the food and nutrient assessments, intending to minimize systematic and random errors in nutrient intake estimations and to allow comparisons between different countries.

New methodologies applied to dietary assessment provide us with a step-change in our ability to reliably characterize food and nutrient intake in different researches. These new approaches may help to reduce measurement error and advance our understanding of diet in health and disease process.

**Keywords:** Food intake; diet; dietary assessment; measurement error

# NUTRITION GUIDANCE IN THE AGE OF GLOBALIZED MARKETS

Fisberg, Mauro.

MD, PhD, pediatrician and nutrologist. Coordinator of Nutrition and Feeding Difficulties Center Pensi Institute Fundação José Luiz Setubal. Associate Professor of Pediatrics Escola Paulista de Medicina UNIFESP. Brazil.

Modernization, globalization and industrialization are active words used very often associated to modified nutritional habits,

and to the epidemiological and nutrition stages of transition in different parts of the world. The double burden of malnutrition and obesity raises costs of health management specially in developing countries. These areas still are counting the number of malnourished inhabitants and the increasing figures of diseases related to excessive weight. At the same time, we do need to understand role of modified nutritional habits, changes in life style, with the decrease of physical activity, despite rising numbers in institutionalized system for physical activity (gyms and sport activities).

Urbanization is a well-known phenomenon seen in many countries, and food production shifts from small producers to huge corporations and large scale soil modification. Industrialized food guarantees the access to food for increasing number of dwellings in urban areas, in a practical, possibly affordable and easy way. Nonetheless this is considered an issue for some researchers, based on the fact that shifting from home made and more natural systems of food producing for the more processed items, the amount of fat, sugar and salt intake could be increased. Many surveys do associate these changes with health outcomes as obesity, hypertension and cardio vascular diseases.

But it is not easily discussed that home and away from home recipes, using the so called natural food, could have higher levels of the same constituents as fat, sugar and sodium. Nutritional education is not so easily accessed as it is possible to control food processing methods in order to reduce this combination of nutrients.

In a globalized market, food is accessible and many items anteriorly only available to higher classes, are now been bought by new population of consumers. Low cost items are usually rich in fat and energy, changing importance in the menus with ancient local and traditional food combinations.

Global brands substitute regional recipes or preparations, modifying the way that families are preparing and consuming different meals. Many families are skipping meals, specially breakfast and dinners and family meals are scarce, rising possible health hazardous outcomes.

How to cope with modern times, with the new possibility of having access to more food items, in a practical and convenient way to combine industrialized and local and traditional food is a puzzle for all health planners. But it is very important to understand that the final consumer has the final word. And he decides what is best for him and his family. Convenience, price, culture and habits do determine his choices.

**Keywords:** Globalization, industrialization, obesity, processed food, family meals

**Conflict of Interest disclosure:** MF is a consultant, speaker and member of scientific boards for public and private sector (Abbot, Coca Cola, Danone, EMS, Hyproca, ILSI and Pensi Institute). Has received grant support for research from FAP, Fapesp, Cnpq, Coca Cola, CPW and Danone.
# Track 8: Agriculture, Food Science and Safety

PS_144/104

## FOOD COMPOSITION IS CENTRAL TO A FOOD SYSTEM APPROACH FOR NUTRITION

### HOW TO DESIGN, PROMOTE AND IMPLEMENT NUTRITION-SENSITIVE FOOD SYSTEMS USING FOOD COMPOSITION DATA, BIODIVERSITY AND THE NUTRIENT PRODUCTIVITY CONCEPT

Charrondiere, U. Ruth; Wijesinha Bettoni, Ramani; Rittenschober, Doris; Vincent, Anna; Stadlmayr, Barbara; Scherf, Beate; Leclercq, Catherine; Hachem, Fatima.

Food and Agriculture Organization of the United Nations (FAO).

A food system covers all the elements (environment, people, inputs, processes, infrastructures, institutions, etc.) and activities that relate to the production, processing, distribution, preparation and consumption of food, and the outputs of these activities, including socioeconomic and environmental outcomes.

Making a food system nutrition-sensitive entails applying a nutrition lens to all its activities, considering all forms of malnutrition. First, an analysis of the food system and nutrition situation shall be done, based on which interventions shall be planned and implemented, explicitly designed to improve nutrition by taking the constraints of the food system into account. This shall be followed by monitoring of impacts. Possible questions can be ‘Will activities improve (or harm) the nutrition situation?’ or ‘Which of the possible activities would best enhance better nutrition – while considering other aspects such as productivity or income?’ or ‘Are the currently produced and processed foods meeting the nutritional requirements of populations? If not, what needs changing, and is this feasible?’

