Maternal, Perinatal, and Pediatric Nutrition

CURRENT DEVELOPMENTS IN NUTRITIONFROM THE AMER ICANSOCIETY FOR NUTR IT ION

© 2018 American Society for Nutrition. All rightsreserved.

Manuscript received September 20, 2017. Initialreview completed March 23, 2018. Revision acceptedMay 27, 2018. Published online July 4, 2018.

Maternal, Perinatal, and Pediatric Nutrition

Growth Velocity and Accumulation of Body Fat in Very Preterm Infants (E04-01)

Ariel Salas, ColmTravers, PaulaChandler-Laney, TimWang, Anisha Bhatia, andWaldemarCarlo

University of Alabama at Birmingham

Objective: The objective of this prospective analysis was to determine the effect of growthvelocity on the development of adipose tissue in very preterm infants. We studied the associationbetween 3 categories of growth velocity and percentage body fat (%BF) at 36 wk of postmenstrualage (PMA).

Methods: Very preterm infants, with gestational age (GA) ≤32 wk at birth, were included.Using the exponential method, we calculated growth velocity in all study participants and defined3 categories (below target or <10 g · kg–1 · d–1, within target or 10–15 g · kg–1 · d–1, and abovetarget or >15 g · kg–1 · d–1). The primary outcome was %BF estimated by air displacementplethysmography at 36 wk PMA.

Results:We assessed body composition in 86 infants (mean birthweight: 1445 g, median GA:30 wk). The median growth velocity was 12 g · kg–1 · d–1 (IQR: 10–15) and the median %BFwas 14.4 (IQR: 12.9–17.1). In an unadjusted regression analysis, there was no linear associationbetween the 3 categories of growth velocity and %BF. In a regression analysis adjusted forbirthweight, GA, sex, and weight z score at birth, the linear association between growth velocityand %BF was statistically significant (mean ± SD %BF in the group with growth velocity belowtarget: 13.0 ± 0.8; mean %BF in the group with growth velocity within target: 14.8 ± 0.5; mean%BF in the group with growth velocity above target: 16.6± 0.7; P= 0.02). The group with growthvelocity above target had higher weight z scores and higher%BF at 36 wk PMA, but length z scoresat 36 wk PMA or hospital discharge did not differ across groups.

Conclusions: By combining quantitative and qualitative outcomes of growth, we determinedthat growth velocity rates >15 g · kg–1 · d–1 are associated with higher percentage body fat at36wkPMA in very preterm infants. Future research should investigate the value of growth velocityrates that increase%BFwithout achieving length differences and the impact of postnatal diets withdifferent caloric densities and feeding volumes on quantitative and qualitative outcomes of growth.

Funding SourcesN/A.

Exclusively HumanMilk Diets for Preterm Infants: Five-Year Outcomes (E04-02)

Lewis P Rubin1 and Amanda Timmerman2

1TTUHSC El Paso, TX and 2El Paso Children’s Hospital

Objective: Exclusively humanmilk (EHM) diets for preterm infants have been associated withshorter hospital stays, sustained growth, and lower rates of necrotizing enterocolitis (NEC). In2012, the preterm NEC rate in our 50-bed neonatal intensive care unit (NICU) was high [14.5%of infants with very low birthweight (BW), i.e., <1500 g] compared with national data. In orderto improve patient outcomes, we began a policy of EHM for these high-risk patients. We presentthe 5-y experience (2013–2017).

Methods: EHM diets require feeding only mother’s expressed milk (when available) or donorhumanmilk (DHM), aswell as supplementingHMonlywithHM-derived fortifiers (e.g., Prolact+and/or Cream). In our NICU, adoption of EHM diets occurred in a stepwise fashion. Initially, wepresented the hospital administration and Board of Directors with a cost-benefit analysis derivedfrom the estimated decline in NEC cases projected for EHM-fed infants with BW<1000 g (basedon then-available data), the estimated number of “excess” NEC cases, and the costs per patient

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for “medical” and “surgical” NEC [NICU costs, hospital length of stay(LOS)]. Review of several months of data in year 1 indicated no newNEC cases in patients <1000 g (the highest risk group), but continuedoccurrence of NEC in infants with BW 1001–1500 g. Subsequently,EHM diets were adopted, first for infants <1250 g, then for infants<1500 g.

Results: Results from this 5-y, stepwise adoption of EHM dietsfor very low–BW infants include a dramatic decline in NEC (Bell’sStage 2 or greater), from 14.5% to 0–3% (2015–2017). Other outcomes(compared with previous years’ data) include comparable growth,and significant decreases in LOS, days of parenteral nutrition, dayswith an indwelling central venous catheter, and days of antibioticadministration (means). We observed elimination of deaths from NECand declines in long-term morbidity and NICU costs.

Conclusions: The stepwise process of adoption of EHM is instruc-tive for centers adopting this nutritional approach. It has facilitatedexamining staged improvements in outcomes. EHM diets for preterminfants are a practical nutritional strategy to improve survival andhealth, and decrease hospital-related morbidities in this high-riskneonatal population.

Impact of Type of Infant Formula and the Feeding Styles ofMothers on Early RapidWeight Gain (E04-03)

Julie A Mennella,1 Loma Inamdar,1 Virginia A Stallings,2 Mia APapas,3 and Jillian C Trabulsi4

1Monell Chemical Senses Center, PA; 2Children’s Hospital ofPhiladelphia; 3Christiana Care Health System Value Institute, DE; and4University of Delaware

Objective: What infants are fed and how they are fed are bothconsidered important determinants for early rapid weight gain, which,in turn, increases risks for comorbidities, including obesity.We recentlydiscovered that randomizing healthy infants during the first weeks oflife to be fed a cow milk formula (CMF) doubled the incidence ofearly rapid weight gain when compared with those randomized to anextensively hydrolyzed formula (EHF), a formula rich in free aminoacids, known satiation signalers. The goal of the present study was toconduct secondary data analyses on this cohort of exclusively formula-fed infants to determine howmaternal feeding styles interacted with thetype of infant formula on weight gain patterns during the first 4 mo oflife.

Methods: Infants (n = 113) who were randomized to either CMFor EHF for the first year of life had monthly measures of food intake(number of formula feeds per day) and growth (weight-for-lengthz scores, WLZ). Infants with an increase in WLZ of >0.67 SD betweenthe ages of 0.5 and 4.5 mo were classified as “rapid grower.” Motherscompleted questionnaires to assess maternal feeding styles mostrelevant to formula feeding (e.g., pressuring, restrictive, responsive) at0.5, 3.5, and 4.5 mo postpartum. Longitudinal models were fit usinggeneralized linear models to compute interclass correlations (ICC) andexamine the impact of formula group on each parenting feeding styleover time.

Results: From 0.5 to 4.5 mo, there was no difference betweenformula groups in the number of formula feedings per day (P = 0.68).Each of the 3 maternal feeding styles was a stable phenotype withinmothers during the first 4 mo of life (ICC were 0.66, 0.75, and 0.70

for restrictive, responsive, and pressuring feeding styles, respectively;all P values < 0.01), indicating stronger between-subject variabilitycompared with within-subject variability. Generalized linear modelsrevealed that maternal feeding styles did not differ between the 2formula groups. Logistic regression models fit with a spline at eachtime point found no significant effect of feeding styles on rapid weightgain (the P values for overall fit were: pressuring, P = 0.86; responsive,P = 0.29; restrictive, P = 0.83), and no interaction between feedingstyles and formula group on early rapidweight gain (allP values> 0.20).

Conclusions: The composition of the formula in the bottle may bemore important for infant weight gain than how or how often infantsare fed formula. Identifying what components of EHF promote infantsatiation and less rapid weight gain during the sensitive period of earlyinfancy is an important area for future research.

Funding SourcesThis research was supported by NIH Grant HD072307.

Growth of Healthy Full-Term Infants Fed with an Infant For-mula Containing Different Protein Concentrations and Breast Milk(E04-04)

Lorena Oropeza,1 Olga Garcia Olga,1 Miguel Ángel Dr Duarte-Vázquez,2 Dolores Ronquillo,1 María del C Caamaño,1 CarlosGarcía-Ugalde,2 and Jorge L Rosado1

1UniversidadAutónoma deQuerétaro,Mexico; and 2Nucitec S.A. deC.V.

Objective: The aim of this study was to evaluate growth parametersin full-term infants who received infant formula containing differentprotein concentrations compared with infants exclusively breastfeedduring the first 4 mo of life.

Methods: Healthy full-term infants (n = 308) participated in arandomized, single-blind, controlled trial. Of the 308 infants, a totalof 96 were randomized to receive 1 of 3 infant formulas, differing onlyin the amount of protein: 1) infants fed a low protein formula (IF-LP:1.3 g protein/dL) (n= 18); 2) infants fed a very low protein formula (IF-VLP: 1.0 g protein/dL) (n = 16); and 3) infants fed a standard proteinformula (IF-SP: 1.5 protein/dL) (n = 24). There was an additionalgroup of infants who received exclusively breastmilk (HM: 0.8–1.0g protein/dL) (n = 82). Weight, length, and head circumference wereevaluated at baseline, then every month for 4 mo. Growth velocityincluded weight gain (g/d), length (cm/mo), and head circumference(cm/mo), and was calculated considering the rate of change frombaseline to day 120. Weight-for-age z score (WAZ), weight-for-lengthz score (WLZ), length-for-age z score (LAZ), head circumference-for-age z-score (HCAZ) andbodymass index-for-age z score (BMIAZ)werecalculated with the WHO 2006 Child Growth Standard and comparedwith the HM group by analysis of variance (ANOVA and ANCOVA)adjusted by the initial value.

Results: A total of 140 infants completed the study (45.5%). Themean± SD age at baseline was 19.7± 12.1 d. There were no significantdifferences between groups in adjusted changes in weight, length, andhead circumference after 4 mo. There were no differences betweenthe groups in WLZ, LAZ, HCAZ, or BMIAZ after 4 mo. WAZs inthe breastfed group were similar to those fed the infant formulas withdifferent concentrations of protein. Weight gain in the breastfed group

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Maternal, Perinatal, and Pediatric Nutrition 3

and IF-VLP were similar, and both were significantly lower than the IF-LP and IF-CSP groups.

Conclusions: No difference in growth was found between thegroups fed nfant formulas with different protein concentrations duringthe first 4 mo of life. An infant formula containing 1.0 g protein/dL

promotes weight gain and normal growth in full-term infants similar toexclusively breastfed infants.

Funding SourcesThe project was funded by FOPER 2015 and CONACYT Grant No.

199,586.


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Diet and Growth in Hospitalized Very Preterm Infants (E04-05)

Mandy B Belfort,1 Patrice Melvin,2 James Moses,3,4 MunishGupta,5,6 and Margaret Parker3,4

1Brigham and Women’s Hospital, MA; 2Boston Children’s Hospital,MA; 3Boston Medical Center, MA; 4Boston University School ofMedicine, MA; 5Beth Israel Deaconess Medical Center, MA; and6Harvard Medical School, MA

Objectives:Human milk is the recommended diet for very preterminfants during the neonatal intensive care unit (NICU) hospitalization.The extent to which current fortified human milk diets optimallysupport growth is unknown. Our aims were to: 1) examine associationsof diet (human milk, preterm formula) with somatic growth during theNICU hospitalization; and 2) examine differences in growth by type ofhuman milk (donor, maternal).

Methods:Westudied 974 very preterm infants from9MassachusettsNICUs born in 2015–2017 during a statewide quality improvementcollaborative to increase maternal milk use. All NICUs routinely fortifyhuman milk. Human milk and formula use were assessed weekly andat NICU discharge or transfer. Our main exposure was the percentageof days assessed on which human milk was fed (%HM). For infantswith 100% HM (n = 569), we determined the percentage of days onwhich any donor milk was fed (%DM). Clinical measures of infant

size (weight, length, head circumference) were collected at birth andNICUdischarge or transfer. Themain outcomeswere: 1) z score changesfrom birth to discharge or transfer which reflect growth relative to afetal reference; and 2) weight gain velocity (exponential model). Weused linear regression to estimate associations of %HM and %DMcategories with growth outcomes, adjusting for potential confoundersand accounting for clustering by birth hospital and multiple gestation.

Results: The mean %HM was 83%. Of infants with 100% HM, themean %DM was 7.7%. Mean z score changes were: –0.45 (weight), –0.92 (length), and –0.09 (head). The mean weight gain velocity was13.3 g · kg–1 · d–1. More favorable linear growth was associated withbeing fed human milk on fewer days. Among infants fed human milkon 100% of the days assessed, more favorable growth was seen in infantsfed donor milk on fewer days (0–49%DM), but none of the differenceswere statistically significant.

Conclusions: Infants fed human milk on more days had lessfavorable linear growth, but the extent to which this reduction in lineargrowth contributes to long-term health or developmental outcomesneeds further investigation. Donor milk use was not associatedwith statistically significant growth differences, but this practice wasinfrequent in our cohort.

Funding SourcesWK Kellogg Foundation.


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Maternal Midpregnancy Lipid Concentrations Are Associatedwith Preterm Delivery and Small-for-Gestational-Age Newborns(E04-06)

Sandra G Okala,1 Sandra Rebholz,2 Ebrima Sise,3 Fatou Sosseh,3Momodou K Darboe,3 Andrew Prentice,4 Laura Woollett,2 andSophie Moore1

1King’s College London, United Kingdom; 2University of CincinnatiMedical School; 3MRC Unit The Gambia; and 4London School ofHygiene and Tropical Medicine, United Kingdom

Objective: Preterm birth (PTB) is the main cause of death inchildren under 5 y, and small-for-gestational-age (SGA) births increasethe risk of infant mortality considerably. Understanding the riskfactors associated with these adverse birth outcomes will enable thedevelopment of appropriate interventions. The aim of this study wasto examine the associations of maternal lipid concentrations duringpregnancy with gestational age (GA) at delivery, PTB, and SGA.

Methods: The sample comprised 800 mother-infant pairs who par-ticipated in a randomized control trial of nutritional supplementation inrural Gambia (ISRCTN49285450). Pregnant women attended a clinicvisit at enrolment (mean GA = 13.7 ± 3.3 wk), and at 20 and 30 wkof gestation. Anthropometric measurements and plasma samples werecollected at each of these visits and analyzed for lipid concentrations[total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglyc-erides (TG)]. Gestational age at delivery and infant anthropometry weremeasured within 72 h of birth. Linear and logistic regression modelswith adjustments for confounders were used to study the associationsof maternal lipid concentrations with 1) gestational age at delivery, 2)preterm birth (<37 wk and 6 d of gestation), and 3) SGA (weight forGA <10th percentile of INTERGROWTH-21st standards).

Results There were 43 (5.4%) preterm births and 88 (16.2%) infantsborn SGA. In the adjusted models, the maternal TG was inverselyrelated to gestational age at delivery (β = –0.008; 95% CI: –0.0012,0.003; P = 0.001) at 20 wk of gestation and associated with increasedodds of preterm delivery at 20 and 30 wk of gestation [adjusted oddsratio (aOR): 1.02; 95% CI: 1.02, 1.04; P = 0.005 and aOR: 1.02; 95%CI: 1.01, 1.03; P = 0.027, respectively]. The odds of giving birth to anSGA infant decreased with maternal TC (aOR: 0.99; 95% CI: 0.98, 1.0;P= 0.012) and TG (aOR: 0.99; 95% CI: 0.98, 1.0; P= 0.035) at 20 wk ofgestation.

Conclusions: These findings indicate that maternal midpregnancyTG concentrations are associated with preterm delivery whereas TCconcentrations reduce the risk of being born SGA.Overall, this researchsuggests that dietary interventions that improve maternal lipid statusduring pregnancy may help reduce the incidence of infants bornpreterm or SGA in nutritionally vulnerable populations.

Funding SourcesThe ENID trial is supported by theMedical Research Council (UK),

through core funding to the MRC International Nutrition Group (MC-A760-5QX00) and the Bill and Melinda Foundation.

Intake of Sugar-Sweetened Beverages from Infancy to 5 y of Agein Relation to Child Weight and Adiposity Outcomes (OR12-01)

Phaik Ling Quah,1 Ya Yin Chang,2 Izzuddin M Aris,3 Jia YingToh,3 Hui Xian Lim,3 Ray Sugianto,4 KeithMGodfrey,5,6 Peter DGluckman,7 Lynette Pei-Chi Shek,3 Kok Hian Tan,8,9 Yap-Seng

Chong,3 Ciaran G Forde,10 Yung Seng Lee,3 Fabian Yap,11 andMary Foong-Fong Chong3

1Agency for Science, Technology andResearch, Singapore; 2NationalUniversity of Singapore; 3Singapore Institute for Clinical Sciences,Agency for Science, Technology, and Research, Singapore; 4Saw SweeHock School of Public Health, National University of Singapore,Singapore; 5Medical Research Council Lifecourse EpidemiologyUnit and National Institute for Health Research, SouthamptonBiomedical Research Centre, University of Southampton, UnitedKingdom; 6University Hospital, Southampton National Health ServiceFoundation Trust, Southampton, United Kingdom; 7Liggins Institute,University of Auckland, Auckland, New Zealand; 8KK Women’s andChildren’s Hospital, Singapore; 9Department of Physiology, Yong LooLin School of Medicine, National University of Singapore, Singapore;10Clinical Nutrition Research Center, Singapore Institute for ClinicalSciences, Agency for Science, Technology and Research, Singapore;and 11Department of Paediatrics, KKWomen’s and Children’s Hospital,Singapore

Objective: High consumption of sugar-sweetened beverages (SSBs)during childhood has been linked with global increases in child obesity.In the Growing Up in Singapore Towards Healthy Outcomes (GUSTO)cohort study, we tracked the consumption of SSBs from infancy topreschool age, and related it to the risk of childhood overweight.

Methods:Mothers reported their child’s SSB intake consumption (as“yes” or “no” intake) at ages 9 and 12 mo; at ages 18 mo and 5 y, thetotal volume (milliliters) of SSBs consumed per day was ascertained,enabling a similar intake “yes” or “no” categorization. Trained researchassistants measured the child’s weight and height at ages 18 mo and2, 3, 4, and 5 y. We calculated body mass index (BMI) z scores usingthe WHO child growth standards, and defined risk for overweight asbeing above the BMI z score 85th percentile. The associations betweenSSB consumption in children from 9 to 18 mo of age and at age 5 ywere assessed using chi-square tests. We used multivariable generallinear models and Poisson regression models to examine associationsof SSB consumption volume at 18 mo and 5 y with BMI z scores andrisk for overweight, respectively. Covariates adjusted for were ethnicity,education, duration of breastfeeding, birth weight for gestational age,and mother’s prepregnancy BMI.

Results: Among the n = 400 children with longitudinal data, thosewho consumed SSBs between ages 9 and 18mo showed a nonsignificanttendency to continue consuming SSBs at age 5 y. Consumption of SSBsat age 18 mo (n = 555) was low [median (IQR): 28 (5.6–1046) mL/d],and was not associated with BMI z scores at ages 18 mo and 2, 3, 4,and 5 y. At age 5 y (n = 778), the consumption of SSBs was higher[median (IQR): 45 (2–1207) mL/d], and every 100 mL increment inSSB consumption was associated with a higher BMI z score (β = 0.26SD units; 95% CI: 0.13, 0.39) and a higher risk of overweight (RR: 1.16;95% CI: 1.12, 1.24).

Conclusions: Higher volumes of SSB consumption at 5 y wereassociated with higher BMI and risk for overweight at 5 y. Ourfindings are relevant to inform policymakers on the importance of SBBconsumption in relation to childhood overweight.

Funding SourcesThis research is supported by the Singapore National Research

Foundation under its Translational and Clinical Research (TCR)


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Flagship Programme and administered by the Singapore Ministryof Health’s National Medical Research Council (NMRC), Singapore-NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Addi-tional funding is provided by the Singapore Institute for ClinicalSciences, Agency for Science, Technology and Research (A*STAR),Singapore. KMG is supported by the National Institute for HealthResearch through the NIHR Southampton Biomedical Research Centreand by the European Union’s Seventh Framework Program (FP7/2007–2013), projects Early Nutrition and ODIN under grant agreementnumbers 289,346 and 613,977. Additional funding of the present studywas provided by the Singapore Institute for Clinical Sciences, A*STAR,and Nestec.

HeadCircumference Age z Score Is Positively Associated with theConsumption of Animal Source Foods inNepali Infants from 3 to 12mo of Age (OR12-02)

Shibani Ghosh,1 Katherine Heneveld,1 Johanna AndrewsTrevino,1 Ashish Pokharel,2 Sudikshya Acharya,2 Dale Davis,2Robin Shrestha,1 Kedar Baral,3 and Patrick Webb1

1Friedman School of Nutrition Science and Policy, Tufts University,MA; 2Helen Keller International, Nepal; and 3Patan Academy of HealthSciences, Nepal

Objectives: Head circumference (HC) is related to brain size. Dis-crepancies in achieving head circumference for age may be suggestiveof cognitive and developmental status. Prior studies in Nepal foundthe HC z score (HCZ) to be positively associated with consumption ofanimal source food in children under 36 mo of age. The objectives ofthis study were to examine the change over time of HC in infants aged3–12 mo and to examine the association between this change and theconsumption of animal source foods (ASF).

Methods: Data are from an ongoing cohort study (n = 1670maternal-infant dyads) conducted in the Banke District of Nepal. Theparticipants are visited in pregnancy, at birth, and when the infant isaged 3, 6, 9, 12, 18, and 24 mo. Anthropometric measurements arecollected from the infant starting at birth (weight and height) and 3 mo(weight, height, HC, and midupper arm circumference). At each visit,infant and young child feeding practice data, a 7-d food frequency recall,and a 24-h qualitative food recall are collected. Head circumferencedata and 24-h recall data from age 3 to 12 mo is used. The HCZ iscomputed (WHO Anthro), with all values under –5 and over +5 beingexcluded. ASF categories include milk, milk products, meat, fish, andeggs. Descriptive statistics and pooled linear regressions adjusted for thetime point are conducted in Stata SE version 15.

Results: Mean HCZ decreased from 3 mo of age through 12 mo,from amean± SD of –1.23± 1.05 to –1.30± 1.00 at 6mo, –1.44± 0.97at 9mo, and –1.46± 0.95 at 12moof age. About 7%of infants consumedat least one ASF at 3 mo, 33% at 6 mo, 49% at 9 mo, and 59% at 12 mo ofage. In pooled analyses, for infants aged 6–12 mo only, adjusted for thetime point, infants who had consumed at least one ASF in the previous24 h had a significantly higher HCZ score (β = 0.253, SE = 0.03,P = 0.0000). Age was negatively associated with HCZ.

Conclusions: HCZ decreased with age in this population of infantsand was positively associated with the consumption of any animalsource food. Further multivariate analysis is being conducted to

determine the effect of frequency and type of ASF consumption (e.g.,meat versus milk).

Funding SourcesSupport for this research was provided by the Feed the Future

Innovation Lab for Nutrition, which is funded by the United StatesAgency for International Development under grant AID-OAA-L-1-00006.

Complementary Feeding andMicronutrient Status: A SystematicReview (OR12-03)

Julie E Obbagy,1 Laural English,2 Nancy F Butte,3 Kathryn GDewey,4 David M Fleischer,5 Mary Kay Fox,6 Frank Greer,7Nancy F Krebs,5 Kelley Scanlon,8 Yat Ping Wong,1 and EveStoody1

1USDA, Center for Nutrition Policy and Promotion, VA; 2ThePanum Group; 3Baylor College of Medicine, TX; 4 Department ofNutrition, University of California, Davis; 5University of ColoradoSchool of Medicine; 6Mathematica Policy Research; 7Department ofPediatrics, University of Wisconsin School of Medicine and PublicHealth; and 8USDA

Objective: The aim of this study was to examine, by systematicreview, whether the timing of introduction or the types or amounts ofcomplementary foods and beverages (CFB) are related tomicronutrientstatus (iron, zinc, vitamin D, vitamin B-12, folate, or fatty acid status)from birth to 24 mo.

Methods: The literature was searched in PubMed, Cochrane,Embase, and/or CINAHL using predetermined inclusion and exclusioncriteria. Nine articles were included that examined timing of CFBintroduction, together with 31 articles that examined types or amountsof CFB consumed. For each study, data were extracted and the risk ofbias was assessed. The evidence was qualitatively synthesized to developa conclusion statement. The strength of evidence was graded.

Results: Moderate evidence suggests that introducing CFB at 4 movs. 6 mo of age offers no long-term advantages or disadvantages interms of Fe status among healthy, full-term infants who are breastfed,fed Fe-fortified formula, or mixed fed. There is insufficient evidenceto determine the relation between timing of CFB introduction and Zn,vitamin D, vitamin B-12, folate, or fatty acid status.

Strong evidence suggests that CFB with Fe (e.g., meat or Fe-fortifiedcereal) helps maintain adequate Fe status or prevent Fe deficiency inthe first year among infants with insufficient Fe stores or sources of Fe.Potential benefits for infants with sufficient Fe stores (e.g., consumingFe-fortified infant formula) are less clear. In the second year, goodFe sources are needed from a variety of CFB, but conclusions aboutspecific CFB could not be drawn. Moderate evidence suggests thatconsuming CFB with Zn (e.g., meat or Zn-fortified cereal) supports theZn status in the first year, whereas consuming CFB with differing fattyacid composition can influence fatty acid status. There is insufficientevidence to determine the relation between other types or amounts ofCFB that may contain less Fe (e.g., fruits and vegetables) and vitamin D,vitamin B-12, or folate status.

Conclusions: Additional research is needed to address gaps andlimitations in the evidence on complementary feeding and micronu-trient status, such as research on vitamin D, vitamin B-12, or folatestatus, and research that accounts for infant milk feeding practices


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and other aspects of the diet, such as fortified products and nutrientbioavailability.

Funding SourcesFunded by the Center for Nutrition Policy and Promotion, Food

and Nutrition Service, USDA, Alexandria, VA and the Office of DiseasePrevention and Health Promotion, Office of the Assistant Secretary forHealth, US Department of Health and Human Services, Rockville, MD.

Snacking Frequency and Energy Intake and Weight Status inEarly Childhood (OR12-04)

Hong Xue,1 Rachel Maguire,2 Jin Liu,1 Scott Kollins,3 SusanMurphy,3 Cathrine Hoyo,2 and Bernard F Fuemmeler1

1Virginia CommonwealthUniversity; 2North Carolina State Univer-sity; and 3Duke University, NC

Objectives: The relation between snacking and obesity in childrenremains unknown. We aimed to examine snacking patterns in toddlersand preschool children, and to investigate the associations betweensnacking frequency and daily energy intake and weight status.

Methods:We analyzed data from children aged 12–72mo (n= 972)in the Newborn Epigenetic STudy (NEST). We used multiple compari-sonmethods to examine the differences in snacking patterns across age,sex, and race or ethnicity subgroups. Quantile regression models werefit to assess the differential impacts of snacking at different points in theweight-for-height and BMI-for-age distributions.

Results: Energy intake from snacks was significantly higher in 12-to 23-mo-old boys compared with girls (607 vs. 549 kcal/d, P = 0.054).Non-Hispanic blacks had the highest energy intake from snacks (667kcal/d), which was significantly different from non-Hispanic whites(528 kcal/d) and Hispanics (533 kcal/d) in 12- to 23-mo-olds. Inchildren aged 2–5 y, the mean energy intake from snacks was about590 kcal/d. Approximately 30% and 25% of the total daily energy intakewas from snacks in children aged 12–23 mo and 2–5 y, respectively.In the group of 12- to 23-mo-olds, snacking frequency was positivelyassociated with total daily energy intake (β = 50.3 kcal/d, P= 0.036). Inthe 2–5 y age group, snacking frequency was negatively associated withtotal energy intake (β = –258.6 kcal/d, P= 0.002) in boys. In 12- to 23-mo-old children, snack frequency was significantly inversely associatedwith weight-for-length percentiles at the lower end of the distribution(25th percentile estimate, β = –6.0, P = 0.029) in boys. For childrenaged 2–5 y, quantile estimates did not suggest a significant associationbetween BMI-for-age and snack frequency.

Conclusions: Snacking frequency was not associated with weightstatus other than among 12- to 23-mo-old boys, among whom therewas a significant negative association in the first quartile of theweight-for-height distribution. Carbohydrates and fats from snacks aresignificant contributors to children’s daily energy intake, indicating thatinterventions may be needed that focus on diet quality of snacks, notnecessarily quantity.

The Good Tastes Study: Exploring Caregiver Feeding Persistenceand the Roles of Perceived Infant Liking, Child Temperament, andCaregiver Food Neophobia (OR12-05)

Kameron J Moding,1 Abigail Flesher,1 Haley Lucitt,1 Alyssa JBakke,2 John E Hayes,2 and Susan Johnson1

1University of Colorado Denver; and 2Pennsylvania State University

Objective: Repeated exposure can increase infants’ acceptance ofinitially disliked foods (e.g., dark green vegetables), but caregiversreport lacking the feeding persistence (i.e., commitment to repeatedlyoffer rejected foods) that is necessary to achieve acceptance. Few studieshave explored factors that positively and negatively affect caregiverfeeding persistence. The aim of this study was to examine infant andcaregiver predictors of caregivers’ intentions to continue offering a novelbitter green vegetable to their infants/toddlers.

Methods: Caregivers (n = 92, 90% mothers) offered infants (6–24mo; n = 92, 47 boys, 45 girls) kale purees during a laboratory visit.Caregivers rated their infants’ liking of the purees (9-point hedonicscale) and the likelihood they would serve the same purees again totheir child (5-point scale; 1 = not at all likely to 5 = very likely).Prior to the study visit, caregivers completed questionnaires assessingdemographic information, infant temperament (i.e., fear/distress tonovelty), and their own levels of food neophobia. After examining po-tential associations between demographics and primary study variables,multiple regression was used to examine infant (age, perceived liking,temperament) and caregiver (neophobia) predictors of caregivers’intentions to persist in offering the food to their children.

Results: Caregiver demographic information for this sample (in-come, education) and child age (weeks) were unrelated to caregivers’intentions to continue offering the kale purees to their children.However, parental report of child liking (β = 0.60, P = 0.000), childtemperament (β = –0.18, P = 0.032), and caregiver food neophobia(β = –0.22, P = 0.013) were significant predictors, explaining 44%of the variance in caregivers’ intentions to persist in offering the food(F = 16.72, P < 0.001).

Conclusions: Our findings suggest that both infant (liking of,fear of or distress toward, novelty) and caregiver (neophobia) factorscontribute to caregivers’ intentions to persist in offering a dark greenvegetable to their infants or toddlers. Addressing both caregiver andchild characteristics may be important in supporting caregivers topersist in offering initially disliked foods to their child and to facilitateacceptance of dietary variety.

Funding SourcesThe project was funded by a research grant from The Sugar

Association.

Prospective Associations between Infant Snack Foods in theFirst Year of Life and Infant Weight-for-Length z scores at 12 mo(OR12-06)

AmyMMoore,Maya Vadiveloo, KarenMcCurdy, Sara BenjaminNeelon, and Alison Tovar

University of Rhode Island

Objectives: A wide variety of less healthy snack foods are marketedto parents of infants, yet associations between snack foods and infantadiposity are unclear. The aim of this study was to explore prospectiveassociations between infant snack foods and sweets and infant weight-for-length (WFL) z scores at 12 mo.

Methods: This was a secondary analysis of data from the Nurturestudy. Women between 20 and 36 wk gestation were recruited fromDurham,NCprenatal clinics from2013 to 2015. Self-reported question-naires to assess sociodemographics and infant diet were administered at


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3, 6, 9, and 12 mo of age. Infant snacking was assessed by asking howoften infant snack foods (e.g., teething biscuits, puffs) and sweets (e.g.,cookies, cakes) were offered during the previous 3 mo. The frequencieswere categorized as never, sometimes, or often. Generalized linearmodels explored prospective associations between infant snack foodsand sweets at 3 time points (4–6, 7–9, and 10–12mo) to understand howtiming of exposure was associated with WFL z scores at 12 mo. Modelswere adjusted for prepregnancy bodymass index, weight for gestationalage z score, total weeks breastfed, and annual household income.

Results: Mothers (n = 666) were on average 27.1 y old, and morethan 70% identified as African American or black. Infant snack foodsoffered at 4–6mowas significantly associated withWFL z scores in fullyadjusted models (mean± SE β : 0.11± 0.90, P= 0.006). Infants offeredinfant snack foods at 4–6mohadhigherWFL z scores than infants neveroffered these foods (1.02 vs. 0.60, P = 0.004). There were no significantassociations between infant snack foods andWFL z scores at other timepoints, or between sweets and WFL z scores at any time point.

Conclusions: Given that less healthy snack foods offered duringearly infancy may contribute to the risk of adiposity, promoting healthyfood environments and snack food choices during this critical windowis important.

Funding SourcesN/A.

Complementary Feeding and Food Allergy, Atopic Dermatitis,Asthma, and Allergic Rhinitis: A Systematic Review (OR12-07)

Julie E Obbagy,1 Laural English,2 Frank R Greer,3 David MFleischer,4 Nancy F Butte,5 Kathryn Dewey,6 Mary Kay Fox,7Nancy F Krebs,3 Kelley Scanlon,8 Yat Ping Wong,1 and EveStoody1

1USDA, Center for Nutrition Policy and Promotion, VA; 2ThePanum Group; 3Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health; 4University of ColoradoSchool of Medicine; 5Baylor College of Medicine, TX; 6 Departmentof Nutrition, University of California, Davis; 7Mathematica PolicyResearch; and 8USDA, Food and Nutrition Service

Objectives:We aimed to examine, through systematic reviews (SR),whether timing of introduction of complementary foods and beverages(CFB) or specific types or amounts of CFB consumed are related to riskof atopic disease, including food allergy, atopic dermatitis, asthma, andallergic rhinitis from birth to 18 y.

Methods: The literature was searched in PubMed, Cochrane,Embase, and/or CINAHL using predetermined inclusion and exclusioncriteria. Data were extracted, risk of bias was assessed, and evidencewas qualitatively synthesized to develop conclusion statements. Thestrength of the evidence was graded.

Results: Thirty-one articles were included that assessed the relationbetween timing of introduction of CFB and risk of AD; 47 articlesassessed the types or amounts of CFB consumed, of which 39 examinedtypes of allergenic foods (cow’s milk, hen’s egg, soy, grain productsor wheat, peanut, tree nuts, fish, and sesame seed); and 14 examineddietary diversity and patterns. Moderate evidence suggests that the ageat which complementary feeding begins is not associated with risk offood allergy, atopic dermatitis or eczema, or childhood asthma. Limited

to strong evidence suggests that introducing allergenic foods early in thefirst year of life (after 4 mo) does not increase the risk of food allergyor atopic dermatitis, but may prevent peanut and egg allergy. There isnot enough evidence to determine a relation between diet diversity ordietary patterns and atopic disease.

Conclusions: Additional research is needed to address gaps andlimitations in the evidence on complementary feeding and atopicdisease, including RCTs using reliable measures to diagnose atopicdisease, and research that accounts for key confounders (e.g., infantcow’smilk feeding practices, exposure to smoking or pets) and potentialreverse causality owing to baseline atopic disease status.


and Nutrition Service, USDA, Alexandria, VA and the Office ofDisease Prevention and Health Promotion, Office of the AssistantSecretary for Health, US Department of Health and Human Services,Rockville, MD.

Consumption of Added Sugars among US Infants Aged 6–23mo,2011–2014 (OR12-08)

Kirsten Herrick1 and Alexandra Cowan2

1National Center for Health Statistics, CDC; and 2NCHS

Background: Added sugar consumption is associated with detri-mental health conditions, such as dental caries, asthma, obesity, alteredlipid profiles, and elevated blood pressure in older children. TheAmerican Heart Association recommends that children <2 y old avoidadded sugar consumption.

Objective: The aim of this study was to provide national estimatesof added sugar consumption among infants aged 6–23 mo.

Methods: Using a single 24-h recall from NHANES 2011–2014, weestimated the prevalence and mean consumption of added sugars (inteaspoons) by age, sex, poverty index ratio (PIR), and race andHispanicorigin, among infants and toddlers aged 6–23 mo (n = 806). We usedSUDAAN to conduct all analyses, andwe evaluated differences betweengroups using a t statistic and tests of trend across ordinal variables usingorthogonal contrast matrices.

Results: It was reported that >8 out of 10 infants and toddlers aged6–23 mo [85% ± 1.5% (mean ± SE)] consumed added sugar on anygiven day. Among infants 6–11 mo old, 61% ± 3.2% consumed addedsugars, and nearly all toddlers aged 12–18 mo (98% ± 0.65%) and19–23 mo (99% ± 1.0%) consumed added sugars. Mean added sugarconsumption was 4.2 ± 0.26 tsp for those aged 6–23 mo. Consumptionincreased significantly by quadratic trend by age, from 0.9 ± 0.12 tspamong infants aged 6–11 mo, to 5.5 ± 0.36 tsp among toddlers aged12–18 mo and 7.1 ± 0.55 tsp among toddlers aged 19–23 mo. Amongall infants and toddlers (6–23 mo old), non-Hispanic whites consumedfewer teaspoons of added sugar (3.8 ± 0.33) than non-Hispanic blacks(5.4 ± 0.62). We observed a similar pattern among toddlers aged 12–18 and 19–23 mo, but not among infants aged 6–11 mo. There were nosignificant differences by sex or PIR for any age group.

Conclusions: Added sugar consumption begins early in life andexceeds current recommendations.

Funding SourcesN/A.


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Influence of Maternal Obesity and Neonatal Factors on InfantGut Microbial Ecology during the First Year of Life (OR25-01)

Kartik Shankar, Umesh Wankhade, Donald Turner, Clark Sims,Ying Zhong, Sree Chintapalli, Brian D Piccolo, and Aline Andres

Arkansas Children’s Nutrition Center

Objective:Maternal body composition and postnatal diet are amongthe factors that influence offspring obesity risk. One hypothesizedmechanism linking maternal and offspring obesity is the reconfigura-tion of the infant microbiome. We examined the associations betweenmaternal obesity and other perinatal or neonatal variables i.e., mode ofdelivery (vaginal vs. cesarean delivery), infant birth weight, sex, breastvs. formula feeding, and breast milk composition on gut microbialecology during the first year of life.

Methods:Maternal and infant anthropometrics, body composition(BodPod, QMR), and dietary intake (3-d food records) were collectedduring pregnancy and postpartum in 171 women and their infants(Glowingstudy). Stool samples were collected from infants at ages 1,6, and 12 mo (n = 123, 102, and 92, respectively) and processedfor microbiome analysis via 16S rRNA amplicon sequencing. Breastmilk macronutrient composition, total energy, insulin and leptinconcentrations were analyzed at 6 mo in those samples that wereavailable (n = 53). Data analyses were performed using QIIME 1.9 andR packages.

Results: α-Diversity (number of operational taxonomic units,Chao1, Shannon, or Simpson index) was significantly influenced byinfant age, mode of delivery (at 1 mo), and breastfeeding (at 6 mo),but unaltered by maternal overweight or obesity status, infant sex,or race. β-Diversity, a measure of global microbial composition, wasinfluenced by infant age, mode of delivery (at 1 and 12 mo), andbreastfeeding (at 6 mo), but not by maternal weight at any infantage. Mode of delivery influenced the abundance of Proteobacteria at1 mo. Further levels of Proteobacteria were 3.4-fold greater at 12 moin infants from overweight or obese compared with normal weightmothers. Regression of taxonomic abundance with infant adiposityshowed positive associations with Verrumicrobia and Bacteroidetes at1 mo of age and the Enterococcus and Enterobacter genera at 12 mo.At 6 mo, α-diversity (Chao1, Simpson) was inversely correlated withbreast milk fat concentrations (P < 0.05). The Proteobacteria phylumwas positively associated with milk insulin and leptin concentrations(P < 0.05).

Conclusions:The results suggest age-specific influences of postnatalbreastfeeding and cesarean delivery with modest influence of maternalobesity on the infant microbiome.

Funding SourcesSupported by USDA-ARS Project 6026-51,000-010-05S.

Impact of a Nutritional Supplement during Pregnancy and EarlyChildhood on Child Salivary Cortisol Stress Response and HairCortisol at 4–6 y of Age (OR25-02)

Brietta M Oaks,1 Seth Adu-Afarwuah,2 Sika Kumordzie,3 MarkL Laudenslager,4 Rebecca Young,3 Harriet Okronipa,3 MakuOcansey,3 and Kathryn G Dewey3

1University of Rhode Island; 2University of Ghana; 3University ofCalifornia, Davis; and 4University of Colorado School of Medicine

Objective: Permanent dysregulation of the neuroendocrine systemthat responds to stress can occur early in life. Poor nutrition duringpregnancy and infancy may be a possible factor in the dysregulation ofthe stress response.Our objectivewas to evaluate the effect of nutritionalsupplementation during pregnancy and early childhood on child stressresponse and hair cortisol (a biomarker of chronic stress) at 4–6 y of age.

Methods: We conducted a follow-up study (January–December2016) of children 4–6 y of age who participated in a nutritionsupplementation trial (2009–2014) in Ghana. During the main trial,pregnant women were assigned to receive either 1) a small-quantitylipid-based nutrient supplement (SQ-LNS, during pregnancy and 6 mopostpartum), 2) multiple micronutrients (during pregnancy and 6 mopostpartum), or 3) iron and folic acid (IFA, during pregnancy only).Infants born towomen in the SQ-LNS group received SQ-LNS from6 to18mo of age; infants in the other 2 groups received no supplementation.The follow-up study included assessment of salivary cortisol in responseto a stressor (finger prick) in a subset of children (n = 311) from all3 trial arms. Hair cortisol concentration was used to estimate cortisolexposure over the previous 2–3 mo in a subset of children (n = 287)from the IFA and SQ-LNS trial arms, serving as a biomarker of chronicstress.

Results: The salivary cortisol response to the stressor did not differby supplementation group (P = 0.53). Geometric mean (95% CI) haircortisol concentration was 5.37 (4.61, 6.28) pg/mg in children from theIFA group and 4.80 (4.17, 5.53) pg/mg in children from the SQ-LNSgroup (P = 0.29). In subgroup analyses, hair cortisol was lower in theSQ-LNS group than in the IFA group among children born to obesewomen (n = 27, P = 0.01) and among children with hair collectedduring the dry season (n = 106, P = 0.03). There was no significantintervention group difference in hair cortisol among children born tononobese women or with hair collected during the wet season.

Conclusions: Nutritional supplementation given during pregnancyand early childhood does not affect child stress response or chronicstress in children at 4–6 y of age in this setting. SQ-LNS may reducechronic cortisol exposure during the dry season or in children born towomen who are obese during pregnancy.

Funding SourcesThe Bill & Melinda Gates Foundation and The Thrasher Research

Fund.

Imbalance in Adequacy of Dietary Intake of Vitamin B-12, Folateand Choline in Pregnant CanadianWomen (OR25-03)

Caroline J Moore,1 Courtney Moore,1 Rene L Jacobs,2 andStephanie Atkinson1

1McMaster University, Canada; and 2University of Alberta, Canada

Objective: The adequacy of maternal intake of folate, vitaminB-12 (B12), and choline in pregnancy is vital to fetal growth. InCanada, risk of intakes in excess of the dietary reference intakes (DRIs)exists for folate/B12 owing to their inclusion in prenatal multinutrientsupplements (PMN); yet choline intakes may be inadequate unlessthe diet is high in animal products, as it is not included in commonPMN. We aimed to assess intakes and primary food sources of the 3micronutrients in Canadian women in early pregnancy.

Methods: Women recruited to the Be Healthy in Pregnancyrandomized controlled trial (NCT01693510) completed 3-d diet and


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supplement records prior to treatment randomisation (12–17 wkgestation). Intakes of folate and B12 (n = 226) were quantified usingNutritionist Pro diet analysis software (Version 5.2, Axxya Systems).Dietary choline was calculated in a subset of women (n = 30) using acomprehensive choline database developed by RL Jacobs (University ofAlberta, Canada). Individual intakes were compared with the estimatedaverage requirement (EAR) or adequate intake (AI) and tolerable upperlimit (UL). Group values are reported as median (min, max).

Results: Daily intake of total folate was 1271 µg (131, 6004), with87% of women meeting the EAR, 11% from food sources alone. Folateintake exceeding the UL was observed in 22% of women. Whereas 81%of women consumed PMN, 7% also consumed an additional singlefolate supplement. Total daily intake of total B12was 12.1 µg (0.3, 1023),with 96% of women meeting the EAR, 54% from food sources alone.Total B12 intake exceeded the EAR 50-fold for 18% of subjects and 100-fold for 7%. Single B12 or B-complex supplements were consumed by7% of women in addition to PMN. Choline intake averaged 351 mg/d(120, 1016), with 13%meeting the AI and no women exceeding the UL.Food was the major choline source; only 7% consumed a supplementwith choline.

Conclusions: A large proportion of Canadian pregnant womenmeet the DRIs for folate and B12, but many also exceed the DRI-UL,likely related to supplement use. Risks of overconsumption of folateand B12 in pregnancy need to be explored. In contrast, few women metthe DRI for choline. Further research is required to establish an EARfor choline before recommendations can be made to include choline inPMN in Canada.

Funding SourcesDairy Farmers of Canada, CIHR, and DFC/AAFC Dairy Research

Cluster; in-kind by GayLea Foods & Ultima Foods.

Impact of 25-Hydroxyvitamin D Concentration at Birth on BoneMineral Accretion in Infants between 0 and 6 mo of Age (OR25-04)

Nathalie J Gharibeh,1 Catherine Vanstone,1 Olusola F Sotunde,1Shu Qin Wei,2 and Hope AWeiler1

1McGill University, Canada; and 2Sainte Justine Hospital, Universityof Montreal, Canada

Objective: The aim of this study was to test whether low vitamin Dstatus demarked by serum 25-hydroxyvitamin D [25(OH)D]

<50 nmol/L at birth relates to bone mineral accretion and densityin healthy infants.

Methods: Term-born, healthy, breastfed infants (n = 67) wererecruited from the greater Montreal area within 24–36 h after birth.Infants with serum 25(OH)D <50 nmol/L (n = 52) were randomizedto receive either 400 or 1000 IU/d of vitamin D up to 12 mo of age.Infants with serum 25(OH)D ≥50 nmol/L at birth formed a healthyreference group (n = 15) and were allocated to receive 400 IU ofvitamin D daily up to 12 mo of age. The data available for analysis wereblinded data from trial infants up to 6 mo of age, with comparisonsmade between the combined trial groups and the reference group.Whole-body bone mineral content (BMC), lumbar vertebrae (1–4)BMC, and bone mineral density (BMD) (dual-energy X-ray absorp-tiometry), anthropometry, skin color (Fitzpatrick scale), and serum25(OH)D (Liaison, Diasorin Inc.) were measured at <1 (baseline), 3,and 6 mo of age. The data were analyzed using MIXEDmodel repeatedmeasures ANOVA (group, time) adjusting for sex, gestational age atbirth, birth during vitamin D synthesizing vs. nonsynthesizing periods,skin color, and weight-for-age z score. Statistical significance was setat P < 0.05.

Results:Neonates (n= 35 male; n= 32 female) were born at (mean± SD) 39.6 ± 1.0 wk of gestational age and were of appropriate birthweight (3387 ± 413 g). Baseline infant characteristics were similarbetween the groups except for birth serum 25(OH)D concentrations(reference: 66.1 ± 16.7 nmol/L, trial: 30.5 ± 10.3 nmol/L, P < 0.0001).Serum 25(OH)D concentrations at birth and time were significantly(P < 0.05) related to lumbar spine BMD adjusting for gestational ageat birth, skin color, sex, season of birth, and weight-for-age z score.Serum 25(OH)D concentration at birth was not related to whole-bodyBMC or lumbar spine BMC at any time point, or to BMC accretionrates.

Conclusions: Birth serum 25(OH)D concentration appears topositively influence lumbar spine BMD during early infancy. Furtherinvestigation of the effect of vitamin D status at birth on BMD at a laterstage of infancy is deemed necessary.

Funding SourcesCanadian Institutes for Health Research, Canada Foundation for

Innovation, and Canada Research Chairs Program.


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FIGURE OR25-04-1 Effect of birth serum 25 (OH)D concentration above (Reference group) and below 50 nmol/L (Trial group) on lumbarspine bone mineral density. Different superscripts depict significant differences using mixed model repeated measures ANOVA (group,time) adjusted for gestational age at birth, skin color, sex, season of birth, weight-for-age z-score (p < 0.05)

Developmental Expression of Fatty Acid Transporters: Implica-tions in Newborn Fatty Acid Accretion (OR25-05)

William Yakah, Pratibha Singh, George Perides, Xinting Yu,Joanne Brown, Steve Freedman, and Camilia R Martin

Beth Israel Deaconess Medical Center, MA

Objective: The developmental expression of FA transporters andtheir role in maintaining fatty acid status in the brain has notbeen evaluated from a developmental perspective. Understanding theinterplay between dietary fatty acids and specific FA transporters acrossage may help identify age-specific nutritional strategies to optimizefatty acid accretion in the brain. The aim of this study was to testthe hypothesis that FA transporters are developmentally expressedand that their expression may limit fatty acid accretion independentof diet.

Methods: C57/BL6 wild-type (WT) mice and fat-1 mice [abilityto enrich docosahexaenoic acid (DHA) from omega-6 precursors]were used to study FA transport expression across a range of diet-induced fatty acid profiles. Real-time quantitative reverse transcriptase-polymerase chain reaction was used to quantify the relative changes ingene expression of murine FATP-1, FATP-4, FABP-5, and FAT/CD36in brain at days 3 and 14, representing the early childhood period, andday 28, representing the postweaning, mature period. DHA concentra-tions were determined using GC-MS.

Results: In brain, the expression of FAT/CD36 and FABP5 forboth fat-1 and WT decreased significantly with increasing age. Withreference to the day-3 baseline, the fold change in FAT/CD36 atday 14 showed a transient increase for WT but decreased to 0.34 forfat-1; and by day 28 compared with baseline the fold change inWT was

0.07, and 0.49 in fat-1. The fold change in FABP5 at day 14 relative today 3 was 1.02 for WT and 0.33 for fat-1; and by day 28 compared withbaseline, the fold change in WT was 0.21, and 0.02 in fat-1. Brain DHAconcentrations demonstrated increasing accretion from day 3 to day 28in fat-1 (10.9 ± 0.4 to 13.6 ± 0.7 P < 0.001) and WT mice (6.6 ± 0.7to 12.8 ± 1.6 P < 0.001). The positive changes in DHA concentrationsover time were unrelated to the reduced expression in FABP5 andFAT/CD36, suggesting that diet has a greater influence on final tissueaccretion of DHA independent of the developmental expression of FAtransporters in the brain.

Conclusions: Diet-induced DHA concentrations can significantlyalter concentrations of DHA in brain independent of transporter statusacross age. This identifies diet as an important modifiable factor inneurodevelopment outcome regardless of the metabolic immaturity ofthe host.

Funding SourcesCharles H and Judy Hood Family Infant Health Research Program

NIH R01 DK104346.

Gestational Weight Gain within the First Trimester: Trade-OffAnalysis Using Intergrowth-21st Standards (OR25-06)

Thais P Rangel,1 Monica Batalha,2 Dayana Farias,2 and GilbertoKac2

1Nutritional Epidemiology Observatory, Rio de Janeiro FederalUniversity, Brazil; and 2Rio de Janeiro Federal University, Brazil

Objective: The aim of this study was to perform a trade-off analysisto evaluate first-trimester gestational weight gain (GWG) classifiedaccording to the Intergrowth-21st standards for gestational week 14 and


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its association with adverse maternal and child outcomes in a Braziliancohort study.

Methods: Data from the 2015 Pelotas’s birth cohort for pregnantwomen was analyzed. The pregnancy booklets were photographed toregister the gestational weight measures and the respective gestationalages, and maternal and child anthropometry was assessed after birthand 3 mo postpartum. A trade-off analysis was performed. Theoutcomes were the postpartum weight retention (PPWR) at 3 mo(continuous and categorical,≥5 kg), and small for gestational age (SGA)and large for gestational age (LGA) infants. The models were adjustedfor GWG during the first trimester, classified according to the 10/90th,5/95th, 3/97th, 25/75th, and 50th Intergrowth-21st percentiles forweek 14. Maternal age and height, smoking and alcohol intake duringpregnancy, parity, schooling, and gestational age at birth were usedas covariates. A linear model was adjusted for continuous outcomes,and binomial and multinomial logistic regressions were applied forcategorical ones.

Results: A total of 673 normal body mass index (BMI), healthysingleton pregnant adult women were included in the analysis. Womengained 1.8 kg during the first trimester (SD = 4.0) and had a mean± SD PPWR of 1.8 ± 6.4 kg; and 23% had a PPWR of ≥5 kg. Theprevalence of SGA was 7.6% and of LGA, 10.3%. Most women (82.2%)had a weight gain of≥50th percentile of the Intergrowth-21st standard.A GWG ≥50th, 75th, 90th, 95th, or 97th percentile had a direct andsignificant influence on the PPWR (β : 2.29–2.82, P < 0.001) and wasassociated with a PPWR of≥5 kg (OR: 2.6–2.8), even after adjustments.Only gains≥90th, 95th, and 97th percentiles were associated with LGA,and gains ≤5th, 10th, and 25th percentiles were associated with SGA.Significance remained after adjustment for LGA at the 95th and 97thpercentiles.

Conclusions: First-trimester GWGs above the 95th and 97th per-centiles of Intergrowth-21st were positively associated with PPWR andLGA. Further investigation is needed to provide new recommendationsfor this gestational period, considering the occurrence of bothmaternaland child adverse outcomes.

Funding SourcesChild’s Pastoral (Pastoral da Criança) National Council for Scientific

and Technological Development—CNPq.

Maternal Vitamin D Depletion Alters Genome-Wide DNAMethylation in Germline of Adult Offspring (OR25-07)

JingXue,1 Ra’adGharaibeh,2 Eddie Pietryk,1 Cory Brouwer,2 LisaM Tarantino,1 William Valdar,1 and Folami Y Ideraabdullah1

1University of North Carolina at Chapel Hill; and 2University ofNorth Carolina—Charlotte

Objective: The aim of this study was to characterize the impact ofmaternal vitaminDdepletion on genome-wideDNAmethylation in theadult germline.

Methods: Female Collaborative Cross CC001 mice were fed witheither an AIN-93G diet (CON) or a modified AIN-93G diet lackingvitamin D (DVD) from prepregnancy to weaning. Offspring wereweaned to a vitamin D–sufficient diet. Bisulfite libraries were preparedfrom the sperm and liver of 8-wk-old offspring using the AgilentSureSelect target enrichment system. Differentially methylated CpG

sites (DMCs) were identified by comparing DVD with CON usinglogistic regression (significance threshold, FDR

Results: Adult offspring exposed to maternal vitamin D depletionexhibited mainly loss of DNAmethylation in sperm (68% of the 16,637DMCs). Loss of methylation was independent of chromosomal or geniclocations. Of the spermDMCs, 36% had a≥10%methylation differencebetween DVD and CON, and these DMCs were significantly enrichedat developmental genes (pTfpt) gene in both sperm and liver coincidedwith a 34% increase (pTfpt expression.

Conclusions: Vitamin D depletion during early development altersthe epigenome of the germline and soma in the adult offspring. Anepigenetic mechanism potentially contributes to developmental originsof phenotypic outcomes associated with maternal vitamin D depletion.

Funding SourcesThis work was supported in part by the NIH Transition to

Independent Environmental Health Research Career DevelopmentAward from NIEHS KES023849A and a Nutrition Research Institutepilot grant (to FYI), and grant R01MH100241 (to LT and WV).

Elevated Fecal pH Indicates a Profound Reduction of Bifidobac-terium in the Infant Gut over the Last Century (OR25-08)

BethanyMHenrick,1,2,3 AndraHutton,1,2,3 Michelle Palumbo,1,2,3Giorgio Casaburi,1,2,3 Ryan DMitchell,1,2,3 Mark Underwood,1,2,3and Steve Frese1,2,3

1Evolve Biosystems; 2Foods for Health Institute, University ofCalifornia, Davis; and 3Department of Pediatrics, UC Davis Children’sHospital

Objective: Historically, Bifidobacterium species have been reportedas being abundant in the breastfed infant gut; however, recent studiesin resource-rich countries show highly diverse gut microbiomes amonginfants, which often lack Bifidobacterium species. Importantly, wepreviously showed that fecal pH is strongly associated with Bifidobac-terium abundance in infants fed Bifidobacterium longum subsp. infantisEVC001, and reasoned that fecal pH could provide a robust proxy forevaluating Bifidobacterium abundance across historical records.

Methods: We undertook a review of 14 studies published between1926 and 2017, representing 312 healthy, breastfed infants wherefecal pH was reported to model population-wide Bifidobacteriumabundances over the past century. Further, we evaluated the relationbetween fecal pH and phylogenetic distances at a family level in theinfant gut microbiome.

Results: Mean fecal pH steadily increased from approximatelypH 5 in early studies to nearly pH 6.4 more recently, which significantlycorrelated with time (adjusted r2 = 0.61). This historical trend ofincreasing infant fecal pH is consistent with an observed reduction ofBifidobacterium species in the gut microbiome in present day, resource-rich countries. Further, we found that increased fecal pH is significantlyassociatedwith the abundance of Enterobacteriacea, Clostridiaceae, andother bacteria, indicating that the loss of highly specialized speciesof Bifidobacterium may create an opportunity for potentially harmfulbacteria to thrive.

Conclusions: Loss of B. infantismay be an unintended consequenceof modern medical interventions (e.g., cesarean delivery and antibioticuse) and infant feeding interventions (ie. formula feeding) commonamong resource-rich nations. The loss of Bifidobacterium, and the


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profound change in the gut environment as measured by fecalpH, provide a possible explanation for the increased abundance ofpotentially harmful bacteria in the infant gut microbiome, which havebeen shown to positively correlate with the incidence of allergic andautoimmune disorders observed in resource-rich nations in recentdecades. Longitudinal studies comparing the incidence of autoimmune

FIGURE OR25-08-1 Correlation of bacterial families to fecal pH.

FIGURE OR25-08-2 Fecal pH trend over time

disorders with microbiome with restored Bifidobacterium populationsare essential to establish the role of Bifidobacterium on immunedevelopment in the infant gut.

Funding SourcesThis work was funded by Evolve BioSystems.


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Women Expressing a Common Genetic Variant in ZnT2 (T288S)Produce Low Milk Volume and Have Milk-Derived miRNA Profilesthat Suggest Suboptimal Lactation (OR36-01)

Olivia C Rivera,1 Steven Hicks,1 Donna Geddes,2 and Shannon LKelleher3

1Penn State College of Medicine, PA; 2The University of WesternAustralia; and 3University of Massachusetts Lowell

Background: Poor milk production is one of the main reasonsfor early breastfeeding cessation; however, the molecular mechanismsunderlying suboptimal lactation are not understood. The zinc trans-porter ZnT2/SLC30A2 is essential for mammary gland function duringlactation, and expression of genetic variants in ZnT2 is common inhumans. Breastfeeding women who express the ZnT2 variant T288Ssecrete markers of breast dysfunction into milk, and in vitro studiessuggest that expression of T288S in mammary epithelial cells (MECs)drives lysosomal-mediated cell death, a hallmark of involution.

Objective: The aim of this study was to determine if T288S isenriched in women with low milk volume, and if milk-derived micro-RNA (miRNA) profiles can be used to identify potential molecularmechanisms underlying poor lactation.

Methods: Targeted sequencing of SLC30A2 (exon 7, containingamino acid 288) was performed on genomic DNA isolated from themilk ofwomen at∼3moof lactation (n= 12).miRNAwas isolated fromthe milk lipid fraction of women expressing T288S (n = 5) or 2 wild-type (WT) ZnT2 alleles (n= 5). High-throughput sequencing evaluateddifferences betweenmilk-derivedmiRNAprofiles. Total counts for bothpremature and mature miRNAs were quantified, and read counts werenormalized across samples using a trimmed mean ofM values method.

Results: T288S was detected in 20% of women who produced lowmilk volume relative to women expressing WT (let-7d, miR-10b, miR-15a, miR-499a-5p; FDRLAMTOR5,VAMP7, and PP2CA) and catabolicprocesses (PRKAA1 and PP2CA). Functional analysis of upregulatedmiRNAs predicted downregulation of target mRNAs related to fattyacid metabolism (FASN).

Conclusions:Our findings suggest that expressing the ZnT2 variantT288S impairsmilk production.Moreover, women expressing T288S havea unique milk-derived miRNA profile that suggests that T288S mayalter the energetic state of MECs, promoting precocious involution anddecreasing milk secretion.

Funding SourcesSupported by intramural funds from the Department of Surgery,

Penn State Hershey College of Medicine.

Human Milk Fatty Acids and Asthma Development in PreschoolChildren (OR36-02)

Kozeta Miliku,1,2 Allan Becker,2 Susan Goruk,3 PadmajaSubbarao,4 Piushkumar Mandhane,2 Stuart Turvey,5 DianaLefebvre,6 Malcolm Sears,6 Catherine Field,3 andMeghan Azad2

1Children’s Hospital Research Institute of Manitoba, Canada;2University of Manitoba, Canada; 3University of Alberta, Canada;4University of Toronto, Canada; 5University of British Columbia,Canada; and 6McMaster University, Canada

Objective: Breastfeeding may reduce asthma risk. However, littleis known about the human milk components that influence asthma

development. Long-chain polyunsaturated fatty acids (LCPUFA) inbreast milk may stimulate the immune system, changing the balancebetween pro- and anti-inflammatory mechanisms in the developingairways. We aimed to examine the associations of LCPUFA and asthmain preschool children.