To answer most of these questions, data are needed to design, implement and monitor nutrition-sensitive activities within the entire food system. Two important datasets are food consumption, e.g. FAO/WHO GIFT platform, or food composition data (FCD).

For example, in food production, FCD can be used to inform decision makers which agricultural products have the optimal nutrient composition to reduce malnutrition using foods. Those foods should then be included in large or small scale production, seed or research programmes and policies; or in incentives considerations to enhance production while lowering prices. A useful tool is FAO's newly developed Nutrient Productivity Scale which combines yield/production of different agricultural goods per hectare with their content of nine nutrients (energy, protein, dietary fibre, iron, zinc, calcium, vitamin A, vitamin C and folate) which is then compared to human nutritional requirements. Biodiversity needs to be considered as nutrient content differ significantly

among the varieties or breeds of the same food, making the difference between nutrient adequacy and inadequacy. If foods or varieties with high micronutrient contents were produced or consumed in higher quantities they would eliminate micronutrient deficiencies worldwide. For that, FDC are needed, including data on different varieties or breeds delivered by different production systems.

During food storage and processing, some foods and nutrients are lost or wasted. FCD are key to develop new approaches to reduce food and nutrient losses or waste; enhance value chains of e.g. nutrient-dense fruits and vegetables; or develop food products being naturally enriched by adding highly nutritious foods. Food labelling is part of trade and marketing and useful in guiding food choices. Food Based Dietary Guidelines (FBDG) can inform policies, guide nutrition education, and inform consumers about healthy food choices at all ages and conditions. For all these purposes, FCD are needed on raw, cooked, processed and biodiverse foods.

Although FCD are needed to formulate and implement appropriate food system policies, they are absent for over 99% of the global foods produced and consumed. This should urgently be addressed to effectively and sustainably reduce malnutrition rates worldwide.

**Keywords:** Food composition, food system, nutrition-sensitive, biodiversity, Nutrient Productivity Scale

### NEW PHYTATE DATA COLLECTION: IMPLICATIONS FOR NUTRIENT REFERENCE INTAKES FOR MINERALS, PROGRAMMES AND POLICIES

In many low-income countries (LICs) staple diets are often plant-based with unrefined cereals, legumes, and oleaginous seeds providing major energy sources. These plant-based foods contain high levels of phytic acid (myo-inositol hexaphosphate, IP6) and its associated Mg, Ca, and K salts -termed phytates, which serve as a storage form of phosphorus and minerals. Phytate is the major inhibitor of iron and zinc absorption, and to a lesser extent calcium, in plant-based diets, forming insoluble complexes in the gastro-intestinal tract that cannot be digested or absorbed because of the absence of intestinal phytase enzyme in humans. The negative effect of phytate on zinc absorption in adults is much greater

<footnote>(1)Gibson, Rosalind; (2)Dahdouh, Sergio; (2)Grande, Fernanda;</footnote>

<footnote>(3)Najera, Sarah; (3)Fialon, Morgane; (3)Vincent, Anna; (4)King, Janet;</footnote>

<footnote>(5)Bailey, Karl; (6)Raboy, Victor; (7)Charrondiere, U. Ruth.</footnote>