Methods: In a representative subset of 417 mother-infant dyadsfrom the CanadianHealthy Infant Longitudinal Development (CHILD)Study, we analyzed milk samples collected at 3–4 mo postpartum andmeasured the relative concentrations (percentage total fatty acids) of n–3 (ω-3) and n–6 (ω-6) LCPUFA by high-resolution capillary GLC. Weused principal components analysis to reduce dimensionality and studyLCPUFA patterns. At 3 y of age, children were assessed by health careprofessionals, and classified as having “possible or probable asthma”or “no asthma”. Associations were examined using regression analysiswith adjustment for infant sex, maternal asthma, lactation stage,breastfeeding exclusivity, and other potential confounders. Analyseswere stratified on maternal fish oil supplement use.

Results: In this subset, 21% of mothers used fish oil supplementsand 11% of children had possible or probable asthma. Milk n–3 LCPUFA concentrations, including eicosapentaenoic acid (EPA),docosopentaenoic acid (DPA), and docosahexaenoic acid (DHA), werehigher in mothers who used fish oil supplements (P < 0.01), butwere not associated with child asthma in this group. However, amongmothers who did not use fish oil supplements, higher milk DPA andDHA concentrations were associated with higher asthma risk at age 3 y(P< 0.05). Furthermore, the first principal component (PC1, explaining26% of LCPUFA variation) was characterized by high n–3 LCPUFAconcentrations and was positively associated with asthma risk (adjustedOR: 1.57; 95% CI: 1.12, 2.22 for each SD increase in PC1 score). Noassociation was observed between n–6 LCPUFA or the n–6 to n–3LCPUFA ratio and asthma.

Conclusions: Our results suggest that human milk n–3 LCPUFAare associated with asthma development in preschool children whenmothers do not use fish oil supplements. Further studies are needed toreplicate these findings and examine the underlying mechanisms.

Funding SourcesThis research was funded by the Manitoba Medical Services

Foundation. The CHILD Study is funded by the Canadian Institutes ofHealth Research and the Allergy, Genes and Environment Network ofCenters of Excellence.

Lipid Metabolites in Human Milk and Associations with InfantGrowth (OR36-03)

Rachel Criswell,1 Virissa Lenters,2 Siddhartha Mandal,3 NinaIszatt,2 Hans Demmelmair,4 and Merete Eggesbø2

1Columbia University College of Physicians and Surgeons, NY;2Norwegian Institute of Public Health; 3Public Health Foundation ofIndia; and 4Ludwig Maximillian University of Munich, Germany

Objective: Lipids make up 40–55% of the energy content of humanbreast milk. Exposure to lipids and their metabolites during theperinatal period can have lasting effects on child health, and many lipidmetabolites have been identified as biomarkers for obesity.We sought toexplore the relation between lipid metabolite concentrations in humanmilk and infant growth in a Norwegian cohort.


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Methods:We used data from the HUMIS-NoMIC study, a Norway-wide cohort of 2606 women and children enrolled between 2002and 2009. Mothers provided milk samples during the child’s first2 mo and completed questionnaires during the child’s first 2 y withinformation about the pregnancy and maternal, paternal, and childhealth. In a subset of 789 mothers oversampled for overweight, breastmilk concentrations of lipid metabolites were analyzed. The primaryoutcome was change in weight-for-age z score between 0 and 6 mo.Exposures included 45 carnitine species, 46 lysophosphatidylcholinespecies, 159 phosphatidylcholine species, and 188 sphingomyelinspecies. Covariates included maternal age, smoking, education,prepregnancy body mass index, gestational weight gain, parity,child sex, gestational age, and birthweight. Variables were run inmultivariable linear regression models.

Results: Median metabolite concentrations ranged from<0.001 µmol/L (multiple) to 35.1 µmol/L (SM.a.C40:1). We foundseveral positive and negative associations between concentrationsof lipid metabolites in human milk and change in weight-for-agez score. The species with the most positive associations includedsphingomyelins and phosphatidylcholines, whereas those with themost negative associations were carnitines and sphingomyelins. Threeinverse associations survived correction for multiple comparisons:carnitine C6:0 (β = –0.12, P < 0.0001), SM.e.C34:3 (β = –0.13,P < 0.0001), and SM.e.C34:4 (β = –0.12, P < 0.0001).

Conclusions: Our results indicate an association between the con-centration of certain lipid metabolites in milk, particularly carnitines,phosphatidylcholines, and sphingomyelins, and infant growth in thefirst 6mo of life. Further researchmay explore themechanisms of actionunderlying these associations.

Funding SourcesThe research leading to these results has received funding from

the project “Early Nutrition,” grant agreement No. 289,346, underthe European Union’s Seventh Framework Program (FP7/2007–2013),and by funds from the Norwegian Research Council’s MILPAAHELprogram, project No. 213,148.F20.

Nutrient Intake from Human Milk, Longitudinal Growth, andBody Composition in Hospitalized Very Preterm Infants (OR36-04)

Caroline Palmer, Katherine Bell, Sara Cherkerzian, Tina Steele,Hunter Pepin, Deirdre Ellard, Kaitlin Drouin, andMandy Belfort

Brigham and Women’s Hospital, MA

Objectives:The extent to which day-to-day variation in humanmilkcomposition impacts cumulative macronutrient intakes and/or growthof very preterm infants during neonatal intensive care unit (NICU)hospitalization is uncertain. Our aims were to: 1) describe differencesin cumulative intake of macronutrients and energy from human milk,and 2) examine associations of macronutrient and energy intake witha) longitudinal growth and b) body composition.

Methods: We studied 24 fortified human milk–fed infants bornat <32 completed weeks’ gestation. We analyzed unfortified milkwith a midinfrared spectroscopy-based human milk analyzer (MirisAB). Trained staff measured anthropometrics and assessed bodycomposition with air displacement plethysmography (PEA POD,Cosmed) at term equivalent age (TEA). We calculated actual dailymacronutrient and energy intake from unfortified milk as (content ×volume)/bodyweight. Before fortification, adequate daily protein intakefrom the “base” unfortified milk was 1.8 g/kg and energy 102 kcal/kg.Weight, length, and head circumference z scores were based on thecorresponding fetal reference. We estimated associations of mean ormedian daily intake with outcomes, adjusting in linear regression forbirth weight z score and number of study days.

Results: We observed substantial variation in daily macronutrientand energy intake from milk both within and between individuals. Intotal, 18 (75%) of participants had low (<1.8 g/kg) mean daily proteinintake and 17 (71%) had low (<102 kcal/kg)mean energy intake. Lowerfat intake from milk was associated with less weight gain relative to thefetal reference and with lower fat mass at TEA; lower energy intake wasassociated with less gain in weight and head circumference.

Conclusions: Macronutrient and energy intakes from human milkover the NICU hospitalization were highly variable, and cumulativeintakes were low formany infants. Even with routine fortification, lowerfat and energy intake from the “base” milk was associated with slowergrowth, including head growth. These findings suggest that currentmilkfortification strategies may not optimally support growth for all verypreterm infants during the NICU hospitalization, which spans a criticalperiod for brain development.

Funding SourcesSundry Fund.


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High-Fructose Corn Syrup–Sweetened Beverage Increases BreastMilk Fructose Concentrations in LactatingWomen (OR36-05)

Paige K Berger,1 David Fields,2 Ellen W Demerath,3 HidejiFujiwara,4 and Michael Goran1

1The University of Southern California; 2The University of Okla-homa Health Sciences Center; 3The University of Minnesota School ofPublic Health; and 4Washington University in St. Louis

Objectives: It remains unclear whether breast milk fructose con-centrations are affected by mother’s intake of fructose during lactation.The primary aim of this study was to determine the acute effects ofconsuming a high-fructose corn syrup (HFCS)–sweetened beverage onchanges in breast milk fructose, glucose, and lactose among lactatingwomen. The secondary aim was to test moderation by prepregnancyobesity status.

Methods: A total of 41 exclusively breastfeeding mothers (54%obese) participated in a crossover study at 6 wk postpartum. Mothersprovided a fasted baseline breast milk sample, and were randomizedto consume either a commercially available HFCS-sweetened beverage(65 g of sugar) or an artificially sweetened control beverage (0 g of sugar)a minimum of 3 d apart. At each session, mothers pumped a completebreast milk expression every hour for 6 consecutive hours. Breast milksugars were measured using LC-MS/MS.

Results: Baseline concentrations of breast milk fructose, glucose,and lactose were 5.0 ± 1.3, 0.6 ± 0.3, and 6.8 ± 1.6 g/dL, respectively.Changes over time in breast milk sugars were significant only forfructose (treatment × time, P < 0.01). Post hoc comparisons showedthat the HFCS-sweetened beverage increased breast milk fructoseconcentrations over control beverage at 120 min (8.8± 2.1 vs. 5.3± 1.9µg/mL), 180 min (9.4 ± 1.9 vs. 5.2 ± 2.2 µg/mL), 240 min (7.8 ± 1.7vs. 5.1 ± 1.9 µg/mL), and 300 min (6.9 ± 1.4 vs. 4.9 ± 1.9 µg/mL) (allP < 0.05). There was no moderation by prepregnancy obesity status.

Conclusions: Our data suggest that consumption of an HFCS-sweetened beverage increased breast milk fructose concentrations,which were sustained up to 5 h postconsumption.

Funding SourcesFunded by the Harold Hamm Diabetes Center, Oklahoma Health

Center Foundation, NIH, Eunice Kennedy Shriver National Instituteof Child Health and Human Development (NIH HD080444), andMetabolomics Facility at Washington University (NIH P30 DK056341)

Lactation Duration and Progression to Type 2 Diabetes amongWomen with a History of Gestational Diabetes (OR36-06)

Sylvia H Ley,1,2 Jorge Chavarro,2 Wei Bao,3 Stefanie Hinkle,4Sjurdur F Olsen,5 Peter Damm,6 James L Mills,4 Frank B Hu,2and Cuilin Zhang4

1Brigham andWomen’s Hospital, MA; 2Harvard THChan School ofPublic Health, MA; 3University of Iowa; 4 ‎Eunice Kennedy Shriver Na-tional Institute of ChildHealth andHumanDevelopment,MD; 5StatensSerum Institut, Denmark; 6University of Copenhagen, Denmark

Objective: Lactation improves short-term glucose metabolism inwomen, but evidence is scarce about its long-term impact on the devel-opment of type 2 diabetes (T2D), especially in high-risk women. Ouraim was to study the association between lactation and long-term riskfor T2D among women with a history of gestational diabetes (GDM).

We hypothesized that a longer duration of total and exclusive lactationwould be beneficial for T2D prevention in these high-risk women.

Methods: We followed 4405 women with a history of GDMparticipating in the Nurses’ Health Study II, a prospective cohort study,from 1991 to 2013. Incident T2D was ascertained through biennialquestionnaires and validated supplementary questionnaires. Lactationhistory was asked in 3 follow-up questionnaires to calculate the lifetimeduration of total and exclusive lactation.

Results: We documented 804 incident cases of T2D over 22 y offollow-up among women with a history of GDM. Longer duration oflactation was associated with a lower risk of T2D for both total (RR:0.71; 95% CI: 0.55, 0.92 for >24 mo vs. none) and exclusive feeding(RR: 0.69; 95% CI: 0.53, 0.90 for >12 mo vs. none) after adjustment forage, race, family history of diabetes, parity, age at first birth, hormonetherapy use, smoking status, alcohol intake, physical activity, anddietaryintake quality. When further adjusted for baseline body mass index(BMI) and updated changes in adulthood BMI across aging, theseassociations become attenuated, and only longer duration of exclusivelactation remained significantly associated with a lower T2D risk (P fortrend = 0.02, across 5 increasing lactation duration categories).

Conclusions: A longer duration of lactation is associated with alower risk for T2D among women with a history of GDM. The long-term beneficial impact of lactation, especially exclusive practices, maypersist in T2D prevention across the lifespan of aging women.

Funding SourcesUM1 CA176726, HHSN275201000020C.

The Impact of Breastfeeding and Gestational Diabetes Mellituson the Prevalence of the Metabolic Syndrome in Offspring ofHispanic Mothers (OR36-07)

Sarvenaz Vandyousefi,1 Erfan Khazaee,1 Matthew J Landry,1Reem Ghaddar,1 Fiona Asigbee,1 Michael Goran,2 EricaGunderson,3 and Jaimie Davis1

1The University of Texas at Austin; 2University of SouthernCalifornia; and 3Kaiser Permanente, CA

Objective: This study aimed to assess the effects of breastfeeding(BF) and gestational diabetes mellitus (GDM) on the prevalence ofthe metabolic syndrome (MetS) in Hispanic children (10–19 y of age).We hypothesized that BF would be linked to decreased MetS risk inoffspring of mothers with and without GDM.

Methods: The data was from a 12-y longitudinal study with 228overweight or obese Hispanic children (10–19 y of age) with a familyhistory of type 2 diabetes and an average of 4 annual visits. Retrospectivedata on GDM status, BF duration, and birth weight were collectedfrom mothers at the baseline visit via a parent questionnaire. Forthis analysis, MetS was defined based on the International DiabetesFederation criteria. The following MetS risk factors were collectedat each annual visit: Tanner stage as gauged by health care providerexamination, weight, height, waist circumference, and blood pressure,with fasting blood draws providing blood glucose, glycated hemoglobin,and lipid panel. Generalized linear models were used to evaluate theeffects of BF, GDM, and BF-GDM interaction on the prevalence ofMetS at the child’s final annual visit with gender, Tanner stage, andbirth weight as covariates. All analyses were performed with SPSSversion 24.


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Results: There was a significant BF-GDM interaction on theprevalence of MetS (β = 1.76; 95% CI: 0.25, 3.27; P = 0.02). Amongchildren born to mothers without GDM, those who were not BFcomparedwith thosewhowere BF had a 7-fold increase in prevalence ofMetS (OR: 7.06; 95%CI: 2.95, 16.91;P< 0.001). AmongGDMoffspring,there was no difference in prevalence of MetS between those BF andthose not BF. However, compared with non-GDM offspring who wereBF, GDMoffspringwhowere BF and not BF had a 5- and 7-fold increasein prevalence ofMetS, respectively (OR: 5.8, 95%CI: 1.8, 18.8; P= 0.003and OR: 7.05; 95% CI: 2.4, 20.1; P < 0.001).

Conclusions: These findings suggest that BF is protective againstthe prevalence of MetS in offspring born to mothers without GDM, butBF does not appear to have the same protective effects in offspring ofmothers with GDM. One potential explanation for this finding is thatthe deleterious effects of GDMmay override the positive benefits of BFon health outcomes in the offspring in this population.

Funding SourcesN/A.

Early Infant Rapid Weight Gain and Odds for Overweight at 1 yof Age Differs in Breastfed versus Formula-Fed Infants (OR36-08)

Jillian Trabulsi,1 Loma Inamdar,2 Virginia Stallings,3 Mia Papas,4and Julie Mennella2

1University of Delaware; 2Monell Chemical Senses Center, PA;3Children’s Hospital of Philadelphia; and 4Christiana Care HealthSystem, DE

Objective: Rapid weight gain (RWG) in infancy is a risk factor forchild and adult obesity. We sought to evaluate early RWG in formula-fed (FF) vs. breastfed (BF) infants and its impact on overweight statusat 12.5 mo.

Methods: Data from 2 studies that followed healthy, term infantsfrom 0.5 to 12.5 mo were combined for this secondary data analysis.One study was comprised 2 groups of exclusively FF infants [cowmilk formula (CMF), n = 59; extensively hydrolyzed formula (EHF),n= 54; total n= 113] and the other of infants who were predominantlybreastfed for at least 4 mo (n = 64), with breastfeeding lasting≥11 mo for the vast majority (92%). Early RWG was defined as achange in weight-for-length z score (WLZ) from birth to 4.5 mo of>0.67 and overweight status at 12.5 mo was defined as an WLZ >85thpercentile (>1.0364 z score). Differences between feeding groups weredetermined by t test for continuous variables and Fisher Exact testsfor categorical variables. Logistic regression was used to compute oddsratios; significance was set at α = 0.05.

Results: The proportion of infants with early RWG differed basedon type of milk (BF: 59%, CMF: 58%, EHF: 20%); for these analysesthe CMF and EHF groups were combined (FF). Among infants withearly RGW, the change in WLZ from birth to 4.5 mo did not differbetween the BF and FF groups (mean ± SD BF: 2.19 ± 0.20, FF:2.01 ± 0.14 WLZ, P = 0.47), but the WLZ change from 4.5 to12.5 mo was significantly higher in FF compared with BF infants (BF:–0.05 ± 0.10, FF: 0.29 ± 0.13, P = 0.04). At 12.5 mo, the early RWG FFinfants had significantly greater WLZ (FF: 1.09 ± 1.02, BF: 0.52 ± 0.76,P = 0.01), and had higher odds for overweight at 12.5 mo whencompared with early RWG BF infants.

Conclusions: The impact of early RWG on weight status at 12.5 moold differed based on the type of milk fed during the first year of life.Compared with FF infants, the WLZ of BF infants with early RWG didnot increase in the latter half of infancy, resulting in lower odds foroverweight at 1 y.

Funding SourcesThis research was supported by NIH Grants HD072307 and

HD37119.

Mothers versus Fathers: Parents’ Perspectives on Infant FeedingStyles and Responsibilities (P13-001)

Elizabeth Adams and Jennifer Savage

Penn State University, PA

Objective: Parent feeding styles shape children’s early experiencewith food, having a profound impact on child growth; yet this research isalmost exclusively based on research with mothers. The purpose of thisexploratory analysis was to compare mothers and fathers’ perception ofinfant feeding responsibilities and their infant feeding style.

Methods: Mother-father dyads (n = 21) independently completedthe Infant Feeding Style Questionnaire (IFSQ) and Who Does What(WDW) Questionnaire when their infants were 24 wk of age. IFSQsubscales included pressure to 1) finish food, 2) use cereal, and 3) usefood to soothe. The WDW Questionnaire determined mothers’ andfathers’ perception of current infant feeding responsibilities. For thispilot study, significance was set at P < 0.1.

Results: For deciding infants’ feeding schedule, 50% of mothersreported sole responsibility, whereas only 25% of fathers reportedmothers solely decided. Almost half (47%) of fathers wanted moreresponsibility in deciding infants’ feeding schedule, whereas 30% ofmothers wanted fathers to havemore responsibility. For infant feedings,20% of mothers reported exclusively feeding infants, but only 10% offathers reported mothers exclusively fed their infant. More than half(60%) of fathers wanted to do more infant feedings. Similarly, 60% ofmothers want fathers to do more infant feedings. Mothers’ and fathers’responses on pressure using cereal (r = 0.39, P = 0.09) and food tosoothe (r = 0.41, P = 0.07), but not pressure to finish (P > 0.1), werepositively correlated.

Conclusions: Fathers report wanting more infant feeding respon-sibilities, which mothers also reported wanting for fathers. Futureresearch should explore specific barriers to father involvement withinfant feeding. In addition, mothers and fathers appear consistent withinfant feeding styles of pressure using cereal and food to soothe, but notto finish food. Intervention messaging should consider delivery to bothmothers and fathers to promote feeding style consistency.

Funding SourcesUSDA Childhood Obesity Prevention Training Program SEED

Grant.

Long-Term Effect of Low Birthweight on Cognitive Developmentof School-Age Children in Lombok, Indonesia (P13-002)

Siti Robiatul Adawiyah,1 Elizabeth Prado,2 Anuraj H Shankar,3Mandri Apriatni,1 Nina Hidayati,1 Ayuniarti Islamiyah,1Sudirman Siddiq,1 Susy K Sebayang,1 Michael Ullman,4Katherine Alcock,5 Husni Muadz,6 and Benyamin Harefa1


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1SUMMIT Institute of Development, Indonesia; 2University ofCalifornia, Davis; 3Harvard TH Chan School of Public Health, MA;4Georgetown University, DC; 5Lancaster University, United Kingdom;and 6University of Mataram, Indonesia

Objective: This study aims to examine the association of birth-weight, small for gestational age (SGA), and preterm birth with cog-nitive and socioemotional ability of children aged 9–12 y in Indonesia.

Methods: We did a follow-up study of the Supplementation withMultipleMicronutrients Intervention Trial (SUMMIT), a double-blind,cluster-randomized trial of maternal supplementation with multiplemicronutrients or iron and folic acid in Indonesia. Of 27,356 live infantsin 2001–2004, we re-enrolled 19,274 (70%) children at age 9–12 y,and randomly selected 2879 for detailed cognitive and developmentalassessment. To examine the impact of low birth weight, SGA, andpreterm birth on cognitive and developmental outcomes, we usedmixed effects models to control for supplementation, randomizationcluster, and assessor bias. Other covariates includedmaternal educationand depression, child age at the time of assessment, gender, HomeObservation for Measurement of the Environment (HOME) inventoryscore, child’s postnatal growth, and gestational age at birth. Outcomesincluded motor development, general intelligence, declarative memory,executive function, procedural memory, academic achievement, andsocioemotional status.

Results: Children born with low birth weight scored 0.19 SD lowerin academic achievement than normal birthweight children (P = 0.01),but did not score significantly lower in other assessments. SGA was as-sociated with lower general intelligence (estimate= 0.13, P= 0.03) andexecutive function (estimate= 0.12, P= 0.05). Examination of relationsalong the continuous distribution of birthweight revealed a nonlinearrelation, with stronger associations with academic achievement andgeneral intelligence between 2500 and 3500 g and no associations from3500 to 4500 g. Preterm birth did not show any significant associationwith any of the cognitive or developmental domains.

Conclusions: After adjustment with multiple known predictorsof cognition, birth weight retained a persistent effect on cognitiveand developmental outcomes. This relation was strongest along thecontinuum from 2500 to 3500 g. These data suggest that interventionsresulting in even modest improvements in birth weight are likely toenhance multiple cognitive and developmental domains.

Funding SourcesSupport for the follow-up re-enrolment project was provided by a

grant awarded to the Summit Institute of Development from the GrandChallenges Canada Saving Brains Program (grant #0067-03), withadditional funding provided by the Summit Institute of Development.The SUMMIT studywas supported by theTurner Foundation,UNICEF,the Centre for Health and Human Development, and the United StatesAgency for International Development-Indonesia (grant #497-G-00-01-00001-00).

Evaluation of an Enteral Complex Lipid Emulsion to PreventFatty Acid Deficits in Preterm Infants with the Use of a PretermPiglet Model (P13-003)

Olajumoke Akinsulire,1 George Perides,2 Lorenzo Anez-Bustillos,3 Xinting Yu,2 Arthur Nedder,4 Elizabeth Pollack,4

Joanne Brown,2 Lady Leidy Sanchez-Fernandez,2 EvelynObregon,2 Ece Bicak,2 Mustafa Vurma,5 Stefan Ehling,5 DouglasGordon,5 Stephen DeMichele,5 Steven D Freedman,2 andCamilia R Martin2

1Brown Alpert Medical School, RI; 2Beth Israel Deaconess MedicalCenter, MA; 3Boston Children’s Hospital, MA; 4Boston Children’sHospital ARCH, MA; 5Research and Development, Abbott Nutrition,Abbott Laboratories

Objective:Docosahexaenoic acid (DHA) and arachidonic acid (AA)decline in preterm infants within the first postnatal week with thecurrent standard of nutritional care. These changes are linked to anincreased risk of neonatal morbidities. Our objective was to determinethe efficacy of early enteral supplementation of a concentrated lipidemulsion (CLE) containing DHA, AA, and specific lipophilic nutrients(lutein, vitamins E and D) in maintaining birth plasma and tissueconcentrations of these nutrients.

Methods: Preterm piglets (gestation ∼107 d) were randomized atbirth to receive either a “control” diet (Sow formula + soybean oilemulsion, n = 6) or a “supplemented” diet (Sow formula + CLE,n = 7) during an 8-d feeding protocol. Five piglets were killed at birthto establish baseline concentrations of fatty acids (FAs), lutein, andvitamins E and D. Blood samples were collected on days 2, 4, 6, and8 to quantify FA changes as a function of diet. On day 8, tissues werecollected for FA and lipophilic nutrient analyses.

Results: Mean baseline plasma DHA concentrations at birth weresimilar in the control and supplemented groups (2.6± 0.6 and 2.8± 0.8mol%, respectively). By day 2, the supplemented group maintainedplasma DHA concentrations, whereas the control piglets experienceda DHA deficit compared with baseline (3.9 ± 0.6 vs. 1.2 ± 0.1 mol%,respectively; P = 0.00001). Differences in DHA between groupsremained throughout the 8-d feeding protocol. In contrast, both groupsdemonstrated a decline in AA from birth, though the supplementedgroup had slightly higher concentrations (9.5 ± 1 vs. 8.3 ± 0.6mol%, respectively; P = 0.047). Similar changes in DHA and AAconcentrations between groups were shown in brain and ileum. Luteinand vitamins E and D showed higher increases from baseline in plasmaand tissues of the supplemented piglets compared with controls; luteinincreased significantly in eye, liver, lung, ileum, and colon; vitamin Eincreased in plasma, proximal ileum, and frontal cortex; and vitaminD3 increased in plasma, proximal ileum, liver, and lung.

Conclusions: Early enteral delivery of CLE was well tolerated inpreterm piglets and minimized the postnatal deficiencies of systemicDHA. Significant accretion of DHA, lutein, and vitamins E and D inplasma and in important tissues was also demonstrated.

Funding SourcesAbbott Nutrition, Harvard Catalyst | The Harvard Clinical and

Translational Science Center (National Center for Research Resourcesand the National Center for Advancing Translational Sciences, NIHAward UL1 TR001102), and financial contributions from HarvardUniversity and its affiliated academic health care centers. Also fundedby Charles H and Judy Hood Family Infant Health Research ProgramNIH R01 DK104346.


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Exclusive Breastfeeding Knowledge, Attitude, Feeding Practicesand Their Effect on Anthropometric Indices of Young ChildrenAttending a Nigerian Teaching Hospital (P13-004)

Nkiru Oly Alawuba,1 Joy AC Amadi,1 and Jacinta Elo-Ilo2

1Imo State University, Nigeria; and 3Nnamdi Azikiwe University,Nigeria

Objective: The study determined mothers’ breastfeeding knowl-edge, attitude, and feeding practices, and their effect on anthropometricindices of young children.

Methodology: A cross-sectional survey using simple randomsampling was adopted in selecting 500 children (0–2 y old) whoattended an immunization programme at a teaching hospital locatedin Southeast Nigeria for a period of 6 mo. A structured and pretestedquestionnaire was used in collecting information on socioeconomiccharacteristics, feeding practices, knowledge of exclusive breastfeeding(EBF), EBF attitude, prelacteal feed practices, and young child feedingpractices till 2 y of age. Anthropometric measurements, includingweight, length, chest, and head circumference, were assessed usingstandard methods. The data were analyzed using Pearson correlationand chi-square tests. Statistical significance was set at P < 0.05.

Results: More than half (54.3%) of the children were aged 0–6 mo, 7–12 mo (9.8%), 13–18 mo (29.2%), and 19–24 mo (6.8%).Over half (54%) of the children were males. The study observed poorknowledge of EBF in 31.4%, whereas 68.6% showed good knowledgeof EBF. A poor attitude toward EBF was seen in 38.0% of the subjects,and the prevalence of poor EBF practices was 47.8%. Prelacteal feedsgiven included plain water (28.8%), glucose water (33.8%), honey(2.2%), herbal tea (1.6%), and infant formula (3.4%), and 30.2% didnot practice prelacteal feeding. The anthropometric indices showed ahigh prevalence of malnutrition, with stunting (42.2%), underweight(23.2%), wasting (11.4%), and overweight (20%). All the childrenhad normal head and chest circumferences. The association betweenEBF knowledge, EBF attitude, feeding practices, prelacteal feeds,and anthropometric measurements showed a significant difference(P < 0.05).

Conclusions: This study observed a high rate of poor EBFknowledge, attitude, and feeding practices among mothers, whichresulted in a poor nutritional status of their children.

A Retrospective Look at Milk Laboratory Data for the Purposeof Identifying Future Avenues for Data Collection and Research(P13-005)

Christi Arthur,1 Josh Phelps,2 Tina Crook,2 and Reza Hakkak2

1University of Arkansas forMedical Sciences; and 2College ofHealthProfessions, University of Arkansas for Medical Sciences

Objective: Preterm newborns, born at a gestational age (GA) of≤32 wk, are at increased risk for multiple comorbidities owing toimmature cardiac, respiratory, renal, and gastrointestinal systems.Better postnatal growth in preterm newborns is achieved whenusing mother’s own milk (MOM). When MOM is unattainable orcontraindicated, pasteurized donor breast milk (DBM) is available as asubstitute. Because the use of DBMwithin neonatal intensive care unitsis relatively new, the objective of this investigationwas to explore currentfeeds and growth data to inform a process of future data collection.

Method: Deidentified data from 61 extremely low birth weight(ELBW), very low birth weight (VLBW) and micro preemie pretermnewbornswere explored via retrospective descriptive analysis. Variablesof interest were body weight, GA, time of initiation and extent on DBM,and weight gain.

Results: The goal feeds volume was determined to be 140–170 mL ·kg–1 · d–1 and the goal weight gain was 15–20 g · kg–1 · d–1 on average.Themicro preemie group received feeds at goal volume 34% of the timeand met the weight gain goal 30% of the time over 11 wk. The weeks ofbest weight gain matched the weeks when the highest volume of feedswas received. TheELBWgroup averaged feeds at goal volume 70%of thetime and met the weight gain goal 34% of the time over 8 wk. The bestweeks of weight gain did not match the period when the highest volumeof feeds was received. This outcomemay be related to advancing towardgoal volume for feeds without fortifying to meet the goal calories perounce of feeds. The VLBW group averaged feeds at goal volume 56% ofthe time andmet the weight gain goal 21% of the time over 7 wk. Again,this outcomemay be related to advancing to goal volume of feeds beforefortification.

Conclusions: The number of days on DBM and the timing of DBMinitiation for feeds do not appear to affect the weight gain of neonates.The micro preemie group received the most consistent amount of feedsvolume corresponding with amount of weight gain, which may bebecause of stricter adherence to feeding guidelines. A standardized datacollection tool and protocol are needed for accuratemonitoring of feedsand growth parameters. Electronic medical records (EMR) can be usedif standardized charting is instituted.

Funding SourcesNo funding was received for this research.

Adequacy of Iron Intakes and Sociodemographic Factors Associ-ated with Iron Intakes of Australian Preschoolers (P13-006)

Linda A Atkins, Sarah McNaughton, Alison C Spence, and EwaA Szymlek-Gay

Institute for Physical Activity and Nutrition (IPAN), DeakinUniversity, Australia

Objective: The aim of this study was to estimate the prevalenceof inadequate iron intakes and identify sociodemographic factorsassociated with iron intakes of Australian children aged 2–5 y.

Methods: Data from the 2011–12 National Nutrition and PhysicalActivity Survey component of the Australian Health Survey wereanalyzed [n = 783, 2 to sociodemographic factors (age and sex ofchild; and adult pair’s country of birth, education level, employmentstatus, area-level disadvantage quintile, food security status, householdtype, and household size], and iron intakes were assessed via linearregression, accounting for the complex survey design.

Results: Mean ± SD iron intakes for preschoolers were 7.9 ±1.9mg/d and the prevalence of inadequate iron intake for this age groupwas 10.1% (95% CI: 7.9%, 12.1%). Male sex (mean difference betweenboys and girls: –0.22 mg/d; 95% CI: –0.03, –0.41 mg/d; P = 0.022)and age (each additional year was associated with 0.11 mg/d lower ironintake; 95%CI: –0.22, –0.00mg/d;P= 0.048)were negatively associatedwith preschooler iron intakes.

Conclusions: Preschooler energy-adjusted iron intakes were greaterfor females than for males. Poor iron intakes continue to be a


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problem for some children beyond the second year of life asiron intakes were inadequate for 10% of Australian preschoolers.Intervention strategies aiming to improve iron intakes in Australianpreschoolers, with emphasis for boys and older children, should beconsidered.

Funding SourcesSAM is supported by an NHMRC Career Development Fellowship

Level 2 (ID1104636).

Multiple Contacts with Frontline Workers during the Pre- andPostnatal Periods are Associated with Better Infant and YoungChildFeeding in India: Evidence for Additive Effects (P13-007)

Rasmi Avula,1 Sneha Mani,1 Phuong H Nguyen,1 LakshmiGopalakrishnan,2 Sumeet Patil,2 Nadia Diamond-Smith,3 LiaFernald,4 Dilys Walker,3 and Purnima Menon1

1International Food Policy Research Institute; 2NEERMAN;3University of California, San Francisco; and 4University of California,Berkeley

Objective: Contact with frontline workers (FLW) and communityevents provide opportunities for women to receive information andsupport for appropriate infant and young child feeding (IYCF) practices.In India, government FLW are expected to meet with women duringthe first 1000 d at home, at a health center, or at community eventsto provide information and services. Our aim was to examine theassociation of women’s contacts with multiple FLWs and participationin community events during the pre- and postnatal period (up to 24mo)on IYCF practices [early initiation of breastfeeding (EIBF), exclusivebreastfeeding (EBF), and minimum diet diversity (MDD)].

Methods:Data are from a cross-sectional survey of 3387 householdswith children 0–23 mo in 12 districts in Madhya Pradesh and Bihar.To examine associations between multiple contacts with FLW andIYCF practices, we conducted multiple regression analyses, adjustingfor child, maternal, and household characteristics, and accounting forsample clustering. We defined contacts with FLWs as an interactionwhere women received IYCF messages at a home visit, a health center,or a community event.

Results:While 74%ofwomen reportedEIBF and 52%EBF, only 16%reported MDD. Contacts during pregnancy ranged from 0 to 4 (mean1.1), and postpartum from 0 to 3 for breastfeeding (BF) (mean 0.5) andfrom 0 to 2 for complementary feeding (CF) (mean 0.4). Only 8% ofwomen had 3 or more contacts for BF and 9% had 2 contacts for CF.Compared with no contacts, women exposed to one contact were morelikely to initiate BF early (OR: 1.3, P < 0.05), but not to exclusivelybreastfeed. Women exposed to 3 or more contacts during pregnancywere thrice as likely to initiate BF early (P< 0.0001) and nearly twice aslikely to exclusively breastfeed (P < 0.05) compared with no contacts.Postpartum contacts were only weakly associated with MDD (OR: 1.4,P < 0.08).

Conclusions: Multiple contacts during pregnancy are stronglyassociated with BF practices, whereas postpartum contacts have aweaker association with MDD. Given the current low level of contacts,strengthening the existing contact opportunities in the Indian programsis key to improving IYCF practices. The weak association between

postpartum contacts and CF needs further investigation to assess theroles of frequency, timing, quality, and other determinants.

Funding SourcesBill & Melinda Gates Foundation, via grants to IFPRI and UCSF.

Associations ofMaternal Resources for Care on Infant andYoungChild Feeding Practices Depends on the Types of Resources andFeeding Practices (P13-008)

Sulochana Basnet,1 Edward Frongillo,1 Phuong H Nguyen,2 andSpencer Moore1

1University of South Carolina; and 2International Food PolicyResearch Institute

Objectives: This paper aimed to examine the associations ofmaternal resources for care with infant and young child feeding (IYCF)practices, and to investigate if the associations differ by the types ofresources and IYCF practices.

Methods: This cross-sectional study is based on the baselineAlive & Thrive household survey collected in 2010 in Bangladesh.Maternal education, nutrition and hygiene knowledge, height, bodymass index (BMI), mental well-being, financial autonomy, decision-making autonomy, employment status, support in chores, and perceivedsupport were themeasures of resources for care. Exclusive breastfeeding(EBF), minimummeal frequency, and dietary diversity score (range: 0–7) were the measures of IYCF practices. Multiple regression analyseswere performed to examine the influence of each measure of theresources for care on EBF (n = 977 children <6 mo old) andcomplementary feeding (n = 1211 children 6–23.9 mo old). Themodels were adjusted for child age and gender, father’s occupation,household wealth, and number of children <5 y old in the household.We accounted for geographic clustering using primary sampling unitsas random effects.

Results: About half (49.9%) were exclusively breastfed and 40.0%and 31.1% met minimum meal frequency and dietary diversity,respectively. Mean dietary diversity was 2.85. Infants of mothers with1 SD higher knowledge and mental well-being were 1.20 times morelikely to be exclusively breastfed. Infants of well-nourished motherswere more likely to be exclusively breastfed than those of underweightmothers (OR: 1.59, P < 0.05). Children of employed mothers weremore likely to meet the minimummeal frequency (OR: 1.85, P< 0.05).Education (middle school: b = 0.22, P < 0.05; high school: b = 0.43,P < 0.05), knowledge (b = 0.18, P < 0.001), and support in chores(b = 0.10, P < 0.05) were positively associated with dietary diversity.

Conclusions: Knowledge, education, BMI, employment status,mental well-being, and support in chores were associated with IYCFpractices. Some resources for care did not influence any IYCF practice,and some associations differed with IYCF practices. Strengtheningmaternal resources for care is essential to improve IYCF practices andshould be considered when designing programs.

Funding SourcesFunded by the Bill & Melinda Gates Foundation and the govern-

ments of Canada and Ireland through Alive & Thrive, managed by FHI360, and the Patrice L Engle Dissertation Grant in Global Early ChildDevelopment.


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ENRICH: Using Integrated Knowledge Translation ApproachesinMultiple Settings to PromoteHealthy Eating andHealthyWeightsin Pregnancy and Postpartum (P13-009)

Rhonda C Bell,1 Paula Robson,2 Maria Mayan,1 Richard Oster,1Linda J McCargar,1 Megan Jarman,1 Yan Yuan,1 Terri Miller,2Jocelyn Graham,2 Maira Quintanilha,1 Sandra Ngo,1 DraganaMisita,1 Grant Bruno,1 and the ENRICH Study Team1

1University of Alberta, Canada; and 2Alberta Health Services,Canada

Objective: Effective strategies promoting appropriate body weightsand healthy diets for pregnant and postpartumwomen are needed. Fea-sible, sustainable strategies should be informed by: knowledge of the de-terminants of healthy weights and nutrition in pregnancy and postpar-tum; greater insight into perceptions and experiences of diverse groupsof women and health care providers (HCP); and knowledge of opportu-nities to integrate innovative approaches in health care and community-based organizations (CBO). The ENRICH research program used aninterdisciplinary, multisectoral, integrated knowledge translation (iKT)approach to promote maternal health in Alberta, Canada.

Methods: A combination of studies were completed: epidemiologicand clinical studies; mixed methods studies with women and HCP inpartnership with health service providers; qualitative and quantitativestudies with CBO staff and migrant/refugee women; and qualitativestudies with indigenous elders, women, and fathers in partnership withtheir communities.

Results: Women’s diets during pregnancy aligned poorly withCanada’s Food Guide, ∼50% of women exceeded gestational weightgain guidelines starting early in pregnancy, and HCP practices did notadequately support women in meeting dietary and weight gain goals.New and revised resources were developed for women, as were noveltraining programs for HCP. Focus groups and surveys with women andinterviews with CBO staff highlighted the complex pathways navigatedby vulnerable women and the CBO in support of maternal health andfood security. Strategies using food as a gateway to improve family foodsecurity allowed CBO staff to begin codeveloping a microenterprisewith women to build business-related skills and begin to improvetheir economic conditions. Guidance from indigenous elders andpartnership with border town HCP extended antenatal care to includementoring by elders and learning activities for HCP that have increasedcultural awareness and security.

Conclusions: An iKT approach focused research on advancingknowledge and implementing feasible, sustainable, and novel strategiesbased on the needs of women and their communities. Evaluationis underway to determine the impact on health in pregnancy andpostpartum, as well as the potential for spread and scale-up.

Funding SourcesAlberta Innovates (CRIO Program Grant), Canadian Institutes of

Health Research.

Associations between Momentary Parental Stress and DepressedMood and Food-Related Parenting Practices atMeals: An EcologicalMomentary Assessment Study (P13-011)

Jerica M Berge and Amanda Trofholz

University of Minnesota

Objective: Research suggests that stress and depressed mood areassociated with food-related parenting practices (i.e., parent feedingpractices, types of food served at meals). However, current mea-sures of parental stress, depressed mood, and food-related parentingpractices are typically survey-based and assessed as static/unchangingcharacteristics, failing to account for fluctuations across time andcontext. Identifying momentary factors that influence parent food-related parenting practices will facilitate the development of effectiveinterventions aimed at promoting healthy food-related parentingpractices. The current study uses ecologic momentary assessment(EMA) to examine the association between momentary factors (e.g.,stress, depressed mood) occurring early in the day and food-relatedparenting practices (e.g., feeding practices, serving healthy foods) at thedinner meal the same evening.

Methods: Children aged 5–7 y and their primary caregiver(n = 150) from low-income and minority households (i.e., AfricanAmerican, Hispanic, Hmong, Native American, Somali, white fam-ilies) were recruited to participate in this mixed-methods studythrough primary care clinics in Minneapolis and St. Paul, MN. In-home visits were conducted with parent-child dyads. EMA datawas collected using parent’s smartphones multiple times throughoutthe day.

Results: Higher stress and depressed mood earlier in the daypredicted more pressure-to-eat feeding practices and less homemadefoods served at meals the same night. Effect modification was foundfor certain racial/ethnic groups with regard to engaging in pressure-to-eat feeding (i.e., Native American, Somali) practices or serving lesshomemade meals (i.e., African American, Hispanic) in the face of highstress or depressed mood.

Conclusions: Dietitians and other professionals that work withparents and children may want to consider discussing with parentsthe influence stress and depressed mood can have on everyday food-related parenting practices. Additionally, future research and interven-tions should consider using real-time interventions, such as ecologicmomentary intervention, to reduce parental stress and depressedmoodto promote healthy parent food-related parenting practices on a day-to-day basis.

Funding SourcesNIH.

Challenges to Measuring Infant Breast Milk Intake from Mater-nal Reports (P13-012)

Lauren T Berube,1 Rachel Gross,2 Kathleen Woolf,3 MichelleKatzow,2 Andrea Deierlein,4 and Mary Jo Messito2

1New York University; 2New York University School of Medicine;3New York University Steinhardt; and 4New York University College ofGlobal Public Health

Objective: Measuring milk intake by breastfed (BF) infants ischallenging as the amount of milk consumed at the breast is unknown.Dietary assessment instruments that rely on maternal report are oftenused to quantify breast milk (BM) volume. Currently, 2 standardcalculations are used by researchers to estimate BM volume in younginfants, which can be valuable in describing energy intake of BF infants.The first (C1) assumes a total daily volume for BF infants and subtractsother milk amounts. The second (C2) assumes separate volumes for


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each BM feeding and adds other milk amounts. These calculations arecontradictory and may result in different estimated BM volumes. Theobjective of this research was to examine BM and total milk volumeusing 2BMvolume calculations in a group of infants at risk of childhoodobesity.

Methods: Data were from low-income Hispanic women and their3-mo-old infants (50% female) enrolled in Starting Early, a randomizedcontrolled trial of a primary care–based child obesity preventionprogram. BM and total milk volumes were estimated from multiple-pass 24-h recalls.We followed published guidelines to estimate volumesfor each calculation. For C1, we assumed exclusively BF (EBF) infantsconsumed 780 mL BM/d. For partially BF (PBF) infants, we subtractedother milk (i.e., formula or expressed BM) from 780 mL. If other milkexceeded 780 mL, we calculated 3 fl oz for each BM feeding. For C2,we assumed infants consumed 125 mL for each BM feeding lasting≥10 min. For feedings

Results: Complete dietary data were available for 454 infants(170 EBF, 194 PBF, 90 exclusively bottle fed). C1 estimated a smallervolume of total milk than C2 in all infants (C1: 826 ± 145 mL vs.C2: 1024 ± 248 mL, P < 0.001). In addition, C1 estimated a smallervolume of BM than C2 for EBF (C1: 780 ± 0 mL vs. C2: 1059 ± 253mL, P < 0.001) and PBF (C1: 454 ± 211 mL vs. C2: 673 ± 305 mL,P < 0.001) infants.

Conclusions: Standard calculations to quantify BM volume from24-h recall produce different estimates among infants at risk ofchildhood obesity. Future studies are needed to validate which calcu-lation more accurately estimates BM volume in young infants.

Funding SourcesFunded by the Agriculture and Food Research Initiative (AFRI)

Childhood Obesity Prevention: Integrated Research, Education, andExtension to Prevent Childhood Obesity program A2101, Grant No.2011-68,001-30,207.

Serum Vitamin D Binding Protein and Free 25-HydroxyvitaminD Concentrations in a Multiracial Cohort of Pregnant Adolescents(P13-013)

Cora M Best,1 Eva Pressman,2 Ruth Anne Queenan,2 ElizabethCooper,2 and Kimberly O O’Brien1

1Cornell University, NY; and 2University of Rochester School ofMedicine and Dentistry, NY

Objectives: According to the free hormone hypothesis, thenonprotein-bound (i.e., free) 25-hydroxyvitaminD [25(OH)D] concen-tration in serum may best indicate vitamin D status, especially whenserumvitaminDbinding protein (DBP) concentration is altered. SerumDBP concentration doubles in pregnancy, but no prior longitudinalstudy has directlymeasured serum free 25(OH)D throughout gestation.Our objectives were to assess how serum DBP or free 25(OH)Dconcentration may vary by gestational age or race, and to determine iffree 25(OH)D better predicts parathyroid hormone (PTH) in pregnantadolescents than total 25(OH)D.

Methods: This was a substudy of a cholecalciferol (D3) supplemen-tation trial set in Rochester, NY (latitude 43°N). Pregnant adolescentsreceived 200 or 2000 IU D3/d. Blood was collected at study entry[18 ± 4 wk gestation (mean ± SD)] and at delivery (40 ± 2 wk).We measured serum free 25(OH)D, DBP, and PTH by immunoassays,and total 25(OH)D and other vitamin D metabolites by LC-MS/MS.Ordinary least squares andmixedmodels were used to analyze the data.

Results: The sample was n = 58 adolescents, aged 17 ± 1 y, 53%African American (AA) and 47% white/other race. Supplement adher-ence was low in both arms, and mean total 25(OH)D concentrationdid not change significantly between entry [27 ± 1.4 (mean ± SE)ng/mL] and delivery (28 ± 1.4 ng/mL). Mean DBP concentration(570 ± 11 mg/L) was above nonpregnant reference values at entryand increased over time (P < 0.001) to 611 ± 11 mg/L. Mean free25(OH)D was 4.3 ± 0.2 pg/mL at both time points. Total and free25(OH)D were highly correlated (r = 0.8, P < 0.0001). Holding total25(OH)D constant, DBP had a weak effect on free 25(OH)D (β =–0.004, P < 0.01) that did not differ by time point. At delivery, PTHwas inversely correlated with both total 25(OH)D (r = –0.27) andfree 25(OH)D (r = –0.24). AAs had lower total (P < 0.0001) and free(P= 0.09) 25(OH)D, whereas DBP did not differ by race. For any giventotal 25(OH)D, however, free 25(OH)D was 0.6 pg/mL higher in AAs.

Conclusions: Despite high serum DBP concentrations in pregnantadolescents, directly measured free 25(OH)D did not better predictPTH any better than total 25(OH)D. DBP concentration was similarbetween races, but our results suggest that there are small racialdifferences in the percentage of free 25(OH)D, perhaps owing to DBP(GC) genotype.

Funding SourcesSupported by USDA award 2011-0,3424 and NIH award T32-

DK007158.


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Determinants of Early Breastfeeding Practices among Childrenunder 12 mo in Nepal (P13-014)

Shiva Bhandari,1 Andrew Thorne-Lyman,2 Binod Shrestha,3Sumanta Neupane,3 Bareng AS Nonyane,2 Swetha Manohar,2Rolf DW Klemm,2 and Keth P West2

1University of South Carolina; 2Johns Hopkins Bloomberg Schoolof Public Health, MD; and 3Nutrition Innovation Lab, Johns HopkinsUniversity, MD

Objectives: The aim of this study was to identify determinants ofoptimal early breastfeeding practices in a national sample of householdswith preschool-aged children in Nepal.

Methods: Breastfeeding practices were explored in 1011 infants<12 mo of age, by retrospective parental interview during a nationallyrepresentative, cross-sectional study in 21 district sites across themountains, hills and terai (southern plains) of Nepal in 2013 (PoSHANCommunity Studies). Dichotomous outcomes included breastfeedingwithin 1 h of birth, receipt of colostrum, feeding prelacteals, andpredominant breastfeeding through 6 mo of age. Adjusted prevalenceratios (APRs) and 95% CIs were estimated using log Poisson regressionmodels with robust variance. Risk factors assessed during the surveywere also explored for each outcome.

Results: The proportion of infants breastfed within 1 h of birth,fed colostrum, fed prelacteals, and predominantly breastfed were 42%,83%, 33%, and 57%, respectively. Infants who received prelacteals wereless likely to be breastfed within 1 h of birth (APR: 0.49; 95% CI: 0.36,0.65) or predominantly breastfed through 6 mo of age (APR: 0.45; 95%CI: 0.32, 0.63) than infants not given prelacteals. Infants fed colostrumwere 25% more likely to be breastfed within 1 h of birth (APR: 1.25;95% CI: 1.02, 1.52). Children born to older mothers were less likely toinitiate breastfeeding within 1 h of birth than teenage mothers. Infantsin the terai were 10% less likely to receive colostrum (APR: 0.90; 95%CI: 0.83, 0.97) and 2.72 times more likely to receive prelacteal feeds(APR: 2.72; 95% CI: 1.67, 4.45) than those in the mountain region.Womenwho reported>1 antenatal care (ANC) visit weremore likely topredominantly breastfeed (APR: 1.27; 95% CI: 1.07, 1.50) than womenwith no ANC visit.

Conclusions: Most infants in Nepal are fed colostrum. However,breastfeeding practices are not optimal, with less than half of infantsbeing breastfed within 1 h of birth and one-third being fed prelacteals,a dominant practice in the terai that negatively affects breastfeedingthroughout early infancy. Antenatal care may help prepare mothers tobreastfeed their infants.

Funding SourcesSupported by the USAID Feed the Future Nutrition Innovation Lab,

US Agency for International Development (USAID), Washington DC,under Cooperative Agreement AID-OAA-L-10-00005.

Effect of Prenatal Vitamin D Supplementation on Cord BloodInsulin-Like Growth Factor Markers in Dhaka, Bangladesh(P13-015)

Monika Bilic,1 Huma Qamar,2 Akpevwe Onoyovwi,1 JillKorsiak,1 Eszter Papp,1 Abdullah Al Mahmud,3 RosannaWeksberg,1 Alison D Gernand,4 Jennifer Harrington,1 andDaniel E Roth1

1The Hospital for Sick Children, Canada; 2University of Toronto,Canada; 3International Centre for Diarrhoeal Disease Research,Bangladesh; and 4Pennsylvania State University

Objectives: The primary objective was to determine the effects ofprenatal vitamin D supplementation on the insulin-like growth factor(IGF) axis of infants at birth in Dhaka, Bangladesh, a region with a highprevalence of childhood stunting and maternal vitamin D deficiency.Secondary objectives were to compare IGF-I concentrations in thisnewborn population with those from reference populations in higherresource settings, and to estimate associations between plasma IGFconcentrations and newborn size.

Methods: This was a substudy of the Maternal Vitamin D forInfant Growth (MDIG) trial, a randomized controlled trial in whichpregnant women received weekly vitamin D supplementation (4200,16,800, or 28,000 IU/wk, or placebo) from gestation weeks 17–24 untilbirth. Plasma IGF-I, IGF-II, insulin-like growth factor-binding protein(IGFBP)-1, and IGFBP-3 were quantified in 559 venous umbilicalcord samples, and values in each treatment group were compared


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with placebo. IGF-I concentrations were compared with a publishedreference range to determine the proportion of the population belowthe lower bound of the reference range. Associations between IGFprotein concentrations and birth anthropometry [length-for-agez scores (LAZ), weight-for-age z scores (WAZ), and headcircumference-for-age z scores (HCAZ)] were assessed.

Results: There was a mean difference of 0.95 ng/mL in IGF-Iconcentrations between the highest dose supplementation group andthe placebo group (95% CI: –3.66, 5.55; P = 0.69). There were nosignificant differences in cord blood concentrations of IGF-I, IGF-II, IGFBP-1, or IGFBP-3 between each treatment group and placebofollowing adjustment for multiple comparisons. For IGF-I, 6% of girlsand 23%of boys were below the 2.5th percentile of a published referencerange. IGF-I was positively associated with each measure of size at birth(LAZ, HCAZ, and WAZ); for example, a 10 ng/mL increase in IGF-Icorresponded to a 0.13 SD increase in LAZ at birth (95% CI: 0.09, 0.17;P < 0.001).

Conclusions: These results do not support the use of prenatalvitamin D supplementation to alter or enhance the IGF axis in thefetus andnewborn.Causes of relatively low IGF-I concentrations amongnewborns in Dhaka have yet to be established.

Funding SourcesThis study was funded by the Bill & Melinda Gates Foundation.

Effects of Milk Fat Globule Membrane and Its Various Compo-nents on Neurologic Development in a Rat Pup SupplementationModel (P13-016)

Lauren R Brink and Bo Lonnerdal

University of California Davis

Objective: Milk fat globule membrane (MFGM) is a componentof breast milk that consists of glycosylated membrane-bound proteinsoriginating from the mammary gland plasma membrane. Additionally,it contains a variety of polar lipids and carbohydrate moieties. A com-mercially available MFGM fraction added to infant formula has beenshown to improve cognitive development in infants at 12 mo of age.Considering that MFGM is a complex mixture, our aim was to deter-mine which component(s) may be leading to these cognitive outcomes.

Methods: Using a postnatal growth restriction rodent model, ratpups were supplemented with 1 of 5 treatments: 1) MFGM, 2) aphospholipid concentrate (PL), 3) sialic acid (Sia) at 200 mg/kg bodyweight (BW) (Sia100), 4) Sia at 2 mg/kg BW, and 5) nonfat milk ascontrol. Pups were randomized, cross-fostered into litters of 17 pupsper dam, and supplemented from postnatal day (PD) 2 to PD 21,at which point they were weaned. Behavioral tests were performedbeginning on PD49 using T-Maze Spontaneous Alternation and NovelObject Recognition. Tissueswere collected, and brain hippocampuswasisolated at PD 14 and PD 21. The expression of 4 genes was measured:those coding for brain-derived neurotropic factor (BDNF), dopaminereceptor 1, (DRD1), glutamate receptor (GluR-1), and ST8 alpha-N-acetyl-neuraminide alpha-2,8-sialytransferase 4 (St8Sia4).

Results: Increased expression owing to supplementation was mostpronounced at the PD 14 time point. At PD 14 and PD 21, MFGMsupplementation increased gene expression of BDNF (PD 14 foldchange (fc) 2.288, P= 0.01; PD 21 fc 3.1, P= 0.001) and St8Sia4 (PD 14fc 2.75,P= 0.0001; PD21 fc 5.57,P= 0.0001). ThePL and Sia100 groups

also had increased expression of BDNF,GluR-1, St8Sia4, andDrd1 at PD14. TheMFGMgroup exhibited higherTMaze scores than the Sia group(P = 0.01). The Sia100 group visited the novel object more frequentlythan the MFGM group in the Novel Object test (P = 0.02).

Conclusions: In this trial, MFGM, compared with its individualcomponents, was shown to have the largest impact on neurodevelop-ment. This suggests a synergistic effect of the complexmixture on infantbrain development.

Funding SourcesArla Foods.

Accounting for Exclusive Breastfeeding Improvements in LatinAmerica and theCaribbean: TheRole of Prelacteal FeedingPractices(P13-017)

Gabriela Buccini,1 Sonia Venancio,2 Cristiano Boccolini,3 MariaHD Benicio,4 Carlos Monteiro,4 and Rafael Pérez-Escamilla1

1Yale University, CT; 2Instituto de Saúde, Sao Paulo, Brazil;3Fundação Oswaldo Cruz (Fiocruz), Brazil; and 4Public Health Schoolof University of São Paulo, Brazil

Objective:Despite efforts to improve exclusive breastfeeding (EBF),its prevalence remains low globally. In LatinAmerica and the Caribbean(LAC), Peru, Colombia, and the Dominican Republic are examplesof countries with different EBF prevalence that have not been ableto increase their EBF prevalence in the last decade. Therefore, it isfundamental to identify key modifiable risk factors that can accelerateEBF improvements in LAC to reach theWHO’s target recommendationof 50% EBF. Prelacteal feeding within the first days after birth hasbeen associated with a short duration of EBF. However, the proportionof improvement in EBF duration attributable to prelacteal feedingremains unknown. This study aims to quantify the proportion of EBFinterruption that could be prevented by eliminating prelacteal feedingpractices in LAC.

Methods:Weundertook a secondary data analysis of 6 demographichealth surveys (DHS) conducted in Peru from 2008 to 2012 (n = 1860singleton babies <6 mo of age), Colombia from 2005 to 2010(n= 2901), and the Dominican Republic from 2007 to 2013 (n= 1269).Multivariable regression analysis was used to test the associationbetween the consumption of at least one prelacteal feed within 3 d(yes/no) and the risk of interruption of EBF based on EBF current status(yes/no) at the time of the survey. The population attributable fractionof EBF was then estimated.

Results: Among the countries studied, the Dominican Republic hasthe lowest EBF rates (7.2% in 2007 and 6.9% in 2013) and Peru has thehighest (66.6% in 2007 and 67.2% in 2012). Approximately one-thirdof the children in Colombia and Peru received some prelacteal feed, asdid two-thirds in the Dominican Republic. Prelacteal feeding was anindependent risk factor for not being in EBF over time in all countries.If prelacteal feeding practices were eliminated, EBF prevalence wouldincrease by 21.5% in Peru, by 15.6% in Colombia, and by 5.1% in theDominican Republic.

Conclusions: Improving prelacteal feeding practices is key toaccelerating EBF improvements in LAC.

Funding SourcesThis work was supported by the USP-Yale-Santander agreement

#2016.1.8163.1.1.


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Lactoferrin Concentrations in BreastMilk: Influence ofDurationof Lactation and Maternal Factors of Mother from 8 Regions inChina (P13-018)

Xiaokun Cai1, Yifang Duan2, Yang Li1, Yingyi Mao1, Jie Wang2,Xianfeng Zhao1, Zhenyu Yang2, Yanrong Zhao1, Yan Guan1, andShian Yin2

1Abbott Nutrition; and 2National Institute for Nutrition and Health,Chinese Center for Disease Control and Prevention

Objectives: Lactoferrin is an abundant protein in breast milk.Studies show that lactoferrin may support gastrointestinal healthin infants and children. Few studies have reported on lactoferrinconcentrations in breast milk of Chinese lactating women. Thisstudy aimed to measure lactoferrin concentrations in the breastmilk of Chinese women at different stages of lactation from 8regions, and to determine the potential nutritional and mater-nal factors impacting the concentration of lactoferrin in breastmilk.

Methods: A total of 248 lactating women were recruited from 8different regions across China: 32 from Beijing, 29 from Shanghai,16 from Guangdong, 13 from Zhejiang, 16 from Shandong, 57 fromGansu, 53 from Yunnan, and 32 from Heilongjiang. Information aboutthe nutrition of each woman and the gender of the infant werecollected. Breast milk samples from different stages were analyzedby ultra performance liquid chromatography to determine lactoferrinconcentration. A 24-h maternal food record was used to collect dietaryinformation.

Results: Lactoferrin concentrations decreased progressively fromday 1 to day 30 (P< 0.01). Among the 8 regions, breastmilk fromGansucontained the highest lactoferrin concentrations (mean 1.40 g/L),whereas a mean lactoferrin concentration of 0.94 g/L was identified inbreast milk from Zhejiang (P < 0.01). Dietary pattern and maternalbody mass index showed weak correlations with breast milk lactoferrinconcentrations. Maternal ethnicity and age had great impact onthe breast milk lactoferrin concentrations. Mothers of Tibetanethnicity in Gansu had the highest mean breast milk lactoferrinconcentrations (1.45 g/L), whereas mothers of Dai ethnicity inYunnan had the lowest mean breast milk concentrations (1.02 g/L).Women in the older age group (≥30 y old) had a median 0.95 g/Lbreast milk lactoferrin concentration, which was significantly lowerthan the median concentrations (1.3 g/L) in the younger age group(20–25 y old) (P < 0.01).

Conclusions: Similar to studies on breast milk of Western women,this study showed that lactoferrin concentrations in breast milk ofChinese lactating women are influenced by lactation time. Also,

ethnicity and maternal age are impact factors on breast milk lactoferrinconcentrations.

Facilitators and Barriers to Implementing the Becoming Breast-feeding Friendly (BBF) Process in Ghana (P13-019)

Grace Carroll,1 Afua Atuobi-Yeboah,2 Amber Hromi-Fielder,1Richmond Aryeetey,2 Cara Safon,1 and Rafael Perez-Escamilla1

1Yale School of Public Health, CT; and 2University of Ghana

Objectives: In 2016, a country committee of 15 Ghanaian nutrition,health, and breastfeeding experts implementedBecomingBreastfeedingFriendly (BBF), an initiative designed to help countries assess theirreadiness to scale-up breastfeeding programs and develop key recom-mendations to strengthen their breastfeeding environment. The aimsof this study were to 1) identify drivers and barriers to implementingBBF, and 2) determine how BBF strengthens the breastfeeding enablingenvironment in Ghana.

Methods: Semistructured interviews were conducted with 13committee members (CMs). Using a grounded theory approach, 2investigators collaboratively developed a codebook by independentlyapplying open-coding schemes to transcripts, iteratively discussingcode applications and adapting the codebook to incorporate emergingconcepts. Once the codebook was finalized, all transcripts were codedin Dedoose v.8.