<footnote>(1)PhD. Nutritionist. Department of Human Nutrition. University of Otago. New Zealand.; (2)Nutrition consultant. Nutrition and Food Systems Division. Food and Agricultural Organization. Italy.; (3)Nutritionist. Nutrition and Food Systems Division. Food and Agricultural Organization. Italy.; (4)PhD. Nutritionist. Children's Hospital Oakland Research Institute. Oakland. California. USA.; (5)PhD. Chemist. Department of Human Nutrition. University of Otago. New Zealand.; (6)PhD. USDA Agricultural Research Service. Pacific West Area. Aberdeen. Idaho. USA.; (7)PhD. Nutritionist. Nutrition and Food Systems Division. Food and Agricultural Organization. Italy.</footnote>
than previously estimated, with a minimal ability to adaptively in-
crease zinc absorption from high-phytate diets. FAO/INFOODS
in collaboration with the International Zinc Nutrition Consulta-
tive Group (IZiNCG) have compiled a new comprehensive global
repository of analytical data on the moisture, phytate, and Fe, Zn,
Ca content (per 100 g edible portion on a fresh weight basis) of
raw and processed plant-based foods. Values for partially dephos-
phorylated isomers of phytic acid (IP5-IP1) are also included,
when available, together with details of analytical methods, bio-
diversity, origin, and food preparation and processing practices.
These data will enable intakes and major food sources of phytate
to be calculated from food consumption data in LIC and devel-
oped countries. Inclusion of data on dephosphorylated isomers
of phytic acid (IP5-IP1) as well as phytic acid (IP6) is important
because many plant-based staples in LICs undergo fermentation,
germination, or soaking, all practices that can result in enzymatic
degradation of phytate to lower inositol phosphates (i.e., IP4-IP1)
which have a negligible adverse effect on mineral absorption. For
each food, molar ratios of phytate: Fe, Zn, or Ca are also specified,
which can provide estimates of the proportion of absorbable zinc
or iron from foods and diet types. Diets with phytate-to-zinc mo-
lar ratios > 15, between 5 and 15, and < 5 are likely to have poor
(~15%), moderate (~30%), or good (~50%) zinc bioavailability,
respectively, whereas for iron, much lower molar ratios must be
achieved to enhance iron absorption (i.e., phytate-to-iron <1.1).
Recently dietary zinc reference values for adults have been set by
the European Safety Authority for four dietary phytate levels. Un-
like zinc and iron, bioavailability estimates for calcium and mag-
nesium do not take into account dietary phytate:mineral molar
ratios and any deficiency is more likely due to a low intake and not
low absorption. In contrast, low absorption of iron and zinc from
high phytate plant-based complementary diets is a major factor in
the etiology of iron and zinc deficiency among infants and young
children in LICs. Enhanced absorption of iron and zinc from such
complementary diets can be achieved by enzymatic degradation of
phytic acid. Implementation of such strategies has the potential to
reduce the need for high levels of iron fortificants or supplements
and their associated safety concerns in LICs where risk of infec-
tion is high.

**Keywords:** Phytic acid. bioavailability. phytate database. inositol phosphates. phytate-to-mineral molar ratios.

CONVINCING DECISION MAKERS TO INVEST IN
HIGH QUALITY FOOD COMPOSITION TABLES
NEEDED ALONG THE FOOD SYSTEM

(1)Longvah, Thingnganing; (2)R., Ananthan; (2)VSS., Prasad; (2)Sharma, Paras; (2)A., Laxmaiah; (2)K., Venkaiah.

(1)National Institute of Nutrition, Jamai Osmania PO, Hyderabad - 500 007, TS, India; (2)National Institute of Nutrition, Jamai Osmania PO, Hyderabad - 500 007, TS, India.

Adequate nutrition and good health of the population is a ma-
jor concern of every government. The food system includes the

many stages of converting natural resource and human efforts into
food involving the production, processing, transport and con-
sumption of food. Food system has also evolved over centuries
into immense magnitude and complexities whereby composition
of foods produced and consumed by the population vary widely
affecting human health profoundly. Capturing precise nutrient in-
take data is critical for effective implementation of national nutri-
tion policies and programmes. Robustness of dietary assessment
by investigators depends on accuracy of database used which, if
found lacking would not have the desired impact. The many po-
tential uses of nutrient intake data impose concerns regarding the
accuracy of many Food Composition Tables (FCTs) that have been
constructed using data that are mostly imputed from other sourc-
es. Government expenditure to enhance food, nutrition and health
depends on many factors including reliable food composition data
that meets strict criteria of accuracy and appropriateness. Thus,
food system investment has to be customized specific for high
quality FCTs in order to utilize resources judiciously.

Food composition tables derived from exclusive analytical
data are expensive to produce and maintain due to the high cost
involved in food sampling and analysis of samples. Unless FCTs
address important scientific questions of national relevance in-
vestment will be hard to come by. Government has the responsi-
bility to improve the nutrition and social well-being and in order
to attract investment in FCTs, the outcome should address at im-
proving such issues. The key to attract funding for FCTs lies in
challenging existing paradigms by addressing critical barriers in
human development where the role of nutrition is paramount.
Most food system policies and interventions are not designed
with nutrition as the primary objective so the link between food
systems and nutrition outcomes is difficult to trace. Nonetheless,
government policies play a critical role in influencing agriculture
and food system to improve nutrition as in the case of food fortifi-
cation where food composition form the fundamental basis. How-
ever, to attract investment for high quality FCTs, research must
align with national nutrition policies and programmes which is an
important step to convince the decision makers as in the case of
the new Indian FCT 2017, the details of which will be discussed.

**Keywords:** Investing, Food Composition Tables, IFCT2017,

PS_144/130

BENCHMARKING GOVERNMENT POLICIES TO IMPROVE FOOD ENVIRONMENTS GLOBALLY

THE HEALTHY FOOD ENVIRONMENT POLICY INDEX (FOOD-EPI)

(1)Swinburn, Boyd; (2)Vandevijvere, Stefanie.