Results: A dynamic committee representing multiple sectors drovethe implementation of BBF. Participation provided personal enrichmentfor CMs, and also strengthened the existing breastfeeding environmentby generating an understanding and appreciation for work conductedby different sectors, facilitating information sharing between sectors,and providing a platform for discussions and networking acrossvarious sectors. CMs faced logistic and methodological challenges withimplementing BBF, including intensive time and work commitments,difficulty accessing data, and the need for strong in-country coordina-tion and technical support for adhering to all BBF implementation steps.CMs felt well positioned to facilitate the dissemination of recommenda-tions and to take key leadership roles to implement recommendationsand communicate progress. CMs agreed thatmoving recommendationsto action requires advocacy as the first step and identified BBF as akey advocacy tool to facilitate that step. Accountability of governmentagencies was identified as essential to ensure recommendations werebeing implemented effectively.

Conclusions: BBF can help Ghana strengthen its breastfeedinggovernance, policies, and programs.

Funding SourcesThe Family Larsson-Rosenquist Foundation.


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FIGURE P13-019-1 Conceptual model of facilitators and barriers identified by Ghanaian committee members for implementing the BBF.

Are Feeding Practices of Family Child Care Home ProvidersAssociated with Child Fruit and Vegetable Intake? (P13-020)

Tayla M Carter,1 Patricia Risica,2 Kim Gans,2 Maya Vadiveloo,1Karen McCurdy,1 and Alison Tovar1

1University of Rhode Island; and 2Brown University, RI

Objective: The aim of this study was to explore the relation between3 feeding practice constructs (role modeling, encouragement, andpressure to eat) of family child care providers (FCCP), and fruit andvegetable intake of the preschool-aged children in their care.

Methods: Baseline data, collected during a 2-d home visit froman ongoing cluster-randomized trial, Healthy Start/Comienzos Sanos,were used (n = 61 homes). Feeding practice data were collected usingthe Environment and Policy Assessment and Observation tool. Childdietary intake was collected using the Dietary Observation in ChildCare protocol. A score for each construct was created by summingthe relevant feeding practice items (averaged across 2 d) for eachand averaging across the number of items. Child whole fruit, totalfruit (whole fruit plus fruit juice), and vegetable intake were averagedacross both observation days and all children observed within a home.Pearson’s correlations were used to examine the relation between FCCPfeeding practice constructs and diet variables.

Results: The majority of providers identified as Hispanic or Latina(78%), all were female, and the mean age of the providers was 50.4 ±8.5 y. The majority of children were Hispanic or Latino (68%), andabout half were female (52%). The mean age of the children was3.4 ± 1.0 y. Mean whole fruit intake was 0.12 ± 0.20 cups/d, meantotal fruit intake was 1.35 ± 1.07 cups/d, and mean vegetable intakewas 0.54 ± 0.41 cups/d. Provider encouragement and pressure to eatwere both significantly positively correlated with child vegetable intake(r = 0.27, P = 0.03 and r = 0.25, P = 0.05, respectively). No otherprovider practices were significantly correlated with child whole fruit,total fruit, or vegetable intake.

Conclusions: Both FCCP encouragement and pressure to eat werepositively associated with vegetable intake. While pressuring childrento eat is typically seen as a negative practice, higher vegetable intakeis a positive outcome. Future studies should further explore therelation between pressure to eat and less-healthy foods, as well as the

longitudinal impact of this type of feeding on diet over time. With thisinformation, interventions can be better tailored to improve the diets ofyoung children.

Funding SourcesThis study was supported by NIH Grant # R01HL123016–01A1.

Comparison of the Effects of Soybean Oil –Based and Fish Oil–Based Lipid Emulsions on Neonatal Cholestasis in Preterm Infants(P13-021)

Merih Cetinkaya and Ozge Saglam

Kanuni Sultan Süleyman Training and Research Hospital, Turkey

Objective: Parenteral nutrition–associated liver disease (PNALD)and neonatal cholestasis are important morbidities in preterm infants.Fish oil–based lipid emulsions were suggested to have an effect onprevention and/or reversal of neonatal cholestasis. Therefore, the aim ofthis prospective randomized trial was to compare the effects of soybeanoil–based and fish oil–based lipid emulsions on prevention of neonatalcholestatis in very-low-birth-weight (VLBW) infants.

Methods: A total of 170 VLBW infants who were given totalparenteral nutrition (TPN) for ≥2 wk were enrolled. Infants wererandomized to 2 groups: 100% soybean-based lipid emulsion (S group)and 50% fish oil + 50% soybean oil (F group). The demographicfeatures, neonatal morbidities, duration of TPN, neonatal cholestatisis,and associated laboratory data were all recorded.

Results:There were 88 and 82 infants in S and F groups, respectively.The frequency of neonatal cholestasis were significantly lower in the Fgroup than in the S group. No PNALDwas detected in the fish oil group.Although there were no statistically significant differences betweenthe 2 groups, the incidences of bronchopulmonary dysplasia (BPD),necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP)were significantly higher in the S group. Soybean-based oil emulsionand duration of TPN were found to be significantly associated withdevelopment of neonatal cholestasis in logistic regression analysis.

Conclusions: Fish oil–based lipid emulsion significantly decreasedthe development of neonatal cholestasis. In addition, the incidencesof severe BPD, NEC, and ROP were significantly lower in the fish oil


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group. We suggest that fish oil should be used safely and effectively forprevention of neonatal cholestasis in VLBW infants.

Funding SourcesN/A.

Cobalamin and Folate Status among Breastfed Infants in Bhakta-pur, Nepal (P13-022)

Ram Krishna Chandyo,1 Manjeswori Ulak,2 Mari Hysing,3Ingrid Kvestad,3 Merina Shrestha,4 Suman Ranjitkar,2 LaxmanShrestha,4 and Tor Strand5

1Kathmandu Medical College, Nepal; 2Child Health ResearchProject; 3Uni Research Health, Bergen, Norway; 4Institute of Medicine;and 5University of Bergen, Norway

Objectives: The objectives of this study were to explore cobalaminand folate status, and to describe their determinants among breastfedinfants 6–11mo of age residing in the Bhaktapur municipality of Nepal.

Methods: We collected plasma samples from 6- to 11-mo-oldbreastfed infants with a length-for-age z score of<–1 and analyzed theirplasma for folate, cobalamin, methylmalonic acid (MMA), and totalhomocysteine (tHcy) concentrations. We also calculated a combinedindicator of cobalamin (3cB12) because individual biomarkers ofcobalamin have their limitations in terms of sensitivity and specificity.Multiple linear regression analyses were done to explore sociodemo-graphic and nutritional characteristics associated with 3cB12.

Results: Among a total of 316 infants, marginal cobalamin defi-ciency (plasma cobalamin 148–221 pmol/L) was found in 24%, whereas11%were cobalamin deficient (plasma cobalamin<148 pmol/L). Basedon 3cB12, 58% had poor cobalamin status. Elevated total homocysteine(>10 µmol/L) or methylamlonic acid (>0.28 µmol/L) were foundin 53% and 75% of infants, respectively. However, folate deficiency(<10 nmol/L) was not found in this population, as the lowest valueof plasma folate was 20.7 nmol/L. The 3cB12 increased with increasingage of the infants in the unadjusted regression analysis. Being bornat low birth weight, exclusively breastfeeding for at least 3 mo, andstunting were associated with lower 3cB12. Except for ownership ofown residence, none of the other variables were associated with 3cB12

when we adjusted for possible confounding variables.Conclusions: More than 50% of the infants had poor cobalamin

status, which is probably because of suboptimal maternal status and thepredominantly vegetarian complementary feeding. The consequencesof poor cobalamin status should be a prioritized research question, andstrategies to improve maternal and child status should be considered.

Funding SourcesThrasher Research Fund.

Vitamin B-12 Predicts Linear Growth after 6 y among Childrenin North India (P13-023)

Ranadip Chowdhury,1 Sunita Taneja,1 Nita Bhandari,1 IngridKvestad,2 Mari Hysing,2 and Tor Strand2

1Society for Applied Studies, India; and 2University of Bergen,Sweden

Objective: The aim of this study was to estimate the effect of dailyvitamin B-12 and/or folic acid supplementation for 6 mo in earlychildhood on linear growth after 6 y, and the extent to which markers

of these vitamins in early childhood are associated with linear growth6 y later.

Method: This is a follow-up study of a randomized double-blind placebo-controlled trial with a factorial design to evaluate theimpact of supplementation with folic acid, vitamin B-12, or both onchildhood infections and growth in 1000 children aged 6–30 mo.After 6 y of supplementation, we measured the weight and height of791 available children. We used multiple linear regression models toestimate the association between supplementation status and vitaminB-12, total homocysteine (tHcy), folate concentrations, and lineargrowth. These regression models included interaction terms betweensupplementation status and log2-transformed folate, vitamin B-12, andtotal homocysteine concentrations.

Results:At the time of follow up, themean± SD age was 7.3± 0.7 y,and∼48%were female. Therewere no significant effects of vitaminB-12and/or folic acid supplementation for 6 mo in early childhood on lineargrowth after 6 y. Baseline vitamin B-12 and tHcy concentrations, butnot folate concentrations, were associated with height-for-age z scoresafter 6 y. This association was significantly modified by vitamin B-12,but not folic acid, supplementation. The association between vitaminB-12 status and growth was observed only in children who were notsupplemented with vitamin B-12.

Conclusions: Vitamin B-12 status in early childhood predictsgrowth in school age. This association was modified by subsequentvitamin B-12 supplementation. Thus, correcting vitamin B-12 status inearly childhood eliminates the association between pre-existing vitaminB-12 status and linear growth. This is an indirect evidence for a causaleffect between vitamin B-12 intake and linear growth.

Funding SourcesThrasher Research Organization.

Obesity during Human Pregnancy Is Associated with AlteredPlacental Tissue Structure and RBMS1mRNAExpression (P13-024)

Kate J Claycombe-Larson,1 Amy Bundy,2 Diane Darland,3Junguk Hur,3 Archana Dhasarathy,3 Danielle Perley,3 AdamScheidegger,3 LuAnn Johnson,2 Danielle Krout,2 and JamesRoemmich2

1USDA-ARS-PA Grand Forks Human Nutrition Research Center;2USDA ARS; and 3UND

Objective: Maternal obesity alters placental tissue function andmorphology, and increases inflammation. We and others have shownthat placenta size, inflammation, and fetal growth are regulated bythe intrauterine environment and maternal nutrition. Studies havealso shown that maternal obesity alters placental DNA methylation.RNA-binding motif single-stranded interacting protein 1 (RBMS1) isexpressed in the placenta. Serum RBMS1 protein concentration isincreased with obesity and RBMS1 gene expression in liver is inducedby high-fat diets and in macrophages by inflammation. The aim of thisstudy was to discover whether placental RBMS1 mRNA expression andDNA methylation are altered by maternal obesity.

Methods: Frozen placental tissue from obese [body mass index(BMI) >25, n = 12) and nonoverweight (BMI

Results: RBMS1 mRNA measured by RT-PCR (pConclusions: These findings suggest that obese women have greater

RBMS1 mRNA and DNA methylation as a feedback mechanism to


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reduce inflammation. Whether other placental cell types also differ inRBMS1 protein expression and differentially contribute to increasedRBMS1 in circulation needs to be determined in future studies.

Funding SourcesThis work was supported by USDA Agricultural Research Service

Project #3062-51,000-052-00D.

Effectiveness of Interventions to Support Optimal BreastfeedingPractices for Children Aged 0–23 mo in South Asia, 1990–2015: AScoping Review (P13-025)

Hope C Craig,1 Rukundo Benedict,1 Rebecca J Stoltzfus,1 andHarriet Torlesse2

1Cornell University, NY; and 2UNICEF

Objective: Though many children in South Asia are breastfed atsome point in their lives, most children are not breastfed optimally,including early initiation of breastfeeding within 1 h of birth (EIBF),avoidance of prelacteal feeds during the first 3 d (APF), exclusivebreastfeeding for 6 mo (EBF), and continued breastfeeding through 2 y(CBF). This review identifies and collates evidence on the effectivenessof interventions to support and promote optimal breastfeeding in 5countries in South Asia from 1990 to 2015.

Methods: A scoping review was conducted in which PubMed, Webof Science, GenderWatch, POPLINE, and Sociological Abstracts weresearched to identify and screen peer-reviewed and program evaluationliterature in Afghanistan, Bangladesh, India, Nepal, and Pakistan.Eligible studies included randomized trials and quasi-experimentaldesigns that were conducted between 1990 and 2015 and reportedbreastfeeding outcomes. Data were charted on intervention design,characteristics, and effectiveness to support EIBF, APF, EBF, and CBF.Analysis was guided by a socioecologic framework on breastfeeding.

Results: A total of 31 studies were included. Most studies re-ported a positive impact of interventions on EIBF (n = 25) or EBF(n = 19) outcomes. Fewer studies reported evidence on CBF or APF.Interventions were delivered at the home, in the community, or at ahealth facility. Common intervention types with positive effectivenesswere education and counseling, and maternal, newborn, and childhealth initiatives.Massmedia and communitymobilization efforts werealso identified, though less often. Programs that reached women andtheir families through repeated exposure, beginning during pregnancy,increased EIBF and EBF outcomes. Interventions with no impact onbreastfeeding were characterized by short duration, irregular frequency,poor gestational timing, and poor intervention coverage and targeting.

Conclusions: Effectiveness of interventions to support optimalbreastfeeding practices is influenced by program design, implemen-tation, and delivery. Research is especially lacking on CBF and APF.Future research must evaluate program implementation pathways toimprove and scale-up strategies that support optimal breastfeedingpractices from birth through 2 y in South Asia.

Funding SourcesN/A.

Release of Functional Peptides from Mother’s Milk and FortifierProteins in the Premature Infant Stomach (P13-026)

David C Dallas,1 Soeren Nielsen,1 Robert L Beverly,1 and MarkA Underwood2

1Oregon State University; and 2University of California Davis

Objective: Digestion of milk proteins provides nutrition andthe release of bioactive peptides exhibiting antimicrobial, opioid,immune-modulating, calcium-delivery, and antihypertensive activities.Premature infants may not be able to digest breast milk adequatelyfor optimal release of bioactive peptides. Which peptides are releasedfrom milk proteins in the stomach of premature infants has not beenreported. Premature infants are often fed a combination of humanmilkand bovinemilk fortifiers, but the variety of functional peptides releasedfrom both human and bovine milk proteins remains uncharacterized.The aim of this study was to identify the functional peptides.

Methods: Human milk samples and their matching gastric milksamples were collected from 5 mother-premature infant pairs in theneonatal intensive care unit, as approved by the UC Davis InstitutionalReview Board. This study applied peptidomics to investigate thepeptides released in gastric digestion of mother’s milk proteins andsupplemental bovine milk proteins in premature infants. Peptideswere assessed for homology against a database of known functionalpeptides—the Milk Bioactive Peptide Database. The peptidomic datawere analyzed to interpret which proteases most likely released themfrom the parent protein.

Results: We applied Orbitrap mass spectrometry to identify 5264unique peptides from bovine and human milk proteins within humanmilk, fortifier, or infant gastric samples. Plasmin was predicted tobe the most active protease in milk, whereas pepsin or cathepsin Dwas predicted to be most active in the stomach. Alignment of thepeptide distribution showed that there were different digestion patternsbetween human and bovine proteins. The number of peptides with highhomology to known functional peptides (antimicrobial, angiotensin-converting-enzyme-inhibitory, antioxidant, immunomodulatory, etc.)increased from milk to the premature infant stomach and was greaterfrom bovine milk proteins than from human milk proteins.

Conclusions: The differential release of bioactive peptides fromhuman and bovine milk proteins may impact overall health outcomesin premature infants. Our ongoing work is examining howmilk proteindigestion proceeds across time in the stomach and how preterm andterm infants differ in their gastric release of milk peptides.

Funding SourcesThis study was supported by the K99/R00 Pathway to Independence

Career Award, Eunice Kennedy Shriver National Institute of ChildHealth and Development of the NIH (R00HD079561) (DCD).


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FIGURE P13-026-1 Total count (a) and abundance (b) of peptides identified in unfortified human milk and preterm infant gastric digestsof fortified human milk from either bovine milk proteins, human milk proteins or either of the two. The graph is divided into sections forthe combined count of the peptides present in number of infants compared with the total number of infants. Results are shown as mean ±standard error.

FIGURE P13-026-2 Bioactive peptides identified in the (a) milk, (b) bovine-based HMF, (c) gastric samples (humanderived) and (d) gastricsamples (bovine-derived) by searching the Milk Bioactive Peptide Database (MBPDB), with a threshold value of ≥ 80% homology.

Maternal Dietary Fat Intake during Pregnancy and Infant BodyComposition at Birth (P13-027)

Natalie Damen, Melanie Gillingham, Joyanna Hansen, JonathanQ Purnell, Kent L Thornburg, and Nicole Marshall

Oregon Health & Science University

Objective: Recent evidence links infant body composition at birthto an increased risk of adult chronic disease. Few human studies have

explored the association between maternal dietary fat intake and infantbody composition. Specific dietary recommendations for pregnantwomen for quantity and quality of dietary fat intake are lacking.Our goal was to investigate the association between maternal dietaryfat intake during pregnancy and infant body composition at birth.We hypothesized that increased infant adiposity at birth is positivelycorrelated with high maternal dietary total fat intake.


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Methods: This was a secondary analysis of a cross-sectional studyof 79 healthy pregnant women with a singleton gestation who wereenrolled at 12–16 wk of gestation. The 2005 Block Food Frequencyquestionnaire was used to assess dietary intake at 12–16, 24–28, and37 wk of gestation. Infant anthropometry and flank skinfold measure-ments were taken within 24 h of birth, then the Catalano equationwas used to calculate infant fat mass. Associations between maternaldietary fat intake and infant anthropometrics were assessed by Pearson’scorrelation and linear regression analyses.

Results: Infant body fat percentage (BF%) is weakly correlatedwith average total dietary fat, saturated fat, and unsaturated fat intakeduring pregnancy (r = 0.27, P = 0.0222; r = 0.26 P = 0.0270;r = 0.26 P = 0.0278, respectively). Regression analyses show thatinfant BF% increases as average total dietary fat, saturated fat, andunsaturated fat intake during pregnancy increase (P= 0.027; P= 0.026;P = 0.036, respectively). These associations did not remain significantafter adjusting for maternal prepregnancy body mass index (BMI), age,and total gestational weight gain (GWG).

Conclusions: Infant BF% at birth is significantly associated withaverage intake of total dietary fat, saturated fat, and unsaturated fatduring pregnancy. However, regression analyses suggest that confound-ing variables such as prepregnancy BMI, age, and total GWG may playa stronger role in infant body composition than maternal dietary fatintake. These results expand our current knowledge of maternal dietaryintake and infant body composition, and will help inform the optimalmaternal diet for beneficial birth outcomes.

Funding SourcesNIH NICHD K23HD069520 (NEM).

FIGURE P13-027-1

The Association ofMicronutrients Status with DNADamage andBirth Outcomes in Infants at Birth: The DADHI Study (P13-028)

Mansi Dass Singh,1 Michael Fenech,2 William Hague,3 PhilThomas,2 and Julie Owens4

1University of Adelaide & Endeavour College of Natural Health,Australia; 2CSIRO; 3School of Medicine, University of Adelaide,Australia; and 4University of Adelaide

Objective: Association of plasma micronutrient with infant birthoutcomes, DNA damage biomarkers and mode of feeding was assessedduring the first 6 mo after birth.

Method: In a prospective cohort study, peripheral blood lympho-cytes were isolated from healthy Australian infants at birth (cord blood)(n= 82), and 3 (n= 64) and 6 mo (n= 53) after birth. Blood micronu-trients were assessed and DNA damage biomarkers were measured bythe cytokinesis block micronucleus-cytome assay per 1000 binucleatedlymphocytes (BNC), which included micronuclei (MN), nucleoplasmicbridges (NPB), and nuclear buds (NBUD). Apoptosis and necrosis werescored per 500 cells. The nuclear division index (NDI) was calculatedwith frequency of mono-, bi- and multinucleated lymphocyte cells.MN and NBUD were also scored in 500 undivided mononucleatedlymphocyte cells (MNC). The infants’ mode of feeding was collectedeach month and given a score according to predetermined criteria.

Results: The mean ± SD frequency of MN, NPB, and NBUD inBNC at birth was 2.0 ± 1.2, 5.8 ± 3.7 and 11.1 ± 5.7 per 1000 BNC,respectively, and tended to decrease significantly at 3 mo (P < 0.01,p12 associated positively whereas potassium correlated negatively withgestational age). Cord iron correlated negatively with NBUD MNC(r = – 0.28, P = 0.01) and magnesium correlated positively withMN MNC (r = 0.23, P = 0.03). At 3 mo, zinc correlated negativelywith NBUDMNC (r = – 0.27, P = 0.05) but positively with NPBBNC (r = 0.29, P = 0.03). At 6 mo, folate associated positively(r = 0.44, P = 0.006), but magnesium, sodium, and potassiumassociated negatively, with NDI. Sulfur and calcium concentrationscorrelated positively with feeding scores at 6 mo.

Conclusions: The micronutrient status and DNA damage biomark-ers vary significantly during the first 6 mo of life, and significantassociations are observed among birth outcomes, bloodmicronutrients,and DNA damage in lymphocytes. Micronutrient deficiencies or excessmay modulate birth outcomes and DNA damage during the first 6 moafter birth.

Funding SourcesCancer Coucil, Australia.

Immune Composition of Mature Human Milk in ExclusivelyBreastfeeding and Mixed-Feeding Mothers (P13-029)

Erin Davis and Sharon Donovan

University of Illinois at Urbana-Champaign

Objective: Human milk (HM) is composed of a diverse profile ofimmune components, which are believed to influence infant innate andadaptive immunity. Factors such asmaternal age, geography, gestationalage, and lactation stage influence immune composition. However, thebreadth of cytokines, chemokines, and growth factors (CCGFs) presentin HM is not well characterized, and whether breastfeeding exclusivityaffects CCGF composition is unknown. The objective was to measureCCGFs in mature HM and assess differences in composition betweenexclusively breastfeeding (EBF) and mixed-feeding (MF) mothers.

Methods:Milk samples (EBF, n = 44; MF, n = 25) collected at 6 wkpostpartum fromhealthymothers enrolled in the STRONGKids 2 birthcohort study were used for analysis. All mothers vaginally deliveredtheir infants at term. Samples were analyzed for 41 CCGFs using ahuman cytokine-chemokine multiplex magnetic bead panel.

Results: A total of 40 components were detectable in the milksamples. We identified 12 CCGFs [epidermal growth factor (EGF),transforming growth factor-α, GRO, MDC, platelet-derived growthfactor-AA, interleukin (IL)-15, IL-4, IL-7, IL-8, interferon γ inducible


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protein 10, monocyte chemoattractant protein-1, vascular endothelialgrowth factor] in more than 94% of samples. Tumor necrosis factor-α, fractalkine, and IL-1α were detected in more than 78% of samples.Among this subset of 15 analytes, IL-8 was the only CCGF withinthe limits of detection (LOD), which differed between groups, withgreater concentrations in the milk of MF relative to EBF mothers(P = 0.002). EGF and GRO were above the LOD (10,000 pg/mL) inmost samples. Fisher’s exact tests were used to determine differencesin frequency of detection for all CCGFs between EBF andMFmothers.The probability of detecting fractalkine was greater among EBF thanMF mothers (P = 0.04). The probability of detecting IL-3 (P = 0.009),IL-6 (P= 0.02), IL-9 (P= 0.02), andmacrophage inflammatory protein-1β (P = 0.006) was greater among MF than EBF mothers.

Conclusions: While concentrations of many CCGFs have beenshown to be higher in early lactation, our results demonstrate that awiderange of immune components are present at detectable concentrationsin mature HM. The high frequency of detection of a subset of CCGFsmay point to a core immune composition in mature HM. Differencesin CCGF components in HM of EBF and MF mothers suggest thatbreastfeeding exclusivity impacts the immune profile ofHM,whichmaybe related to differences in oral microbiota of EBF and MF infants.

Funding SourcesNational Dairy Council, The Gerber Foundation, The Doris Kelley

Christopher Foundation, and USDA Hatch funds.

Calcitriol is Associated with Fe Status in Term Neonates (P13-030)

Katherine M Delaney,1 Ronnie Guillet,2 Eva K Pressman,2 RuthAnne Queenan,2 Elizabeth M Cooper,2 and Kimberly O’Brien1

1Cornell University, NY; and 2University of Rochester, NY

Objective: Iron deficiency and anemia at birth are detrimental tothe neonate. The potential etiologies of anemia at birth are usually notidentified or may be misclassified as Fe deficiency anemia (IDA) usingthe current cutoffs for Fe status indicators. Vitamin D deficiency alsorequires exploration, since vitamin D status can impact erythropoiesis.The objective of this studywas to examine interrelations between Fe andvitamin D concentrations in neonates born to pregnant adolescents.

Methods: A comprehensive panel of Fe status indicators, regulatoryhormones, and vitamin D metabolites, including hemoglobin (Hb),serum Fe, hepcidin, erythropoietin, calcium, calcitriol (1,25(OH)2D)and calcidiol (25(OH)D), were assessed in cord blood from 74 full-termneonates (mean ± SD 39.8 ± 1.2 wk of gestation) born to adolescentsin Rochester, NY.

Results: The average cord Hb at birth was 14.19 ± 2.81 g/dL; 23%of the neonates were anemic. Approximately 50% of neonates had25(OH)D concentrations <20 nmol/L and 18% were <12 ng/mL. Theaverage 1,25(OH)2D concentration was 44.73 ± 1.43pmol/L. Therewas no significant association between 25(OH)D and 1,25(OH)2D(P = 0.78, n = 71). Calcidiol was not significantly associated with Hb(P = 0.87), but 1,25(OH)2D was inversely associated with Hb status(P = 0.0005, n = 44). Calcitriol alone explained 25% of the observedvariability in cord Hb (n = 44). Calcitriol appears to be associated withFe status, as it was inversely associated with hepcidin (P < 0.0001,n = 74) and serum Fe (P = 0.005, n = 71). Anemic neonates had

significantly lower calcitriol (P < 0.001) and hepcidin (P = 0.02)concentrations than nonanemic neonates.

Conclusions: Neonatal calcitriol in cord serum explained a sig-nificant portion of the variation in Hb concentrations at birth, andwas associated with Hb and the Fe regulatory hormone hepcidin.Further analysis of these interrelations is needed to better understandneonatal anemia and Fe deficiency to enable clinicians to try to preventor ameliorate the risk of neurodevelopmental deficits.

Funding SourcesFunding was from the NIH (grant T32HD052471) and the USDA

(grants 2005-35,200 and 2008-0,1857).

The Survival of HumanMilk Immunoglobulins across Postpran-dial Time in the Premature Infant Stomach (P13-031)

Veronique Demers-Mathieu,1 David Dallas,2 Mark AUnderwood,3 and Robert L Beverly2

1Oregon State University; 2College of Biological Population andHealth Sciences, Oregon State University; and 3University of CaliforniaDavis

Objective: Breastfeeding provides protection against bacterial andviral infection, and promotes development of the newborn infant’simmature immune system. The protection of breastfeeding derives, inpart, from the transfer ofmany immunoglobulins (Igs) from themotherto the newborn. Our objective was to evaluate the survival of humanmilk Igs in the preterm stomach across postprandial time.

Methods: Human milk and infant gastric samples were collectedfrom 11 preterm [23–32 wk gestational age (GA)] mother-infant pairswithin 7–98 d postnatal age. Preterm gastric samples were collected 1,2, and 3 h after the beginning of the feeding. Samples were analyzedfor concentration of total IgA, secretory IgA (SIgA) plus secretorycomponent (SC), total IgM, and IgG via ELISA. Peptide counts andabundance of Ig chain fragments released by digestion were determinedusing peptidomic analysis. One-way ANOVA with repeated measuresfollowed by Tukey’s multiple comparison tests were applied to comparesamples.

Results: Concentrations of total IgA were 76%, 62%, and 46% lowerin the gastric contents at 3 h postprandially compared with humanmilkand gastric contents at 1 and 2 h, respectively. Human milk SIgA plusSC, IgG, and total IgM concentrations remained stable in the pretermstomach across postprandial time. Peptide counts from the Ig α-chainand the Ig γ -chain increased by 2.2- and 1.2-fold in gastric contentsfrom 1 to 2 h postprandial, but stayed stable at 3 h. Peptide counts fromthe human milk Ig µ-chain, Ig J-chain and SC (f19–603 of polymericimmunoglobulin receptor) were stable across postprandial time.

Conclusions: Human milk SIgA plus SC, IgM, and IgG survivemostly intact through the preterm infant stomach, whereas IgA ispartially digested. The longer that milk Igs remain intact withinthe infant gastrointestinal tract, the longer they can provide passiveimmune protection to the infant while its own secretion of serum IgAand SIgA in the intestine is low and the overall immune system isimmature.

Funding SourcesK99/R00 Pathway to Independence Career Award, Eunice Kennedy

Shriver National Institute of Child Health and Development of the NIH(R00HD079561).


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FIGURE P13-031-1 Schematization of the origin of SIgA and IgA in human milk. (A) B cells differentiate into plasmacells that producedimeric IgA containing a J-chain in the interstitial spaces of the mammary gland. (B) IgA binds to the secretory component (SC) ofpolymeric immunoglobulin receptor (PIgR) on the basolateral membrane of the mammary epithelial cell and the IgA-PIgR complex travelto the apical membrane. (C) PIgR is then cleaved by a protease (unknown), releasing SC which covalently binds to IgA, creating thecomplex secretory IgA which is secreted across the apical membrane. (D) We hypothesize that B cells differentiate into plasma cells andproduce dimeric IgA in human milk inside the alveolus and contribute to production of dimeric IgA.

FIGURE P13-031-2 Concentration of immunoglobulin (Ig) in human milk (blue boxplot) and preterm infant gastric samples at 1 (G-1h), 2(G-2h),3 h (G-3h) after the beginning of feeding. Concentrations of (A) total IgA (IgA + SIgA), (B) secretory IgA (SIgA) plus secretory component(SC), (D) total IgM and IgG were determined by ELISA. Paired milk and gastric samples were collected in preterm infants (2332 wk ofgestational age (GA), 798 days of postnatal age). Letters a, b and c show statistically significant differences between groups (p < 0.05)using one-way ANOVA with repeated measures followed by Tukey’s multiple comparison tests. Values are min, median and max, n = 11.


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FIGURE P13-031-3 Peptide counts of immunoglobulin (Ig) fragments in human milk (blue boxplot) and preterm infant gastric samples at1 (G-1h), 2 (G-2h), 3 h (G-3h) after the beginning of feeding. Peptide counts of (A) total Ig alpha (heavy constant alpha-1 and -2 chainsfrom IgA or SIgA), (B) total Ig gamma (heavy constant gamma-1, -2 and -3 chains from IgG), (C) Ig mu (heavy constant mu chain from IgM),(D) Ig J (from IgA, IgM or SIgA). Paired milk and gastric samples were collected in preterm-delivering motherinfant pairs (2332 wk ofgestational age (GA), 798 days of postnatal age). Letters a, b and c show statistically significant differences between groups (p < 0.05)using one-way ANOVA with repeated measures followed by Tukey’s multiple comparison tests. Values are min, median and max, n = 11.

FIGURE P13-031-4 Peptide counts of immunoglobulin (Ig) fragments in human milk (blue boxplot) and preterm infant gastric samples at1 (G-1h), 2 (G-2h), 3 h (G-3h) after the beginning of feeding. Peptide counts of (A) total Ig lambda (from IgA, SIgA, IgM or IgG), (B) Igkappa (from IgA, SIgA, IgM or IgG), (C) total polymeric immunoglobulin receptor (PIgR) (f19764), (D) secretory component (SC, f19-603 ofPIgR). Paired milk and gastric samples were collected in preterm-delivering mother-infant pairs (2332 wk of gestational age (GA), 798 daysof postnatal age). Letters a, b and c show statistically significant differences between groups (p < 0.05) using one-way ANOVA withrepeated measures followed by Tukey’s multiple comparison tests. Values are min, median and max, n = 11.


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Colonic andFecalMetabolites in Piglets Fed FormulaContainingSialyllactose (P13-032)

Sharon M Donovan,1 Mei Wang,1 Marcia H Monaco,1 Brian MBerg,2 Maciej Chichlowski,2 and Ryan Dilger1

1University of Illinois, Urbana; and 2Mead Johnson PediatricNutrition Institute, IN

Objective: The gut microbiota is a highly metabolically activecommunity of microorganisms. The sialylated milk oligosaccharidesare metabolized by the infant microbiota. Herein, the effect of dietarysialyllactose (SL) on metabolite profiles in the colon and feces of pigletswas investigated.

Methods: Piglets, 2 d old (n = 34), were fed formulas containingpolydextrose and galacto-oligosaccharides (2 g/L, each) supplementedwith 0 (CON) or 380 mg/L SL, added as an SL-enriched bovinewhey (Lacprodan SAL-10, Arla Foods Ingredients Group P/S, Aarhus,Denmark), for 22 d. AC contents and feces were collected for analysisusing ultrahigh-performance liquid chromatography/tandem accurateMS methods (Metabolon, Durham, NC). Metabolite concentrationswere compared between regions (AC, feces) and by dietary SL by 2-wayANOVA.

Results: A total of 685 named biochemicals were detected in ACcontents and feces. There were significant main effects of region (585compounds), diet (16 compounds) and diet × region (12 compounds).In terms of region, the majority of metabolites were higher (P < 0.05)in AC compared with feces, regardless of diet, and AC and feces wereclearly distinguishable by principle component analysis. Comparingthe same diets between AC and feces, amino acids and carbohydrateswere the main differentiating compounds for the SL diet. Vitamins andcofactors, amino acids, and carbohydrates were the top differentiatingbiochemicals for the CON diet between AC and feces. In the AC,the SL diet resulted in higher (P < 0.05) concentrations of fructose,but lower (P < 0.05) concentrations of caproate, heptanoate, and N-acetylglucosaminylasparagine than CON. In the feces, sedoheptulose,maltose, and fructose were all higher (P < 0.05) in SL samples than inCON. Lastly, diet altered primary and secondary bile acids; SL pigletshad higher (P < 0.05) glycocholate in the AC and lower (P < 0.05) 3β-hydroxy-5-cholenoic acid in both the AC and feces.

Conclusions:Metabolomics can identify subtlemetabolic variationsinduced by diet and variations of the gut microbiota. Herein, distinctmetabolite differences between piglet AC contents and feces wereapparent. Dietary SL produced differences in carbohydrates, mediumchain fatty acids and bile acids, which may be related to differences inmicrobiota composition.

Funding SourcesFunded by Mead Johnson Nutrition.

Dietary Patterns before and during Pregnancy and GestationalAge at Birth: A Systematic Review (P13-033)

Carol Dreibelbis,1 Ramkripa Raghavan,1 Brittany L James,1 YatPing Wong,2 Barbara Abrams,3 Alison Gernand,4 Kathleen MRasmussen,5 Anna Maria Siega-Riz,6 Jamie Stang,7 Kellie OCasavale,8 Joanne M Spahn,2 and Eve E Stoody2

1The PanumGroup; 2USDA, Food andNutrition Service; 3School ofPublic Health, University of California, Berkeley; 4Pennsylvania State

University; 5Cornell University, NY; 6University of Virginia Schoolof Nursing; 7University of Minnesota School of Public Health; and8US Department of Health and Human Services, Office of DiseasePrevention and Health Promotion

Objective: Preterm birth (PTB) is an important cause of perinatalmorbidity and mortality in the United States. A systematic review wasconducted as part of the USDA-Department of Health and HumanServices’ Pregnancy and Birth to 24 Months project to assess therelation between dietary patterns (DP) before and during pregnancyand gestational age at birth.

Methods: Nine databases, including PubMed, Embase, Cochrane,and CINAHL, were searched from January 1980 to January 2017for peer-reviewed articles related to DP and pregnancy and birthoutcomes. Articles were dual-screened using a priori inclusion andexclusion criteria; relevant information was then extracted from theincluded articles, and the risk of bias was assessed. After qualitativelysynthesizing the data, a conclusion statement was drafted to answerthe systematic review question and the evidence was graded. Finally,recommendations for future research were identified.

Results:Of the 9103 search results, 11 studies representing 7 cohortsand 1 randomized controlled trial met the criteria for inclusion. Samplesizes ranged from 290 to 72,072 subjects. A significant association wasfound in 5 of the 8 studies that examined DP during pregnancy andPTB. A sixth study found a significant association with early PTB(<35 wk) but not PTB (<37 wk). Additionally, 4 of the 5 studiesthat examined DP during pregnancy and spontaneous PTB found asignificant association. Only 3 studies assessedDP before and/or duringpregnancy and gestational age at birth as a continuous outcome.Overall,the DASH diet, theMediterranean diet, the NewNordic Diet, and otherDP were protective. The body of evidence was limited in several ways(e.g., themethods used across studies varied considerably, andminorityand lower socioeconomic status populations were underrepresented).

Conclusions: Limited but consistent evidence suggests that DPduring pregnancy are associated with a lower risk of PTB andspontaneous PTB. These protective DP are higher in vegetables, fruits,whole grains, nuts, legumes, seeds, and seafood (PTB only), and lowerin red and processed meats and fried foods. Most of the research wasconducted in healthy Caucasian women with access to health care.There was insufficient evidence to estimate the association between DPbefore pregnancy and gestational age at birth as well as the risk of PTB.Additional research is needed.



Infant and Young Child Feeding Status in China: A NationalRepresentative Survey in 2013 (P13-034)

Yifan Duan,1 Zhenyu Yang,1 Jianqiang Lai,1 Dongmei Yu,1Suying Chang,2 Xuehong Pang,1 Shan Jiang,1 Huanmei Zhang,1Ye Bi,1 JieWang,1 RobertW Scherpbier,2 Liyun Zhao,1 and ShianYin1

1National Institute for Nutrition and Health, Chinese Center forDisease Control and Prevention; and 2United Nations Children’s Fund


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Objective:Appropriate infant and young child feeding could reducemorbidity and mortality, and could improve the cognitive developmentof children. However, nationwide data are scarce on infant and youngchild feeding status in China. The aim of this study was to assess thecurrent infant and young child feeding status in China.

Methods: A national representative survey (Chinese NationalNutrition and Health Survey) of children aged <6 y was done in 2013.Stratified multistage cluster sampling was used to select study partic-ipants. WHO infant and young feeding core indicators (exclusivelybreastfeeding, minimum dietary diversity, minimum meal frequency,and minimum acceptable diet) were used to assess breastfeedingand complementary feeding practice. Logistic regression was used toanalyze the characteristics associated with the 4 core indicators.

Results: In total, 14,458 children aged <2 y (0–<730 d) werestudied from 55 counties in 30 provinces in China. The exclusivelybreastfeeding rate at<6 mo old was 20.7% (908/4381). The prevalencesofminimumdietary diversity,minimummeal frequency, andminimumacceptable diet were 52.5% (5286/10,071), 69.8% (7027/10,071), and27.4% (2764/10,071) among children aged 6–23 mo, respectively.Multivariate analysis results showed that age of child, residential area,household income, and maternal education were positively associatedwith the complementary feeding indicators. By contrast, residentialarea and household income were negatively associated with exclusivelybreastfeeding.

Conclusions: The exclusively breastfeeding rate at <6 mo old islow, and complementary feeding practice is not optimal in China.Residential areas, household income, and maternal education might berelated to infant and young child feeding indicators.

Funding SourcesChinese Central Government.

Association betweenBreastfeedingDuration andDietary Intakesduring Childhood According to Exposure to Gestational DiabetesMellitus in Utero (P13-035)

Camille Dugas,1 Julie Perron,2 S JohnWeisnagel,3 IsabelleMarc,3and Julie Robitaille1

1Laval University, Canada; 2Institute of Nutrition and FunctionalFoods, Canada; and 3CHU de Québec Research Center, Canada

Objective: The aim of this study was to evaluate the associationbetween breastfeeding duration and dietary intakes during childhoodamong children exposed and not exposed to gestational diabetesmellitus (GDM) in utero.

Methods:A total of 107 children exposed (GDM+) and 54 childrennot exposed (GDM–) to GDM in utero participated in this cohortstudy. At the time of the visit, data on breastfeeding duration (inmonths) were retrospectively collected using a questionnaire. A traineddietician assessed children’s dietary intakes using two 24-h recalls.Mean dietary intakes of children were used. Spearman correlationswere performed to assess the association between total and exclusivebreastfeeding duration with children’s diet, i.e., intakes of fruits andvegetables, meat and alternatives, grain products, milk and alternatives,energy and dietary fiber intakes, as well as percentage of energyfrom macronutrients. Dietary intakes of children were comparedaccording to the median duration of breastfeeding (8 mo) in GDM+and GDM– children separately. Dietary intakes were also compared

between GDM+ and GDM– children breastfed ≤8 mo and thosebreastfed >8 mo. Adjustments for age and sex were made.

Results: The mean ± SD age of GDM+ and GDM– childrenwas 6.0 ± 2.5 and 7.1 ± 3.0 y, respectively (P = 0.01). The meandurations of total and exclusive breastfeeding were similar betweenGDM+ and GDM– children (P > 0.05). Among the GDM+ children,neither total nor exclusive breastfeeding duration was correlated withdietary intakes (P > 0.05). However, among GDM– children, totalbreastfeeding duration tended to be negatively associated with energyintake (r = –0.27, P = 0.07) and with grain products servings (r = –0.29, P= 0.06). Dietary intakes were similar between children breastfed≤8mo and those breastfed>8mo amongGDM+ andGDM– children.However, GDM+ children breastfed ≤8 mo consumed significantlyless dietary fiber than GDM– children who were breastfed >8 mo(P = 0.04).

Conclusions: These results suggest that breastfeeding durationtends to be associated with diet in GDM– children but is not associatedwith later dietary intakes among GDM+ children, a group at high riskof obesity and type 2 diabetes.

Funding SourcesThe Danone Institute of Canada, Diabetes Canada.

Validation of a Nutritional Risk Screening Tool for HospitalizedPediatric Patients (P13-036)

Eliane Said Dutra, Juliana Rolim Vieira Maciel, Camila Cruz,Monique Cunha, and Kênia Carvalho

University of Brasilia, Brazil

Objective: The aim of this study was to validate a nutritional riskscreening tool in hospitalized pediatric patients.

Methods: We undertook a descriptive cross-sectional study of arepresentative sample of children hospitalized for pediatric emergenciesin Brasilia, Federal District of Brazil. The inclusion criterion was agebetween 1 mo and 10 y old (both sexes). All those whose nutritionalstatus required specific procedures for evaluation were excluded. Thesamplewas randomized by stages, and the error estimatewas fixed at 5%with a margin of error of 5%. The final sample comprised 207 children,from 10 hospitals. The data was collected over 3 consecutive months,and it was realized in blocks, on random days of the week. The toolused was Screening Tool for Risk On Nutritional Status and Growth(STRONGkids), which allows the risk of malnutrition to be classifiedas high, medium, or low. To validate the tool, the results were comparedwith anthropometric measures: weight, height, and arm circumference.The classifications of the anthropometric indices were according tothe WHO reference curves. Data were tabulated, dispersion measuresand the frequencies of variables were calculated, and associations weremade. The accuracy of the tool was verified by the sensibility, specificity,and positive and negative predictive values. The study was approved bythe Research Ethics Committee.

Results: A sample of 271 children was studied, 56.46% of whomwere male, and the mean ± SD age was 37.94 ± 31.33 mo (95% CI:34.20, 41.69 mo). The anthropometric indices identified that 46.13%of the children were at risk, 12.18% of whom were malnourished.The STRONGkids identified 75.28% at medium and 3.32% at highnutritional risk. The screening tool showed 84.8% sensibility, 26.7%


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specificity, 49.8% positive predictive value, and 67.2% negative predic-tive value when patients were identified as being at risk according to theanthropometric assessment.

Conclusions: It was possible to validate the tool; its sensibility washigh and allowed the early identification of nutritional risk. It is an easy-to-use tool for nutritional risk screening at hospitalization. It does notreplace anthropometry; rather, it is complementary to it.

Best Portion Control Practices for Young Children: What DoParents Think and Do? (P13-037)

Kaitlyn Eck,1 Oluremi Famodu,2 Kaitlyn Eck,1 Colleen Delaney,1Melissa D Olfert,3 Carol Byrd-Bredbenner,1 and Karla Shelnutt2

1Rutgers University, NJ; 2Univeristy of Florida; and 3West VirginiaUniversity

Objective:The aim of this study was to determine parents’ attitudes,beliefs, barriers, and facilitators related to controlling children’s portionsizes.

Methods: Brief questionnaires were completed by 185 English- andSpanish-speaking parents of children 6–11 y old from 3 states (FL, WV,NJ), and 36 participated in portion control–themed focus groups.

Results: Survey completers indicated that they let children decidehow much to eat most the time, but not always. Content analysis offocus group data revealed an overarching attitude of parents feelingit was not important for them to exert control over the amounts offood their children ate because children were very physically active andthey relied on internal hunger cues to regulate their intake. However,if children had health or weight problems, or a potential to be sickfrom overconsumption, parents sought professional advice and reliedon past experience to determine the amounts to serve the children.Parents agreed that their own portion control behaviors affected theamounts that children eat, as did siblings and media. Changes frompreschool to elementary school that facilitated portion control includedchildren being more aware of how much and what they should eat andhaving more structured mealtime routines. However, busy schedulesthat interrupted the children’s routines and their exposure to anddesire for unhealthy snacks hindered keeping serving sizes healthy.Other barriers to controlling children’s portion sizes named by English-speaking parents included children snacking often and not beinghungry for meals, or lacking interest in eating when meals were served.A barrier among Spanish-speaking parents was lack of knowledgeregarding age-appropriate portion sizes for children. Strategies thatparents used to overcome barriers were portioning food ahead oftime, talking with children about appropriate amounts of food, usingresources (e.g., plates, utensils) to guide serving sizes, and restrictingfree access to snack foods. Strategies for serving healthy amounts topicky eaters were accepting that they may not like certain foods andoffering them other food options.

Conclusions: Nutrition education efforts that enhance parentknowledge of and value placed on portion control and that providestrategies for effective, healthful portion control could help parents toprevent childhood obesity.

Funding SourcesUSDA, National Institute of Food and Agriculture, Grant Number

2017-680,001-26,351.

Complementary Feeding andGrowth, Size, and/or BodyCompo-sition: A Systematic Review (P13-038)

Laural K English,1 Julie Obbagy,2 Nancy F Butte,3 Kathryn GDewey,4 David M Fleischer,5 Mary Fox,6 Frank R Greer,7 NancyF Krebs,8 Kelley S Scanlon,2 Eve E Stoody,2 and Yat Ping Wong2

1The Panum Group; 2USDA, Food and Nutrition Service; 3BaylorCollege of Medicine, TX; 4University of California, Davis; 5Universityof Colorado School of Medicine; 6Mathematica Policy Research;7University of Wisconsin School of Medicine and Public Health; and8University of Colorado School of Medicine

Objective: The aim of this study was to conduct systematic reviewsto examine the relation between timing of introduction or types andamounts of complementary foods and beverages (CFB) and growth,size, and/or body composition outcomes across the lifespan.

Methods: The literature was searched in PubMed, Cochrane,Embase, and CINAHL using predetermined inclusion and exclusioncriteria. The systematic review consisted of the following steps: dataextraction, risk of bias assessment, qualitative synthesis, conclusionstatement development, and grading based on strength.

Results: A total of 81 articles examined the timing of CFB intro-duction and 49 examined the types or amounts of meat, cereal, fats orfatty acids, sugar-sweetened beverages (SSB), juice, and other CFB, andspecific dietary patterns. Moderate evidence suggests that introductionofCFBbetween the ages of 4 and 5mo comparedwith 6mo is not associ-ated with growth, size, and body composition among generally healthy,full-term infants. Limited evidence suggests that introduction of CFBbefore age 4 mo may be associated with higher odds of overweightor obesity. Insufficient evidence exists regarding introduction at age≥7 mo and growth, size, or body composition. Moderate evidencesuggests that meat or CFB with different fats or fatty acids do not favor-ably or unfavorably influence growth, size, and/or body composition.However, there is insufficient evidence to determine a relation betweenintake of meat or CFB with different fats or fatty acids and overweightor obesity. Limited evidence is available to draw conclusions about therelation between cereal, SSBs, and juice relative to outcomes. Insufficientevidence is available to draw conclusions about the relation betweenother CFB and dietary patterns relative to outcomes.

Conclusions: Additional research, including RCTs, is needed toaddress gaps and limitations in the evidence on complementary feedingand growth, size, and/or body composition, such as research examininga wider range of specific types of CFB, and that accounts for potentialconfounders (e.g., milk-feeding, baseline growth status) and reversecausality (e.g., rationale for timing, type, and/or amounts of CFB).



Maternal Fish Oil Supplementation Potentiates Fetal Brown Adi-pose Tissue Development Conferring Augmented Thermogenesis toOffspring (P13-039)

Rong Fan, Ashley Mulcahy, and Soonkyu Chung

University of Nebraska-Lincoln


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Objective: Brown adipose tissue (BAT) plays a crucial role in energyhomeostasis by promoting thermal energy expenditure. Previously, wedemonstrated that n–3 (ω-3) polyunsaturated fatty acids (n–3 PUFA)promote brown adipogenesis in vitro. Given that BAT is formed duringthe late stage of pregnancy, we aimed to investigate the effects ofmaternal n–3 PUFA supplementation on fetal BAT development andthermogenic responses in later life.

Methods: Parental C57BL/6 mice were fed with an isocaloricdiet containing either 10% fish oil (FO) or 10% palm oil (Cont)throughout pregnancy and lactation. The BAT from the weaned pups(n = 8) was collected to determine the brown-specific gene, protein,and micro-RNA (miRNA) profiles, and epigenetic marks for histonemodification. Subsequently, 10-wk-old offspring mice that received adiet with (FO, n = 8) or without (Cont, n = 8) maternal n–3 PUFAwere used to measure energy expenditure by a metabolic cage andcold-induced thermogenesis. To determine the histone acetylation inthe UCP1 promoter region, a chromatin immunoprecipitation (ChIP)assay was performed in H1B1B brown preadipocytes treated witheicosapentaenoic acid (EPA, 100 µM) during adipocyte differentiation.

Results: Maternal n–3 PUFA intake was effectively delivered tothe neonates with a 5-fold elevation of blood n–3/n–6 ratio. Also,maternal n–3 PUFA intake resulted in augmented BAT in neonates,as evidenced by 1) upregulation of brown-specific genes and proteins,2) increases in functional clusters of brown-specific miRNAs (i.e.,miR30b and miR193b/365) and Drosha, an miRNA-editing enzyme formiRNA biogenesis, and 3) increased histone H3 acetylation at lysine27 (H3K27Ac), an epigenetic marker for adipogenesis, and decreasedhistone deacetylase 1. The ChIP assay revealed >3-fold enrichment ofH3K27Ac at the UCP1 and Pgc1-α promoter regions in the EPA-treatedbrown adipocytes compared with the control. The offspring of the micereceiving FO exhibited a significant increase (P= 0.037) in whole-bodyenergy expenditure and better maintenance of core body temperatureagainst acute cold treatment (8°C).

Conclusions: Maternal n–3 PUFA intake potentiates fetal BATdevelopment via synergistic modifications of histone acetylation andmiRNA production, which may confer long-lasting metabolic benefitsto offspring.

Funding SourcesNIH Grant 1P20GM104320.

Association between Vitamin D Status in Early Pregnancy andGestational Weight Gain: A Prospective Cohort in Rio de Janeiro,Brazil (P13-040)

Amanda CCunha Figueiredo,1 Thais Rangel,1 Mônica de AraújoBatalha,1 Dayana Rodrigues Farias,1 Erica Guimarães Barros,1Aline Ferreira,1 Michael F Holick,2 RanaMokhtar,2 and GilbertoKac1

1Rio de Janeiro Federal University, Brazil; and 2Boston University,MA

Objective: The aim of this study was to evaluate the associationbetween vitamin D status in early pregnancy, body weight (BW)throughout pregnancy, and total gestational weight gain (GWG).

Methods: A prospective cohort of 163 healthy pregnant womenfrom Rio de Janeiro was followed during gestational weeks 5–13(baseline), 20–26 and 30–36. Plasma 25-hydroxyvitamin D [25(OH)D]

concentration was measured using LC-MS/MS and categorized asadequate (≥50 nmol/L) or inadequate (<50 nmol/L). Maternal BWwas evaluated in each gestational trimester. GWG (kilograms) wascalculated as the difference between weight measured prior to deliveryand weight measured at the baseline, and was classified as insufficient,adequate, or excessive according to the Institute of Medicine. Statisticalanalyses were performed using longitudinal linear mixed-effects andlogistic regression models. The confounders were selected based on adirected acyclic graph, and the model was adjusted for gestational age,age, self-reported skin color, alcohol intake, smoking, education, anddaily energy intake during pregnancy.

Results:The prevalence of vitaminD inadequacy was 16.6% in earlypregnancy. The mean± SD BW in the first, second, and third trimesterwas 63.3± 11.9, 68.6± 11.7, and 72.5± 11.8 kg, respectively. RegardingGWG, 30% of the women had insufficient, 35% adequate, and 35%excessive GWG. There was a longitudinal increase (β = 4.49; 95% CI:2.37, 6.60; P < 0.001) in BW throughout pregnancy among womenwith vitamin D inadequacy at baseline compared with women withadequacy. Women with vitamin D inadequacy in early pregnancy werealso at higher risk of having excessive total GWG (OR: 2.61; 95% CI:1.07, 6.36; P = 0.035).

Conclusions: We found an inverse association between vitamin Dstatus adequacy in early pregnancy and gestational BW and GWG.

Funding SourcesFunded by the Carlos Chagas Filho Foundation for Research

Support of Rio de Janeiro State (FAPERJ) and the National Council forScientific and Technological Development (CNPq).

Association between Dietary Fiber Intakes and Nutrient Intakes:Data from the Feeding Infants and Toddlers Study 2016 (P13-041)

Kristen L Finn,1 Emma Jacquier,2 BrianKineman,1 Heidi Storm,1Erin Quann,1 and Ryan Carvalho1

1Nestlé Nutrition; and 2Nestlé Research Center, Switzerland

Objective: The aim of this study was to compare energy-adjustednutrient intakes among young children between low energy–adjusteddietary fiber intake and those who had high energy–adjusted dietaryfiber intake according to data from the Feeding Infants and ToddlersStudy (FITS) 2016.

Methods: FITS 2016 is a cross-sectional survey of children aged0–47.9 mo in the United States. One 24-h dietary recall was used tocollect data on food and beverage intake (n = 3428). The energy-adjusted nutrient intakes (nutrient per 1000 kcal) of children in thelowest quartile of energy-adjusted dietary fiber intake (12–23.9 mo≤5.6 g/1000 kcal, 24–35.6 mo ≤6.3 g/1000 kcal, 36–47.9 mo ≤5.9g/1000 kcal) were compared with those in the highest quartile (12–23.9mo ≥10.7 g/1000 kcal, 24–35.6 mo ≥10.9 g/1000 kcal, 36–47.9 mo≥10.2 g/1000 kcal) with paired t tests.

Results: Intakes of fat and saturated fat were significantly loweramong children in the highest quartile compared with the lowestquartile across all age groups. Sodium intakes were lower amongchildren in the highest quartile compared with the lowest quartileamong children aged 12–23.9 and 36–47.9 mo. Intakes of dietaryfiber, vitamin C, vitamin A, niacin, vitamin B-6, folate equivalents,magnesium, iron, and potassium were significantly higher amongchildren in the highest quartile comparedwith the lowest quartile across


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all age groups. Intakes of certain vitamins andmineralswere lower in thehighest quartile compared with the lowest quartile differentially acrossage groups (12–23.9 mo for vitamin B-12 and calcium, 12–23.9 and36–47.9 mo for vitamin D).

Conclusions: Dietary fiber intakes of ≥10 g/1000 kcal are as-sociated with improved average nutrient intakes of saturated fat,dietary fiber, vitamin C, vitamin A, niacin, vitamin B-6, folateequivalents, magnesium, iron, and potassium compared with intakes of≤5–6 g/1000 kcal among children aged 12–47.9mo. Encouraging intakeof diets with adequate fiber may be an effective strategy to improve dietquality among infants and young children.

Funding SourcesNestlé Research Center, Switzerland.

Frequency of Milk Consumption and Malaria in the DemocraticRepublic of Congo Positively Associated with Linear Growth (P13-042)

Merry Fitzpatrick and Shibani Ghosh

Friedman School of Nutrition Science and Policy, Tufts University,MA

Objective: Formulations for supplementary foods to prevent stunt-ing or to promote catch-up growth vary by their ingredients andtherefore their cost and shelf life. The inclusion of milk solids hasbeen at the center of this debate. This analysis investigates the relativeassociation of different nutrient-dense foods and linear growth in theDemocratic Republic of Congo (DRC) in a population of children withhigh rates of kwashiorkor and stunting.

Methods: This study is a secondary analysis of a cross-sectionalobservational survey of young children aged 36–48 mo (n = 333) ineastern DRC. In addition to anthropometric measures [age, height,weight, midupper arm circumference (MUAC), and edema], care-givers responded to a 7-d household food frequency questionnaireand a 24-h diet recall for the child, and provided other relatedinformation on the household and the child. The relative associationof amounts of individual foods, frequency of consuming those foods,MUAC, weight for height, recent illness, child care habits, sanitation,and wealth with height-for-age z scores (HAZ) was assessed usingmultivariate linear regressions with standardized coefficients.

Results: The mean ± SD HAZ was –2.43 ± 1.38, and 61.26% ±0.49% of children had aHAZ score<–2. The prevalence of kwashiorkorwas 3.0%. While controlling for age and sex, MUAC and frequency ofcow’s milk consumption had the strongest positive associations withlinear growth (HAZ), whereas frequency of onion consumption had thestrongest negative association. Presence ofmalaria was also significantlyand positively associated with HAZ.

Conclusions: This secondary analysis adds to a growing body of ev-idence associating linear growth andmilk consumption in a populationof children that have high rates of stunting and kwashiorkor. While thefrequency of consumption of milk was associated with linear growth,we also find a positive association of HAZ andmalaria, possibly becauseparasites like malaria are likely to thrive in better nourished children.

Funding SourcesNo funding was required for this secondary analysis. SG was

supported in part by AID-OAA-L-10-00006.

Infant and Young Child Feeding Practices in Lagos and KadunaStates: Baseline Alive & Thrive Nigeria Household Survey Findings(P13-043)

Valerie L Flax,1 Safaa Amer,1 Jennifer Unangst,1 Shawn Karns,1Comfort Boman,1 Kavita Singh,2 Timothy Kim,2 AshleyHagaman,2 Michael Close,2 and Mariam Fagbemi3

1RTI International; 2University of North Carolina; and 3TNS RMSNigeria Ltd

Objectives: Our aims were to obtain baseline data on infant andyoung child feeding (IYCF) practices in 2 states of Nigeria to helpAlive & Thrive (A&T) finalize interventions and to compare practicesby intervention area and urban or rural location.

Methods:We randomized two-thirds of the local government areasto intervention and one-third to comparison, and collected population-based household survey data on IYCF knowledge and practices frommothers with a child 0–23 mo of age (n = 6288). We calculatedWHO IYCFpractice indicators and testedweighted differences betweengroups using chi-square and t tests.

Results: We found no differences in core IYCF practices betweenthe A&T intervention and comparison areas. Approximately 43% ofmothers reported initiation of breastfeeding within 1 h of birth. Someof the delays in breastfeeding initiation may be related to the prelactealfeeds given to 20% of children. Of the mothers with children aged 0–5 mo, 40% exclusively breastfed. Early introduction of water and/orcomplementary foods was common, and was likely related to mothers’belief that infants need water when it is hot, their perceptions ofinsufficient breastmilk production, and their lack of awareness thatmore frequent breastfeeding can increase milk supply. Only 30% ofchildren achieved minimum dietary diversity, in part because severalfoods were introduced late, especially meat and green leafy vegetables.Nearly 60% of children achieved minimum meal frequency; however,the mean meal frequency was lower than recommended for childrenaged 9–23 mo. We found many differences between urban and ruralareas. Early initiation of breastfeeding (48% vs. 32%) and exclusivebreastfeeding (51% vs. 20%) were more common in urban than ruralareas. A lower percentage of mothers continued breastfeeding at 1(80% vs. 96%) and 2 y (10% vs. 25%) in urban than rural areas.Minimum dietary diversity was higher (35% vs. 19%), but minimummeal frequency was lower (55% vs. 76%), in urban than rural areas.

Conclusions: These findings point to gaps in IYCF knowledge andpractices that can be used to guide the design of A&T messaging andshed light on urban IYCF practices, which are not well characterized insub-Saharan Africa.

Funding SourcesThis research was funded by the Bill & Melinda Gates Foundation

through FHI 360.

Nigerian Private and PublicHealth Providers’ Knowledge, Coun-seling, andOtherActionsRelated to Infant andYoungChild Feeding(P13-044)

Valerie L Flax,1 Safaa Amer,1 Jennifer Unangst,1 Shawn Karns,1Comfort Boman,1 Timothy Kim,2 Kavita Singh,2 and MariamFagbemi3


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1RTI International; 2University of North Carolina; and 3TNS RMSNigeria Ltd

Objective: As part of the Alive & Thrive (A&T) Nigeria impactevaluation, we documented health providers’ knowledge, counseling,and actions related to infant and young child feeding (IYCF) prior tothe intervention, and assessed baseline differences between randomizedstudy arms.

Methods: We selected a random sample of facility-based providers(n= 159), stratified by facility type, pharmacists or chemists (n= 140),and traditional birth attendants (TBAs, n = 71). All of the pharmacistsor chemists and TBAs and 64% of the facility-based providers in thesample were private providers. We used separate questionnaires foreach type of provider. We calculated proportions and means, and testedweighted differences between study arms using chi-square and t tests.