(1)Professor. School of Population Health. University of Auckland.
New Zealand; (2)PhD. Senior Research Fellow. School of
Population Health. University of Auckland. New Zealand.

INFORMAS (International Network for Obesity/NCD Re-
search, Monitoring and Action Support) was established in 2012
and is currently measuring and benchmarking food environments and policies in more than 20 countries on all continents. One of the modules is the Food Environments Policy Index (Food-EPI) which seeks to measure progress on the implementation by governments of recommended food policies and infrastructure support systems. The Food-EPI is a participatory, evidence-based approach to measuring the ‘implementation gap’ compared to international best practice and prioritising actions to better implement food policies. It is being implemented in about a dozen countries which allows for comparative cross-national studies and will be repeated over time within countries. This symposium will present some of the experiences and results of Food-EPI studies in different countries.

**Keywords:** Food policies, food environments, governments, benchmarking

## THE FOOD-EPI IN AUSTRALIA: COMPARING PROGRESS ON IMPROVING THE HEALTHINESS OF FOOD ENVIRONMENTS ACROSS STATES

(1)Sacks, Gary; (2)Sacks, Gary.

(1)Global Obesity Centre. Deakin University; (2)Senior Research Fellow. Global Obesity Centre. Deakin University. Geelong. Australia.

**Objective:** To benchmark current government actions to improve the healthiness of food environments in Australia, and to identify priority policy actions for Federal/State/Territory governments

**Methods:** The Healthy Food Environment Policy Index (Food-EPI) tool, developed by INFORMAS (International Network for Food and Obesity / non-communicable diseases Research, Monitoring and Action Support) to assess government progress towards good practice in improving the healthiness of food environments, was modified for the Australian context. For each of the 46 indicators in the Food-EPI tool, details of each Australian government's current policies were collected and validated by government officials. Panels of non-government public health experts were convened in each State/Territory (total number of participants = 101) to assess the extent to which current government policies meet international benchmarks. Panel members then prioritised actions for each government, taken into account their relative importance and achievability.

**Results:** At a national level, level of implementation was assessed as high for some indicators, such as nutrition labelling, regulating health claims on packaged foods, and monitoring of population BMI. However, most indicators received relatively low ratings. State/Territory comparisons revealed several important differences in policy across the country (such as in the area of school food and restrictions of unhealthy food marketing), and helped to identify highly achievable policy actions.

**Conclusion:** The Food-EPI tool provides a useful set of indicators that can focus attention on where government action is needed. The results of this study can be used to increase accountability

of governments, stimulate government action and support advocacy efforts.

**Keywords:** Food and nutrition, non-communicable diseases, advocacy

## CONSENSUS PRIORITIES BETWEEN EXPERTS AND POLICYMAKERS FOR IMPROVING THE HEALTHINESS OF FOOD ENVIRONMENTS IN THAILAND

Phulkerd, Sirinya.

BSc, MSc, MPhil. Researcher. Institute of Population and Social Research. Mahidol University. Thailand.

Bringing together diverse groups of stakeholders, including government officials and non-government experts, to make consensus recommendations for government is important to increase awareness, accountability and commitment on policy outcomes and impacts as well as to gain support for implementation of the proposed recommendations. The objective of the study was to conduct a joint meeting between government officials (simply called state actors) and non-government experts (simply called non-state actors), and seek consensus on priority actions to create healthy food environments for obesity and non-communicable disease prevention for Thai Government.

The joint meeting was conducted after completion of assessment of level of implementation of food environment policies and of prioritization of concrete actions for the government by each of the two actor groups using the adapted Healthy Food Environment Policy Index (Food-EPI). The assessment and prioritization results from both groups were key inputs for a discussion on the priority actions in the meeting.

The meeting was facilitated by the research team with the following key steps: (i) the participants were invited to ask questions and request clarification about the study before the discussion started; (ii) the research team presented the prioritization results for both groups; (iii) the participants reviewed the proposed actions, and then had a discussion with the view of reaching consensus on the priority actions; (iv) the participants discussed if any other actions (not previously discussed) should be included as a priority; and (v) the participants approved a set of consensus priority actions for the Thai Government.

Forty-eight state and non-state actors attended the meeting. Eleven consensus actions were selected as top priorities. Four actions focused on food labeling; two were on food provision; and one each was on food composition, food promotion, leadership, monitoring and intelligence, and food trade and investment. The actions included setting standards for food and beverage products provided and sold in schools and child-care centers; promoting provision and sale of healthy foods and drinks in hospitals and other public settings; developing a Thai nutrient profiling system; establishing a marketing framework for foods and beverages, particularly promotional strategies; setting the government's clearly defined goal in limiting intake of salt, sugar and saturated