Results: Across providers, we found high levels of knowledge aboutearly initiation of breastfeeding (74–80%), colostrum (85–100%), andthe definition of exclusive breastfeeding (86–100%). Facility-basedproviders and pharmacists or chemists knew the appropriate feedingfrequency for children aged 6–23 mo. However, we found several gapsin providers’ IYCF knowledge. Only 35–49% knew that more frequentbreastfeeding increases milk production, 41–54% said it is okay to usefeeding bottles, and 25–50% recommended breastfeeding for <24 mo.The facility-based providers and pharmacists or chemists thought thatmany foods, such as animal-source foods and tubers, should not beintroduced until after a child is 9 mo old. Knowledge of timing ofintroduction of complementary foods was lower in the interventionarm. Of the facility-based providers, 43% and 37% said they hadconducted individual and group IYCF counseling, respectively, in thelast 6 mo. Their counseling focused on breastfeeding. Nearly 40% ofthe TBAs reported that their first action after delivery was to clean theinfant, and 36% said they had advised their clients at delivery not tostart breastfeeding until the infant is clean. Only 52% of TBAs said thatcolostrum or breastmilk was the first thing put in the child’s mouth. Themost commonly given prelacteal feeds were honey and water.

Conclusions: These findings fill the gap in information aboutNigerian providers’ IYCF knowledge and capacity, and can be used totailor A&T Nigeria training for health providers.

Funding SourcesThis study was funded by the Bill & Melinda Gates Foundation

through FHI 360.

Dietary Bovine and Human Milk Oligosaccharides InfluenceRegional Brain Volumes and Recognition Memory in the Young Pig(P13-045)

Stephen A Fleming,1 Austin Mudd,1 Jonas Hauser,2 Jian Yan,3Sharon M Donovan,1 and Ryan Dilger1

1University of Illinois at Urbana-Champaign; 2Nestlé ResearchCenter; and 3Nestlé Nutrition R&D

Objective: The presence of prebiotics in the neonatal diet is impor-tant for stimulation and maturation of the infant microbiome. Recentresearch suggests provision of particular prebiotics also influencesbrain development and behavior. The objective of this study was todetermine the influence of dietary bovine (BMOs) and human milkoligosaccharides (HMOs, as a combination of 2′-fucosyllactose and

lacto-N-neotetraose) on brain development and cognition using atranslational piglet model.

Methods: Beginning at 2 d of age, 48 (n = 12 per treatment) malepigs received 1 of 4milk replacers formulated to contain: control (CON;0 g/L BMOs + 0 g/L HMOs), BMOs (CON + 6.5 g/L BMOs), HMOs(CON + 1. 5 g/L HMOs), or BMOs + HMOs (CON + 1. 5 g/LHMOs + 6.5 g/L BMOs). All diets contained a formulation space of8 g/L, which was reserved for the addition of dietary test articles, andlactose was used to balance the formulations. At 22 d of age, pigs weretested on the novel object recognition task using delays of 1 h or 2 d. At32 d of age, pigs were subjected to MRI procedures to assess structuralbrain development.

Results: Pigs in the HMOs group exhibited recognition memoryafter a 1-h delay (P = 0.038) and pigs in the BMOs + HMOs groupexhibited recognition memory after a 2-d delay (P = 0.045). Analysisof relative brain volumes indicated interactive dietary effects for thecaudate (P = 0.02), lateral ventricle (P = 0.034), and pons (P = 0.014).Pigs in the BMOs group exhibited smaller (P = 0.038) relative corpuscallosum volumes than the other treatment groups. Conversely, pigs inthe HMOs group exhibited larger relative volumes of the right cortex(P = 0.023) and left cortex (P = 0.005) than the other groups.

Conclusions: To our knowledge, this is one of the first studies to useMRI to assess the impact of bovine and human milk oligosaccharideson brain development. Based on this evidence, it is possible thatobserved differences in brain volumes could be because of alterationsin synaptogenesis, neuronal expansion, or increased glial presence inthe brain, which may have impacted behavioral performance. Futurework will seek to analyze changes in brain gene and protein expressionto elucidate mechanisms by which dietary prebiotics might influencethe brain changes.

Funding SourcesFunded by Nestlé Nutrition R&D.

Dietary Oligofructose andHumanMilk Oligosaccharides Differ-entially Improve Recognition Memory while Minimally InfluencingBrain Development in the Young Pig (P13-046)

Stephen A Fleming,1 Austin Mudd,1 Jonas Hauser,2 Jian Yan,3Sharon M Donovan,1 and Ryan Dilger1

1University of Illinois at Urbana-Champaign; 2Nestlé ResearchCenter; and 3Nestlé Nutrition R&D

Objective: Emerging research suggests dietary intake of oligosac-charides may improve cognition and affect brain development. Theobjective of this study was to determine the influence of dietaryoligofructose (OF) and human milk oligosaccharides (HMOs, as 2′-fucosyllactose) on brain development and cognition using a transla-tional piglet model.

Methods: Beginning at 2 d of age, 36 (n = 12 per treatment) malepigs received 1 of 3milk replacers formulated to contain: control (CON;0 g/L OF + 0 g/L HMOs), OF (CON + 5 g/L OF), or OF + HMOs(CON + 5 g/L OF + 1.0 g/L HMOs). All diets contained a formulationspace of 8 g/L, which was reserved for the addition of dietary testarticles, and lactose was used to balance the formulations. Pigs weretested on the novel object recognition task using delays of 1 h or 2 dat 22 d of age. At 32 d of age, pigs were subjected to MRI procedures toassess macrostructural and microstructural brain development.


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Results: Piglets consuming OF exhibited recognition memory aftera 1-h delay and piglets consuming OF + HMOs exhibited recognitionmemory after a 2-d delay (all P < 0.001). There were no significantdifferences in behavior during the habituation or sample trials (allP > 0.125). However, across the duration of the first habituation trial,piglets consuming OF trended toward moving less (P = 0.084). Pigletsprovided with OF + HMOs visited the novel object a greater numberof times during the test trial after a 2-d delay (P = 0.013) comparedwith CON piglets. Additionally, piglets provided with OF + HMOshabituated to the sample object more quickly than the CON pigletsgroup after a 2-d delay, but this effect was reversed after a 1-h delay(P= 0.039). As a proportion of total brain volume, OF andOF+HMOspiglets exhibited a larger relative volume of the olfactory bulbs thanthe CON piglets (P = 0.02). Piglets consuming the CON diet tendedto have larger (P = 0.07) relative caudate volumes, whereas OF pigletstended to have larger left (P = 0.06) and right (P = 0.06) hippocampalvolumes. Voxel-basedmorphometry indicated diet-induced differencesin cerebellar grey matter concentrations as well as white matterconcentrations of the internal capsule.

Conclusions: Collectively, these data indicate that OF orOF + HMOs differentially improve cognitive performance but donot greatly alter the trajectory of brain development in young pigs.

Funding SourcesThis project was funded by Nestlé Nutrition R&D.

Longitudinal Associations of Maternal Vitamin D Status duringPregnancy and Neonatal Anthropometric Measures (P13-047)

Ellen C Francis,1 Stefanie Hinkle,2 Shristi Rawal,3 Yiqing Song,4Sarah Donnelly,5 Danping Liu,6 Yeyi Zhu,7 Michael Tsai,8 LiweiChen,1 and Cuilin Zhang2

1Clemson University, SC; 2NIH/NICHD; 3Rutgers University, NJ;4Indiana University; 5Virginia Tech; 6NIH/NCI; 7Kaiser Permanente,CA; and 8University of Minnesota

Objective: Previous findings on maternal vitamin D [25(OH)D]and neonatal anthropometry are conflicting, partly because of a lackof longitudinal 25(OH)Dmeasurements across gestation to account forits variations. The current study investigated longitudinal associationsof maternal 25(OH)D during pregnancy with neonatal anthropometricmeasures.

Methods: The study included 321 mother-offspring pairs enrolledin the prospective NICHD Fetal Growth Study—Singletons. Maternal25(OH)D was measured 4 times during pregnancy [at 10–14, 15–26, 23–31, and 33–39 gestational weeks (GW)], and categorized asdeficiency, insufficiency, and sufficiency using the cutoffs of 50 and 75nmol/L. Weighted generalized linear models with robust variance wereused to examine associations of maternal 25(OH)D concentrations ateach visit with birthweight z score, length, and sumof (abdominal flank,anterior thigh, subscapular, and triceps) skinfolds at birth, adjusting formaternal demographics, body mass index, and GW of blood collection.

Results: At 10–14 GW (enrollment),16.8% and 49.2% of womenhad 25(OH)D deficiency and insufficiency, respectively. The directionof association of maternal 25(OH)D with neonatal anthropometrydiffered by women’s prepregnancy obesity and GW. Among overweightor obese women, 25(OH)D deficiency compared with sufficiency at 10–14 GW was associated with lower birthweight z score (β = –0.56; 95%

CI: –0.99, –0.13) and length (β = –1.56 cm; 95% CI: –3.07, –0.06). Inthe normal weight group, women with 25(OH)D deficiency comparedwith those with sufficient 25(OH)D at 33–39 GW had neonates withhigher birthweight z scores (β = 1.22; 95% CI: 0.71, 1.73). Amongoverweight or obese women before prepregnancy, 25(OH)D deficiencyat 23–31 GWwas associated with lower neonatal length (β = –2.77 cm;95% CI: –13.38, –4.98) and sum of skinfolds (β = –9.18 mm; 95% CI:–13.38, –4.98). Among women with normal weight, 25(OH)D de-ficiency at 10–14 GW was associated with lower neonatal sum ofskinfolds (β = –2.64 mm; 95% CI: –5.03, –0.24).

Conclusions: Our findings suggest that maternal 25(OH)D statusduring pregnancy is significantly related to neonatal anthropometricmeasures, and the associations vary by GW andmaternal prepregnancyobesity status.

Funding SourcesThis research was supported by the Eunice Kennedy Shriver

National Institute of Child Health and Human Developmentintramural funding, as well as the American Recovery andReinvestment Act funding (contract numbers HHSN275200800013C,HHSN275200800002I, HHSN27500006, HHSN275200800003IC,HHSN275200800014C, HHSN275200800012C, HHSN275200800028C, HHSN275201000009C, and HHSN275201000001Z).

A Review of the Eating Behaviors and Attitudes Associated withPicky Eating (P13-048)

Lisa R Fries,1 Stef Kremers,2 and Klazine van der Horst1

1Nestlé Research Center; and 2Maastrict University, Netherlands

Objectives: Picky eating is a broad construct that has beeninterpreted in a variety of ways by different researchers, and is probablycomprised of several types of behaviors that contribute to a perceptionof a limited diet or food refusals. The current objectives were to reviewthe literature for the eating behaviors most commonly associated withpicky eating and to discuss potential interventions.

Methods: A systematic literature review was conducted to identifypublications which included behavioral associations with picky eatingin children <10 y old. From the 38 manuscripts that met the inclusioncriteria, the behaviors associated with degree of picky eating or thosethat differentiated picky and nonpicky eaters were extracted.

Results:Picky eatersmay display several different types of behaviors,among which the most common are neophobia (15 studies), lower fruitand vegetable intake (8 studies with a difference; 1 with no difference),food refusals (6 studies), less enjoyment of eating (7 studies with adifference; 1 with no difference), and sensory sensitivities (5 studies).Fruit and vegetable intake and sensory sensitivities were the topicswith the most objective assessment methods. The other domains reliedprimarily on parent response to questionnaire items or subscales, andcould benefit from confirmation from behavioral assessments. Potentialfamily-based intervention strategies from the broader feeding practiceliterature will be discussed.

Conclusions: There is a growing body of evidence that picky eatersmay differ from nonpicky eaters in their neophobia, fruit and vegetableintake, food refusals, enjoyment of eating, and sensory sensitivity. Someof these behaviors (e.g., neophobia) are typically included in pickyeating assessments, whereas others (e.g., sensory sensitivity) are oftenoverlooked.


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Funding SourcesThis review did not have an external funding source. All authors

were supported by their salaries.

Adiponectin Modulates Photoreceptor Metabolism to PreventHyperglycemic Retinopathy of Prematurity (P13-049)

Zhongjie Fu,1,2 ChatarinaA Löfqvist,3 Raffael Liegl,1,2 ZhongxiaoWang,1,2 Ye Sun,1,2 Chi-Hsiu Liu,1,2 Rubi Duran,1,2 AlexanderPoblete,1,2 Steve S Cho,1,2 James D Akula,1,2 Mike Kinter,4Saswata Talukdar,1,2 Ann Hellström,3 and Lois Smith1,2

1Harvard Medical School, MA; 2Boston Children’s Hospital, MA;3University of Gothenburg, Sweden; and 4University of OklahomaHealth Sciences Center

Objective: Hyperglycemia is a novel risk factor for retinopathy ofprematurity (ROP), but its impact has not been widely studied. ROP is aleading cause of blindness in children with early vessel loss followed byneovascularization. We investigated if hyperglycemia inhibited retinalneurovascular development in a newly established mouse model, and ifadiponectin (APN) protected against hyperglycemic ROP.

Methods: To induce hyperglycemia, C57BL/6J (WT) and APN-deficient (Apn-/-) mouse neonatal pups were treated with continuouslow-dose streptozotocin (STZ) for 9 d. Blood glucose and seruminsulin concentrations were measured (n = 4–7), and the retinalvascular network (n = 17–27) and retinal function (n = 7–12)were examined. Retinal key metabolic enzyme concentrations weremeasured by quantitative proteomics (n = 6). Localization of APNreceptors was examined by quantitative polymerase chain reaction inlaser-captured, microdissected retinal neurons (n = 3). The oxygenconsumption rate in 661W photoreceptor cells and hyperglycemicretinas was measured by Seahorse analysis (n = 9). AAV2-RK-shPdgfbwas used for photoreceptor-specific knockdown of platelet-derivedgrowth factor subunit B.

Results: Higher blood glucose and lower serum insulin con-centrations were found in STZ-treated WT mice. Hyperglycemiadelayed retinal vascular growth and decreased retinal function. APNdeficiency further inhibited retinal vessel growth. APN administrationin hyperglycemic WT mice restored retinal vessel growth and retinalfunction (particularly cones). The APN receptor AdipoR1 was dom-inantly expressed in photoreceptors. APN deficiency reduced retinalmetabolic enzyme concentrations. Activation of the APN pathwayincreased the oxygen consumption rate (mitochondrial activity) ofhyperglycemic retinas and 661W. Blockade of mitochondrial respi-ration abolished Pdgfb induction by activating the APN pathwayin 661W. APN deficiency reduced Pdgfb expression in photore-ceptors and photoreceptor-knockdown of Pdgfb inhibited retinalvessel growth.

Conclusions:APNmodulates photoreceptormetabolism to preventhyperglycemia-associated retinal abnormalities at an early stage. Sup-plementation of recombinant APN in parental nutrition may suppressROP in premature infants.

Funding SourcesThis work is supported by NIH EY024864, EY017017, BCH

IDDRC (1U54HD090255), Lowy Medical Research Institute, Euro-pean Commission FP7 project 305,485 PREVENT-ROP (LEHS); The

Swedish Research Council (DNR# 2011-2432) andGothenburg CountyCouncil (ALFGBG-426,531) long-term support by De Blindas Vännerand Kronprinsessan Margaretas Arbetsnämnd för synskadade (AH);project 305,485 PREVENT-ROP (VINNOVA 2009-0,1152) from theEuropean Commission FP7 (CAL); NIH P30AG050911 and the HaroldHamm Diabetes Center at the University of Oklahoma (MK); theKnights Templar Eye Foundation (#76,293) and Blind Children’s Center(#89,282) (ZF); the German Research Foundation (DFG), Li2650/1-1(RL). Knights Templar Eye Foundation (CHL); Boston Children’sHospital OFD/BTREC/CTREC Faculty Career Development Grant(YS).

Dietary Supplement Use among Infants and Toddlers (P13-050)

Jaime J Gahche,1 Kirsten Herrick,2 Nancy Potischman,3 Regan LBailey,4 Namanjeet Ahluwalia,2 and Johanna Dwyer3

1NIH, Office of Dietary Supplements; 2National Center for HealthStatistics; 3NIH; and 4Purdue University, IN

Background: Limited nationally representative data are available onthe use of and nutrient exposures from dietary supplements (DS) ininfants and toddlers; such information is needed to inform policy andresearch needs.

Objective:The aim of this studywas to characterize DS use, estimatenutrient intake from DS, and assess DS trends over time among USinfants and toddlers.

Methods: Using NHANES data (2007–2014), we estimated theprevalence of taking ≥1 DS in the past 30 d by demographiccharacteristics and feeding practices for US infants and toddlers aged<2 y (n = 2823). We estimated average daily intake for vitaminsand minerals typically consumed through DS by age groups and byfeeding practice for infants aged 0–5.9 mo. We also assessed DStrends over time using NHANES 1999–2014 data. SUDAAN was usedto analyze the data, incorporating the survey design and weights;group differences were compared using a t statistic, and tests of trendacross ordinal variables were examined using orthogonal contrastmatrices.

Results: Overall, 18.2% of infants and toddlers had used ≥1 DS inthe past 30 d (19.2% boys; 17.1% girls). Usage was higher in toddlers(12–23.9 mo old; 23.3%) than in infants (0–5.9 mo old: 14.6%; and6–11.9 mo old: 11.6%). Vitamin D and multivitamin infant dropswere the most commonly reported supplement products for those aged<12 mo, whereas chewable multivitamin products were most commonamong toddlers (12–23.9 mo old). For those consuming vitamin D or asupplement containing vitamin D, the average daily intake fromDSwas7.4 µg/d for both infants (0–11 mo old) and toddlers (12–23 mo old).For those consuming a supplement containing vitamin C (common inmultivitamin products), the average daily intake fromDSwas 28.3mg/dfor those aged 0–11 mo and 37.2 mg/d for those aged 12–23 mo. DSuse has remained steady for infants aged 6–11.9 mo and toddlers ahed12–23.9 mo from 1999–2002 to 2011–2014. Over the same time period,DS use has increased for infants aged 0–5.9 mo from 7% to 20%, largelyowing because of the increased use of vitamin D supplements.

Conclusions: Our findings show that 1 in 5 children < 2 y of ageuses ≥1 DS. DS contribute key nutrients such as vitamin D to the dietsof US infants and toddlers.


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Anthropometry andRecipe Acceptability in BreastfeedingMoth-ers and Their Infants Targeted for aMultiple Biofortified Food CropIntervention (P13-051)

Bryan M Gannon,1 Vincent Bonam,2 Varsha Thakker,3 Jere DHaas,1 Shobha Udipi,3 Wesley Bonam,2 Julia L Finkelstein,1 andSaurabh Mehta1

1Cornell University, NY; 2Arogyavaram Medical Centre, India; and3Medical Research Centre, Kasturba Health Society, India

Objective: A multiple biofortified food crop trial among youngchildren and their mothers is planned in India. We sought to determinethe potential to benefit from intervention in this population by assessinganthropometry and acceptability of recipes prepared with multiple bio-fortified foods, including pearl millet, wheat, lentils, and sweet potato.

Methods: Recipes were developed containing crops to be used in anintervention trial. Mother-child pairs were recruited in a preliminaryphase. Weight and height or length were determined in all participants.Mothers and children were separately individually randomized ina crossover design to receive recipes made from either control orbiofortified crops. For children, food intake wasmeasured and averagedover a 3-d period per recipe and crop variety. For mothers, a9-point hedonic scale was used to evaluate color, odor, taste, and overallacceptability. Outcome means were compared using 2-tailed t tests.

Results:Children’smean± SDheight-for-age z scorewas –1.6± 1.5,with 41% <–2. Mean weight-for-length z score was –0.5 ± 1.4, with9.4% <–2. Of the mothers, 25% had a body mass index (BMI) <18.5and 33%had aBMI>25.With regard to children’s food intake, therewasno difference in the intake of biofortified vs. control crop (48.3 ± 26.5vs. 50.9 ± 24.6 g, respectively, P = 0.70). Mean hedonic scores forcolor, odor, taste, or overall did not differ for any recipe (P ≥ 0.12); thecombined overall acceptability score was 8.6 ± 0.1.

Conclusions: In this pilot study, we have confirmed a significantburden of malnutrition in this population, indicating a potential tobenefit from consuming a diet developed with multiple biofortifiedcrops. The recipes piloted were acceptable, and no differences wereevident between the biofortified and control varieties.

Funding SourcesSupported by HarvestPlus.

Heavy Metal Contamination in a Large Sample of United StatesInfant Formulas and Baby Foods (P13-052)

Hannah Gardener,1 Jaclyn Bowen,2 and Sean Callan3

1University of Miami Miller School of Medicine, FL; 2Clean LabelProject; and 3Ellipse Analytics

Objective: Data is lacking on heavy metal contamination inbaby food, which is aimed at a population uniquely susceptible tothe neurotoxic and carcinogenic effects of mercury, lead, arsenic,and cadmium. The goal of this study was to examine heavy metalconcentrations in US baby foods to identify the most contaminatedproduct types and potentially responsible ingredients.

Methods: In total, 564 baby foods were tested across infant andtoddler formulas, cereals, meals, juices/drinks, jars, pouches, snacks,and electrolyte water. Inductively coupled plasma mass spectrometryanalysis of lead, arsenic, mercury, and cadmium was completed usinga modified version of EPA method 6020A. Samples were analyzed

using kinetic energy distribution mode. The heavy metal distributionswere examined, and nonparametric tests were performed to identifycharacteristics (organic, food type, first 5 ingredients) associated withheavy metal concentrations.

Results: Of the 564 products tested, 476 (84%) contained at leasttrace amounts of heavymetals: 37% contained lead (maximum= 183.60µg/kg), 65% arsenic (maximum = 662.73 µg/kg), 57% cadmium(maximum = 103.90 µg/kg), and 4% mercury (maximum = 5.79µg/kg). There was no association between whether the productwas organic and its heavy metal concentrations. Cereals and snackscontained the highest concentrations. Among the products withdetectable mercury, 81% contained rice. Products containing ricewere also higher in arsenic, lead, and cadmium; wheat and quinoawere independently predictive of cadmium; and oat ingredients wereassociated with elevated arsenic and cadmium.

Conclusions: Grain-based baby foods had the highest concen-trations of heavy metals, particularly rice. The long-term effects ofchronic daily low-concentration heavy metal exposure in vulnerablebabies remains poorly understood. This study adds to a growing bodyof literature suggesting the need for public health recommendationsregarding rice consumption in babies.

Funding SourcesClean Label Project.

Feeding Children with Autism Spectrum Disorders: MealtimeBehaviors and Feeding Issues Identified by Parents (P13-053)

Heewon L Gray, Acadia Webber, Chantell Robinson, and BiancaAnuforo

University of South Florida

Objective: Children with autism spectrum disorder (ASD) aremore likely to have problematic mealtime behaviors, which may affectlong-term eating habits and nutritional status. Before conducting anintervention, there is a need to better understand the nature of thefeeding difficulties experienced by the target population. The purposeof this preliminary study was to better understand mealtime behaviorsand feeding issues in children with ASD in Florida.

Methods: A cross-sectional survey was administered to parents of35 children with ASD living in Florida (71% male). The MealtimeSurvey with 49-items, developed and validated by Provost et al.,assessed early history, mealtime location, mealtime behaviors, andfood preferences and restrictions, which reflect parents’ perceptions ofchildren’s mealtime and feeding issues. A total score was calculatedbased on 44 questions and was compared with reference data withtypically developing children from a previous study. Descriptivestatistics and one-sample t test were performed.

Results: Of the 23 out of 35 mothers who nursed their children,61% reported difficulties with breastfeeding.Nearly one-third of parents(31%) reported that their child has food allergies. Most parents (74%)reported that their child resists trying new foods, 71% crave certainfoods, and almost all (97%) avoid certain foods. Almost two-thirds(63%) of parents identified their children as picky eaters, and themost prominent mealtime behavior problems (46%) were “leaves tablefrequently” and/or “restless but sits.” About half (51.4%) reported thattheir child has favorite food textures, and 50% of those reported that itlimits the child’s food intake. There were 29% of participants currently


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avoiding food additives or coloring, 23%were on a lactose-free diet, 17%on a casein-free diet, and 14% on a gluten-free diet. The total scores forthe 44 questions ranged from 1 to 19. The mean ± SD (9.7 ± 4.6) wassignificantly higher than the reference data (6.3 ± 4.3; P < 0.001).

Conclusions:Difficulties in feeding may start early in children withASD, including during breastfeeding. Interventions addressing foodselectivity and mealtime restlessness may be beneficial. Further studiesare needed to determine whether children with specific problems or onspecial diets have any nutrient deficiencies.

Funding SourcesUniversity of South Florida, New Researcher Grant.

Associations between Adult Food Choice Values, Family Charac-teristics, and Child Dietary Intakes from the NHANES 2009–2010FCBS-Child Module (P13-054)

Erin M Green, Urshila Sriram, and Jamie Dollahite

Cornell University, NY

Objective:The aimof this studywas to explore the relations betweenadult food choice values and child dietary intakes, and to identify childand family characteristics associated with stronger food choice values.

Methods:We performed a cross-sectional analysis of the NHANES2009–2010 FCBS-Child Module. Eligible respondents were adults witha child aged 1–15 y (n = 2421). Average daily intakes of fruit,vegetables, dairy, and added sugar among children were assessed usingtwo 24-h diet recalls. Adult food choice values were assessed using5 survey items about the importance of 1) nutrition, 2) price, 3)taste, 4) convenience, and 5) food durability. Additional covariatesincluded child and adult demographic characteristics. Associationswere examined using multiple logistic and linear regression models,with a P value of 0.05 for all models.

Results: Higher importance of nutrition among adult respondentswas significantly associated with higher intakes of fruit (P = 0.018)and lower intakes of added sugar (P = 0.014) among children.Childrenwhose parents reported a higher importance of food durabilityconsumed less added sugar (P = 0.049). In contrast, children whoseparents reported a higher importance of taste consumed more addedsugar (P = 0.04). Adult respondents with less than high schooleducationwere significantlymore likely to value convenience (OR: 1.73,P= 0.039) and food durability (OR: 2.82, P< 0.0001) than respondentswith higher education levels. Non-Hispanic black, Mexican-American,and Hispanic children were significantly more likely to have parentswho highly valued nutrition, convenience, and food durability thanchildren from non-Hispanic white families (P < 0.05 for all). Childage was positively associated with respondents valuing price (OR: 1.03,P= 0.039), but negatively associatedwith respondents valuing nutrition(OR: 0.94, P = 0.002).

Conclusions: Our findings suggest that adult food choice valuesmay impact the nutritional quality of children’s diets and that thesevalues vary significantly based on sociodemographic characteristics ofboth adults and children. Future interventions to improve child dietaryintake should consider parents’ food choice values, paying particularattention to racial and ethnic differences in food choice.

Funding SourcesN/A.

Human Milk Feeding and Diabetes Outcomes in Offspring: ASystematic Review (P13-055)

Darcy Güngör,1 Perrine Nadaud,1 Concetta C LaPergola,1 CarolDreibelbis,1 Nancy Terry,2 Yat Ping Wong,3 Steven A Abrams,4Leila Beker,5 Tova Jacobovits,6 Kirsi M Järvinen-Seppo,7 LaurieA Nommsen-Rivers,8 Kimberly O O’Brien,9 Emily Oken,10,11Rafael Pérez-Escamilla,12 Ekhard E Ziegler,13 and Joanne MSpahn2

1The Panum Group; 2NIH Library; 3USDA, Food and NutritionService; 4Dell Medical School at the University of Texas; 5US Foodand Drug Administration, retired; 6US Food and Drug Administration;7University of Rochester Medical Center, NY; 8University of CincinnatiCollege of Allied Health Sciences; 9Cornell University, NY; 10Divisionof Chronic Disease Research Across the Lifecourse, Department ofPopulation Medicine, Harvard Medical School and Harvard PilgrimHealth Care Institute, MA; 11Department of Nutrition, Harvard Schoolof Public Health, MA; 12Yale School of Public Health, CT; and13University of Iowa

Objective: The USDA and the Department of Health and HumanServices initiated the Pregnancy and Birth to 24 Months project toexamine important public health topics for these populations withsystematic reviews (SRs). The purpose of this SR is to examine therelation between human milk feeding and types 1 and 2 diabetes (T1D,T2D) in offspring.

Methods: An SR team identified articles in PubMed, Cochrane,Embase, and CINAHL with a date range of January 1980 to March2016 thatmet a priori inclusion criteria. After dual-screening the searchresults, extracting data from the included studies, and assessing theirrisk of bias, the SR team synthesized the evidence, drew conclusionstatements, and graded the strength of the evidence.

Results: A total of 38 articles examined the duration of any humanmilk feeding, 18 examined the duration of exclusive human milkfeeding, 21 examined never vs. ever feeding human milk, and noneexamined the intensity, proportion, or amount of human milk fed tomixed-fed infants. Moderate evidence suggests that, among infants fedsome amount of human milk, a shorter vs. longer duration of any orexclusive human milk feeding is associated with a higher relative riskof T1D. Limited evidence suggests that never vs. ever being fed humanmilk is also associated with a higher relative risk of T1D. Limited butconsistent evidence suggests that never vs. ever being fed human milkis associated with a higher relative risk of early-onset T2D; however, noconclusions can be drawn regarding the relations between other humanmilk–feeding practices and T2D.

Conclusions: There is evidence of a relation between the durationsof any and exclusive human milk feeding and T1D, and never vs.ever feeding human milk and T1D and early onset T2D, most ofwhich is observational. Future research should address the gaps inthe literature, and researchers should clearly define their independentvariables, collect data using validated methods, and more consistentlyaddress critical confounders.




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Human Milk Feeding and Risk of Cardiovascular Disease inOffspring: A Systematic Review (P13-056)

Darcy Güngör,1 Perrine Nadaud,1 Concetta C. LaPergola,1 CarolDreibelbis,1 Yat Ping Wong,2 Nancy Terry,3 Steve A Abrams,4Leila Beker,5 Tova Jacobovits,6 Kirsi M Järvinen-Seppo,7 LaurieA Nommsen-Rivers,8 Kimberly O O’Brien,9 Emily Oken,10,11Rafael Pérez-Escamilla,12 Ekhard E Ziegler,13 and Joanne MSpahn2

1The Panum Group; 2USDA, Food and Nutrition Service; 3NIHLibrary; 4Dell Medical School at the University of Texas; 5US Foodand Drug Administration, retired; 6US Food and Drug Administration;7University of Rochester Medical Center, NY; 8University of CincinnatiCollege of Allied Health Sciences; 9Cornell University, NY; 10Divisionof Chronic Disease Research Across the Lifecourse, Department ofPopulation Medicine, Harvard Medical School and Harvard PilgrimHealth Care Institute, MA; 11Department of Nutrition, Harvard Schoolof Public Health; 12Yale School of Public Health, CT; and 13Universityof Iowa

Objective: The USDA and the Department of Health and HumanServices initiated the Pregnancy and Birth to 24 Months project toexamine important public health topics for these populations withsystematic reviews (SRs). The purpose of this SR is to examine therelation between humanmilk feeding and risk of cardiovascular disease(CVD) in offspring in childhood, adolescence, and adulthood.

Methods: An SR team identified articles in PubMed, Cochrane,Embase, and CINAHL with a date range of January 1980 to march2016 that met a priori inclusion criteria. After dual-screening the searchresults, extracting data from the included studies, and assessing theirrisk of bias, the SR team synthesized the evidence by age group, drewconclusion statements, and graded the strength of the evidence.

Results: A total of 28 articles examined the duration of any humanmilk feeding, 7 examined the duration of exclusive humanmilk feeding,16 examined never vs. ever feeding human milk, and none examinedthe intensity, proportion, or amount of human milk fed to mixed-fedinfants. An SR team developed conclusions that varied in strength fromgrade not assignable for CVD as an endpoint outcome to limited ormoderate for some intermediate outcomes like blood pressure (BP).For example, moderate evidence suggests that never vs. ever beingfed human milk is associated with higher BP at age 6–7 y. However,moderate and limited evidence suggest, respectively, that the durationsof any and exclusive humanmilk feeding do not appear to be associatedwith childhood BP. Because of a lack of evidence, no conclusionscould be drawn regarding the relations between human milk–feedingpractices and BP in adolescents and adults.

Conclusions: The relation between human milk feeding and CVDhas not been widely studied, although some research, most of which isobservational, examines intermediate outcomes like BP. Future researchshould address the gaps in the literature, and researchers shouldclearly define their independent variables, collect data using validatedmethods, and more consistently address critical confounders.



Iron Deficiency and Weight Status in Young Children withElevatedWeight-for-Length: NHANES 2005–2010 (P13-057)

Priya M Gupta, Jennifer Nelson, Alyson B Goodman, Heather CHamner, Andrea J Sharma, Zuguo Mei, and David S Freedman

Centers for Disease Control and Prevention

Objective: There is a growing body of evidence describing theassociation between inflammation and iron deficiency (ID). Evidencesuggests that obesity is an inflammatory state. To our knowledge, onlyone study, published in 2004, examined the relation between weightstatus (overweight or obese) and ID in the United States. This studyprovides the most current prevalence estimates of ID by weight statusamong children in the United States.

Methods: Data were pooled from the 2003–2010 NHANES, themost recent survey year that included indicators for total body iron(TBI). ID was defined as TBI <0 mg/kg. Weight categories for childrenaged 1–<2 and 2–5 y were based on weight-for-length z scores (WHZ)and body mass index z scores (BMIZ), respectively. Weight categoriesfor children aged <2 y included –1 ≤ WHZ < 1, 1 ≤ WHZ < 2,and WHZ ≥ 2. Weight categories for children aged ≥2 y included–1.645 ≤ BMIZ < 1.036 (healthy weight), 1.036 ≤ BMIZ < 1.645(overweight), and BMIZ ≥ 1.645 (has obesity). We calculated ID byweight status and compared overall differences in prevalence by weightcategory (chi-square test,P< 0.05).We used logistic regression to assessthe relation between increases in WHZ and BMIZ on odds of irondeficiency. All analyses were weighted and account for the complexsurvey design.

Results: The prevalence of ID was 15.5% and 5.4% for children aged1–<2 and 2–5 y, respecively (chi-square test, P < 0.05). Unadjustedmodels suggest that single-unit increases in WHZ and BMIZ wereassociated with increased odds of iron deficiency (OR: 1.4; 95% CI: 1.1,1.9 and OR: 1.4; 95% CI: 1.2, 1.7, respectfully).

Conclusions: Nationally representative data suggest that the oddsof iron deficiency may be higher among children with high WHZ orBMIZ. Our findings suggest that guidelines for screening for ID inyoung children may need to consider elevated weight-for-length andbody-mass-index.

Funding SourcesN/A.

B-Vitamins Are Correlated, but also Low, in Milk from RuralCambodianWomen (P13-059)

Daniela Hampel,1 Setareh Shahab-Ferdows,2 Hou Kroeum,3Prak Sophonneary,4 Timothy J Green,5 Lindsay Allen,2 and KylyC Whitfield5

1UC Davis/USDA/ARS-WHNRC; 2USDA/ARS-WHNRC; 3HelenKeller International; 4Ministry of Health; and 5South Australia Healthand Medical Research Institute

Objectives: While thiamin deficiency remains a public healthconcern in Cambodia, less is known regarding the status of otherB vitamins. The aims of this study were to determine B vitaminconcentrations in milk (as a proxy for maternal and infant status)fromCambodianmothers previously enrolled in a thiamin-fortified fishsauce trial (NTC02221063), and also examine correlations among milkB vitamins.


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Methods: Pregnant women (18–45 y old, 23 ± 7 wk gestation atbaseline) in Prey Veng province were randomized to receive control(0 g/L thiamin hydrochloride), low (2 g/L), or high (8 g/L)concentrations of thiamin-fortified fish sauce for ad libitumconsumption for 6 mo. Human milk samples (n = 68; full expression)were collected between 3 and 28 wk postpartum and analyzedfor vitamins B-1 [free thiamin (T) + thiamin monophosphate(TMP) + thiamin pyrophosphate (TPP)], B-2 [riboflavin + flavinadenine dinucleotide (FAD)], B-3 (nicotinamide), B-5 (pantothenicacid), B-6 [pyridoxal (PL) + pyridoxine (PN)], B-7 (biotin), and B-12.

Results: Only T and B-1 were affected by fortification, whereasTMP and TPP, and the other B vitamins were not significantly differentbetween the treatment groups. Extrapolating to compare the milk B-vitamin concentrations to the Adequate Intake (AI) for infants aged0–6 mo, only 0–33.8% of the samples met the recommendation forall vitamins, including for B-1 (B-1: control = 0%, low = 24.0%,high = 10.5%). Strong significant correlations were found amongvitamers of each vitamin (B-1, B-2, B-6; r > 0.6). TPP revealedsignificant moderate associations (r > 0.45) to B-2, FAD, and PN,but had no relation to T, TMP, or B-1. Other significant moderateassociations (r > 0.3) were found for B-3 (FAD, B-12) and B-5 (TPP,PL, B-6).

Conclusions: Rural Cambodian women had low B-vitamin con-centrations in milk, potentially putting their exclusively breastfeedinginfants at risk for micronutrient deficiencies. The selective effect offortification may have caused the lack of associations between TPP andother B-1 vitamers. TPP and FAD are both coenzymes in vitalmetabolicprocesses, whereas PL (which represents >95% of B-6) represents aprecursor of its respective coenzymatic form, which could explain theirassociation inmilk.Whethermaternal dietary intakes ofmicronutrientsaffect these vitamin associations in milk remains to be determined.

Funding SourcesFunded by Grand Challenges Canada Stars in Global Health (S6

0490-01-10), International Research Centre, Canadian Institutes ofHealth Research, IntramuralUSDA/ARSProject 5306-51,000-003-00D.

Use of Midupper Arm Circumference to Assess Growth ofPreterm Infants Receiving Enteral Nutrition Support (P13-060)

Stephanie G Harshman,1 Katy Patton,2 and Julie K Ross2

1Simmons College, MA; and 2Franciscan Children’s Hospital, MA

Objective: Growth of preterm infants is known to fall behind thatof their full-term counterparts and contributes to an increased riskof morbidity and mortality. Measures of weight, length, and headcircumference (HC) are common parameters used to assess growth.However, weight can be influenced by fluid shifts, and accuracy oflength is dependent on specialized equipment warranting the use ofadditional growth measures, such as midupper arm circumference(MUAC). The purpose of this study was to evaluate the use of MUACas an additional anthropometric measure to assess the quality of growthin infants who were born preterm on enteral nutrition support.

Methods: A retrospective analysis of medical records was com-pleted. Eligibility criteria included gestational age < 37 wk, chrono-logical age <24.0 mo, indication and placement of enteral access, and

a minimum of one measurement for each anthropometric measureof weight, length, HC, and MUAC. We identified n = 14 records.We generated z scores using corrected gestational age and the Centerfor Disease Control 0–36 mo growth chart for each anthropometricmeasure, and correlation analysis was completed with significancedetermined by P < 0.05.

Results: There was high concordance between weight and MUAC,weight and weight for length, and weight and HC (all correlationcoefficients ρ > 0.65, P < 0.05 for all). There was also a significantpositive correlation between MUAC and weight for length (ρ = 0.61,P < 0.05).

Conclusions: The results demonstrate that MUAC in preterminfants receiving enteral nutrition support is a feasible, minimallyinvasive, and appropriate measure for monitoring growth, and furthersupports the implementation of this measure in clinical protocols.

Funding SourcesN/A.

Breastfeeding Practices in Obese Women in Mexico (P13-061)

Sonia Hernandez-Cordero,1 Luz-Dinorah González-Castell,1Alicia Muñoz-Espinosa,2 Sonia Hernández-Salazar,1 and Tere-sita González de Cosío-Martínez2

1Instituto Nacional de Salud Pública, Mexico; and 2UniversidadIberoamericana, Mexico

Objective: The aim of this study was to report breastfeedingpractices (BFP) in obeseMexican women participating in a randomizedtrial.

Methods: We recruited women with a body mass index (BMI)>28 kg/m2 after the second trimester of pregnancy and followed themto 12mo postpartum.We included 101 women who delivered singletoninfants with information of feeding practices. BFP were measuredmonthly for the first 6 mo by telephone interview, except at 1 mopostpartum, when women were visited at their home, and every 2 mofrom 6 mo onward. BFP were estimated with the status quo method.

Results: On average (mean ± SD), women had been pregnant for28.4± 4.1 wk at recruitment, were 25.6± 6.0 y of age, and had a BMI of30.8 ± 2.7 kg/m2. The percentage of infants exclusively breastfeeding(EBF) at <1 and 2 mo of age was 68.1% and 58%, respectively. Atthe follow-up, the prevalence of EBF in infants <6 mo old was 27.9%,whereas 42.6% had predominant breastfeeding.

Conclusions: This paper describes BFP during 6 mo amongoverweight and obese Mexican women.

Funding SourcesThe Consejo Nacional de Ciencia y Tecnologia (CONACyT) and

Universidad Iberoamericana financed this study.


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Concentrations of Cadmium, Lead andHemoglobin in the Bloodof Pregnant Mothers at the Metallurgical Center, Oroya, Peru(P13-062)

Edith Rosana Huaman Guadalupe,1 Elva Rios Rios,2 CesarChirinos Tellez,3 Rainer Gross,4 Guillermo Lopez de Romaña,4and Ursula Gross4

1Universidad Nacional Del Centro Del Peru; 2Universidad NacionalAgraria la Molina, Peru; 3MINSA-PERU; and 4GIZ

Objective: The aim of this study was to determine the relation ofcadmium, lead, and hemoglobin concentrations in maternal blood, inthe city of La Oroya, Peru.

Methods:We undertook an observational, cross-sectional, descrip-tive study. Samples were obtained from 40 pregnant women, residingin the city of La Oroya for at least 2 y, and involved in the operationstage of Pb, Cu and Zn smelters. Blood samples were obtained fromthe pregnant woman before delivery, and samples of hemoglobin weretaken after the birth. The Cd and Pb concentrations of these sampleswere evaluated by atomic absorption spectrometry with a graphitefurnace. The analysis was performed with the statistical package SPSSversion 22.

Results: Information was collected from 40 normal deliver-ies. The average concentration of lead in the maternal bloodwas 21.6136 ± 31.6736 µg/dL, that of cadmium was 6.1033 ±11.1942 µg/dL, and hemoglobin was 7.1197 ± 8.9035 g/dL. We foundsignificant correlation coefficients for lead in maternal blood andhemoglobin concentration (r = –0.268, P = 0.047) and cadmiumand lead in maternal blood (r = 0.760, P = 0.000). However, thecorrelation coefficient for cadmium in maternal blood and hemoglobinconcentration was not significant (r = –0.066, P = 0.343).

Conclusions: Since the statistic r = –0.311 is less than the criticalvalue r = –0.304, it is in the critical region, which means that wemust reject the null hypothesis and consequently accept the alternativehypothesis. Therefore, we conclude that for a level of confidence at 95%,there is a significant negative relation between lead in maternal bloodand hemoglobin concentration. Since the statistic r = 0.760 is greaterthan the critical value r= 0.304, this is also in the critical region, so againwemust reject the null hypothesis and accept the alternative hypothesis.Therefore, we conclude that for a 95% confidence level, there is asignificant relation between lead and cadmium in maternal blood.The pregnant mothers had high concentrations of lead and cadmium,but low concentrations of hemoglobin. So, at higher concentrations oflead, there were lower concentrations of hemoglobin, and at higherconcentrations of lead, there were higher concentrations of cadmiumin maternal blood.

Funding SourcesUNALM GIZ.

Undernutrition in Young Children Living in Urban Slums ofMumbai, India: Prevalence and Correlates (P13-063)

Samantha L Huey,1 Julia Finkelstein,1 Sudha Venkatramanan,1Shobha Udipi,2 Padmini Ghugre,2 Varsha Thakker,2 Ramesh DPotdar,3 Harsha Chopra,3 Jere D Haas,1 and Saurabh Mehta1

FIGURE P13-062-1 madre gestante

FIGURE P13-062-2 muestras de sangre materna

1Cornell University, NY; 2SNDT Women’s University, India; and3Centre for the Study of Social Change, India

Objective: The aim of this study was to characterize correlates ofstunting, underweight, wasting, and anemia among young children atscreening for participation in a randomized controlled feeding trial inurban slums of Mumbai, India.

Methods: Young children (aged 12–<19 mo) and their mothersliving in urban slums of Mumbai, India were screened from March toNovember 2017 after informed caregiver consent had been obtained.Anthropometry and sociodemographic data were collected by trainedstudy personnel. Anthropometric measurements, including length-for-age, weight-for-age, and weight-for-length z scores (LAZ, WAZ, WLZ),stunting (LAZ <–2), underweight (WAZ <–2), and wasting (WLZ<–2) were defined using the WHO Growth Standards. Blood wascollected for hemoglobin (Hb) and complete blood counts. Binomialregression was used to estimate risk ratios for potential risk factors ofundernutrition.


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Results: The prevalence of stunting, underweight, and wastingamong children (n= 324) was 31%, 25%, and 9%, respectively. Anemia(Hb <11 g/dL) affected 76% of children who gave blood samples(n= 274). In multivariate models, males were 47% (95% CI: 7%, 100%)more likely to be stunted as well as having lower Hb [–0.4 g/dL (95%CI: –0.8, –0.1 g/dL)] compared with females. Mean LAZ, WAZ, andWLZ were lower by –0.7 to –0.5 (95% CI: –1.0, –0.2), and Hb was lower[–0.6 g/dL (95% CI: –1.0, –0.1 g/dL)], among children with lowbirthweight. Low birthweight (<2.5 kg) was also associated with ahigher risk of underweight (RR: 1.8; 95% CI: 1.3, 2.6) and wasting(RR: 3.3; 95% CI: 1.6, 6.5). Each 1-cm increase in maternal height wasassociated with a 6% (95% CI: 3%, 9%) lower risk of underweight anda 7% (95% CI: 4%, 9%) lower risk of stunting. Each additional year ofmaternal age was associated with a 0.08 g/dL (95% CI: 0.04, 0.12 g/dL)increase in child’s hemoglobin. Firstborn children had an 18% (95%CI: 4%, 29%) lower risk for anemia, and being firstborn was associatedwith a 0.63 g/dL (95% CI: 0.27, 0.99 g/dL) higher Hb concentrationcompared with later-born children.

Conclusions: Our findings highlight the burden of undernutrition,including stunting, underweight, wasting, and anemia, in the urbanslums of Mumbai. Low birthweight and male sex are associated withhigher risks of poor growth and anemia, whereas greater maternalheight, older maternal age, and being firstborn are associated withhigher hemoglobin concentration and lower risk of anemia.

Funding SourcesHarvestPlus.

Choline and Placental Macronutrient Metabolism in GestationalDiabetes-Complicated Pregnancies (P13-064)

Chauntelle Jack-Roberts,1 Mudar Dalloul,2 John Kral,2 MicheleHaughton,2 Yaelle Joselit,1 and Xinyin Jiang1

1Brooklyn College, NY; and 2SUNY Downstate Medical Center, NY

Background: Gestational diabetes mellitus (GDM), characterizedby hyperglycemia during pregnancy, complicates 4.6–9.2% of pregnan-cies in the United States. Maternal obesity is a major risk factor ofGDM. Macrosomia, defined as a birth weight >4 kg, is one of theleading neonatal complications of GDM, which has a lasting influenceon affected infants, increasing their risk of cardiometabolic diseasesin adulthood. Increased placental transport has been proposed as amechanism by which fetuses amass excess macronutrients, leading tomacrosomia. In a prior study, we found that choline, a semi-essentialnutrient that participates in lipidmetabolism and transport, normalizesfetal growth and placental macronutrient transport at midgestation inGDMmice.

Objective: We sought to determine whether choline intake isassociated with fetal growth outcomes in human pregnancies affectedby GDM.

Methods: We recruited 10 GDM and 10 non-GDM pregnantwomen at 20–33 wk gestation from SUNY Downstate Medical Center,Brooklyn, NY and collected their 3-d 24-h dietary recalls in the thirdtrimester of pregnancy to assess choline intake. We also collected birthoutcome data from medical charts and placentas at delivery to assessmacronutrient transporter expression.

Results: Our preliminary results indicated that the GDM grouphad a higher prepregnancy body mass index than the non-GDM

group (GDM: 33.8 ± 8.5 kg/m2 vs. control: 25.5 ± 4.1 kg/m2).The choline intake of the 2 groups did not differ (GDM: 448.2 ±113.2 mg vs. control: 485.5 ± 265.6 mg, P > 0.05). Birth weight andmacrosomia incidence did not differ between groups and were notassociated with maternal choline intake in this pilot dataset. Placentalfatty acid transport protein 1 expression was positively associatedwith the expression of enzymes involved in choline metabolism,including phosphatidylethanolamine methyltransferase (P = 0.039)and choline-phosphate cytidylyltransferase A (P = 0.003).

Conclusions: The preliminary data did not support a correlationbetween maternal choline intake and GDM–related macrosomia.However, placental choline metabolism may be related to its transport.A larger sample size is needed to provide more insight into thecorrelation of maternal choline status with GDM birth outcomes andplacental function.

Funding SourcesCUNY Interdisciplinary Research Grant.

The Feeding Infants and Toddlers Study (FITS) 2016: FoodSources of Energy and Key Nutrients in the Diets of Infants andYoung Children in the United States (P13-065)

Emma F Jacquier

Nestlé Research Center, Switzerland

Objective: The objective of this study was to describe the foodsources of energy and key nutrients among infants, toddlers, andpreschool children from the Feeding Infants and Toddlers Study (FITS)2016.

Methods: FITS 2016 is a cross-sectional survey of caregiversof children aged 0–3.9 y in the United States. Demographic andfeeding practices data were collected using a recruitment questionnaire(n= 4380).One 24-h dietary recall collected data on food, beverage, andsupplement intake (n= 3235).We used 1-d food intakes to calculate thepercentage contribution of foods and beverages from 8 food groups tototal energy and nutrient intakes, with a focus on nutrients consumedin excessive or inadequate amounts.

Results: Breastmilk and infant formula supplied 93% of the totalenergy intake (TEI) among 0- to 5.9-mo-olds and 59% TEI among6- to 11.9-mo-olds. Among children 12–47.9 mo of age, the topsource of dietary energy was cow’s milk (12–23.9 mo old, 18% TEI;and 24–47.9 mo old, 11% TEI); second was meats, with chicken andturkey the most common (12–23.9 mo old, 9% TEI; and 24–47.9 moold, 10% TEI); third was fruit (12–23.9 mo old, 7% TEI; and 24–47.9mo old, 7% TEI). Non-meat protein sources, such as eggs and eggdishes, cheese, yogurt, and peanut butter, were ranked fourth for 12-to 23.9-mo-olds (5% TEI) and fifth for 24- to 47.9-mo-olds (6% TEI).Sweet bakery items and 100% fruit juice both provided 4% TEI among12- to 23.9-mo-olds. In>24-mo-olds, the sweet bakery contributed 6%TEI and sugar-sweetened beverages (SSBs) contributed 4% TEI. Milks,all types, were the top source of fat among 0- to 23.9-mo-olds, and werethe top source of potassium, saturated fat, and vitamin D among 0- to47.9-mo-olds. Fruits, all types, were the top sources of fiber (6–47.9 moold) and the second top source of potassium (12–47.9 mo old). Infantcereal was the top food source of iron among infants aged 0–5.9 and6–11.9 mo. Ready-to-eat cereal was the top source of iron among 12- to47.9-mo-old children. Non-meat protein sources were the top sources


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of vitamin E and meats were the top sources of sodium among 12- to47.9-mo-olds. SSBs were the top sources of added sugars followed bysweet bakery items among 12- to 47.9-mo-olds.

Conclusions: These findings are of importance to future di-etary guidelines for the 0- to 24-mo-old population, and indicateopportunities to improve caregiver food choice and food productimprovement.

Funding SourcesNestlé Research Center, Lausanne, Switzerland.

Effects of Fruit Juice Intake during Preadolescence on Later DietQuality in the National Growth and Health Study Cohort (P13-066)

Phani Deepti Jakkilinki, Li Wan, Martha R Singer, Loring MBradlee, and Lynn L Moore

Boston University School of Medicine, MA

Objective: The overall goal of these analyses was to evaluate theimpact of childhood intake of 100% fruit juice on subsequent dietquality. We explored the association between preadolescent (ages 9–10 y) fruit juice consumption and the likelihood of meeting DietaryGuidelines for total fruit andwhole fruit intake at the end of adolescence(ages 17–20 y). The effects of earlier juice consumption on diet qualitywas assessed from scores on the Healthy Eating Index (HEI). Finally, weexplored whether these effects differed by race.

Methods: The National Growth and Health Study (NGHS) wasa prospective cohort of 2379 female children enrolled at 9–10 y ofage. The ratio of white to black girls was 50:50. Data on physical,sociodemographic, and behavioral risk factors were recorded annually.Whole fruit and 100% fruit juice consumption were assessed using 8sets of 3-d diet records collected over 10 y of follow-up.

Results: Preadolescent girls who drank ≥1.0 cups/d of 100% fruitjuice (vs. those who did not drink juice) consumed 0.44 more cups/dof total fruit at 17–20 y of age (P < 0.0001). Girls consuming the mostfruit juice also consumed slightly more whole fruit at the end of follow-up (0.10 cups/d, P = 0.0097). Total HEI scores during childhood andadolescence increased in a linear fashion with increasing fruit juiceintake. In particular, the late-adolescent HEI scores for both total fruit(P < 0.0001) and whole fruit (P = 0.0009) increased linearly withincreasing preadolescent juice intake. The linear association betweenearlier fruit juice consumption and the total fruit HEI score was similarfor blacks and whites. However, a higher proportion of total fruitconsumed among blacks was derived from fruit juice rather than wholefruit.White preadolescent girls whodrank≥1.0 cup/d of fruit juicewere2.6 times as likely (95% CI: 1.5, 4.3) to meet Dietary Guidelines rec-ommendations for whole fruit intake; black preadolecents consumingthe same amount of juice were 1.8 times as likely (95% CI: 1.0, 3.3) tomeeting Dietary Guidelines recommendations.

Conclusions:Girls who consumed 100% fruit juice at a younger agein this study had higher intakes of both total and whole fruit duringlater adolescence and were more likely to meet Dietary Guidelinesrecommendations for fruit consumption.

Funding SourcesJuice Products Association.

Dietary Patterns before and during Pregnancy and Risk ofHypertensive Disorders of Pregnancy: A Systematic Review(P13-067)

Brittany L James,1 Ramkripa Raghavan,1 Carol Dreibelbis,1 YatPing Wong,2 Barbara Abrams,3 Alison Gernand,4 Kathleen MRasmussen,5 Anna Maria Siega-Riz,6 Jamie Stang,7 Kellie OCasavale,8 Joanne M Spahn,2 and Eve E Stoody2

1The Panum Group; 2USDA, Food and Nutrition Service;3University of California, Berkeley; 4Pennsylvania State University;5Division of Nutritional Sciences, Cornell University, NY; 6Universityof Virginia School of Nursing; 7University of Minnesota School ofPublic Health; and 8US Department of Health and Human Services,Office of Disease Prevention and Health Promotion

Objective: Hypertensive disorders of pregnancy (HDP), includinggestational hypertension and pre-eclampsia, are common maternalcomplications during pregnancy, with known short- and long-termhealth risks for both mother and child. However, the associationbetween dietary patterns before and during pregnancy and theseoutcomes is not well understood. A systematic review to assess thisrelation was conducted as part of the USDA-Department of Health andHuman Services’ Pregnancy and Birth to 24 Months project.

Methods: Nine databases, including PubMed, Embase, Cochrane,and CINAHL, were searched from January 1980 to January 2017 forpeer-reviewed articles related to dietary patterns and to pregnancyand birth outcomes. A priori inclusion/exclusion criteria were used todual-screen articles; relevant data were extracted, and risk of bias wasassessed for included articles. After qualitatively synthesizing the data,a conclusion statement was drafted, and the evidence was graded.

Results: Of the 9103 studies identified, 8 were included for thisreview (from 4 cohorts and one randomized clinical trial), with samplesizes ranging from 290 to 72,072. Of the 8 studies, 5 showed anassociation between dietary patterns before and during pregnancyand reduced risk of HDP. The Mediterranean Diet, the New NordicDiet, and other dietary patterns were beneficial. The current evidenceis based on a small body of evidence with heterogeneity in studydesign andmethodology, andminority and lower socioeconomic statuspopulations were under-represented.

Conclusions: Limited evidence in healthy Caucasian women withaccess to health care suggests that dietary patterns before and duringpregnancy that are higher in vegetables, fruits, whole grains, nuts,legumes, fish, and vegetable oils and lower in red and processed meatsand refined grains are associated with a reduced risk of HDP, includingpre-eclampsia and gestational hypertension. Not all components of theassessed dietary patterns are associated with all hypertensive disorders.Evidence is insufficient to estimate the association between dietarypatterns before and during preconception or pregnancy and risk ofHDPin minority women and those of lower socioeconomic status. Furtherresearch is needed that reflects the diversity of the US population, usesconsistent dietary patterns and methods, and has adequate statisticalpower to address this issue.




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Comprehensive Patterns of Breastfeeding Behaviors at 3 and6mo Postpartum in the Alberta Pregnancy Outcomes and Nutrition(APrON) Study (P13-068)

Megan Jarman,1 Paula Robson,2 Ye Shen,1 Mette Madsen,1 andRhonda Bell1

1University of Alberta, Canada; and 2Alberta Health Services,Canada

Objective: The Interagency Group for Action on Breastfeeding(IGAB) recommends the use of a detailed framework to define breast-feeding (BF) behavior. Previous studies have tended to characterize BFbehaviors in simpleways, such as exclusive vs. nonexclusive BF. A lack ofdetail in describing BF has contributed to challenges in comparing studyfindings. The objective of this study was to use the IGAB frameworkto describe patterns of BF at 3 and 6 mo postpartum in women in theAPrON study.

Methods: Women (n = 561) completed prospective BF diaries toassess duration, frequency, and method of all milk feeding over 3 d at 3and 6mo postpartum. Feeding behaviors were grouped according to theIGAB framework.Mean daily number of feeds bymethod (fed at breast,expressed breastmilk, formula, or expressed breastmilk and formula inthe same bottle) andmean total duration of at-breast feeds (minutes perday) were described by feeding group.

Results:Themajority ofwomenwere in the exclusive BF group (79%and 72% at 3 and 6 mo), with 10% and 11% in the partial-high, 7% and11% in the partial-medium, and 3% and 5% in the partial-low groupat 3 and 6 mo, respectively. Most women (76%) remained in the sameBF group at 6 mo as they were at 3 mo. Women in the exclusive BFgroup fed for 139 and 96 min/d at 3 and 6 mo, respectively. Comparedwith the exclusive BF group, women in the partial-medium group fedat breast for 24 and 27 min less per day and those in the partial-lowgroup for 135 and 93 min less per day at 3 and 6 mo, respectively. Incontrast, women in the partial-high group fed at breast 20 min moreper day than those in the exclusive group at 3 mo and for the same timeat 6 mo.

Conclusions: Preliminary results show that patterns of BF remainedstable between 3 and 6 mo postpartum. However, there was widevariation in duration of at-breast feeds among those in the partial BFgroups. In previous studies, these womenwould typically be categorized

as “nonexclusive” breastfeeders. This level of aggregation may havecontributed to inconsistent findings, especially in studies of maternalpostpartum weight retention, owing to lack of consideration of highvariability of time spent feeding at breast. This classification will enablestudies to assess maternal and infant outcomes with a more refinedpicture of BF behaviors.

Funding SourcesMJ is funded by an Alberta Innovates postdoctoral fellowship.

Analyses reported in this abstractwere also funded byAlberta InnovatesHealth Solutions through a Collaborative Research Innovation Oppor-tunities Program Grant awarded to the ENRICH study team.

Breast Milk Eicosapentaenoic Acid and Infant Executive Func-tion (P13-069)

Keyu Jia and Ying Gao

Chinese Academy of Science

Objective: Eicosapentaenoic acid (EPA, 20:5n–3) is an essentialfatty acid for nerve system function. Breast milk EPA could reflectinfant intake of EPA and maternal status of EPA, which was correlatedwith postpartum depression (MDD); maternalMDD could affect infantbrain function. However, no study has reported the effects of EPAin breast milk on infant brain function. We aimed to investigate theassociation between EPA and infant brain executive function.

Methods: Clinical data and human milk were collected from 375mothers and their breastfed infants fromBeijing onday 42 after delivery.The concentration of EPA in breast milk was detected via GC-MS.Bayley Scale III, AB task, and Planning task were used to evaluatethe executive function of infants aged 8 mo. Linear regression modelsand restricted cubic spline regression were used to evaluate the linearand nonlinear associations between EPA concentration in breast milkand infant executive function.

Results: EPA concentration was significantly decreased in 8 mobreast milk compared with that at 42 d. Increased breast milk EPAconcentration at day 42 was significantly associated with decreaseddistraction score of infants. A strong dose-response effect was observedwhen the EPA concentration was lower than the median (P = 0.027).Also, increased EPA in 8-mo breast milk was significantly associatedwith decreased infant distractibility (P = 0.003).

FIGURE P13-068-1 Framework for describing breastfeeding patterns developed by Interagency Group on Actionfor Breastfeeding(figure adapted from Labbok etal 1990 Studies in Family Planning 21(4) 226-230).


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Conclusions: Breast milk EPA was negatively associated with infantdistractibility, with a threshold effect. Further research is needed witha larger sample size to refinie the sensitive threshold in different stages,which might help to determine the required concentration of EPA forinfants.

The Good Tastes Study: Infants’ and Toddlers’ Acceptance of aFamiliar Food and Novel Green Bitter Vegetable Purees (P13-070)

Susan L Johnson,1 Kameron Moding,1 John Hayes,2 AlyssaBakke,2 Haley Lucitt,1 and Abigail Flesher1

1University of Colorado Denver; and 2Pennsylvania State University

Objective: Bitter green vegetables are infrequently consumed bychildren. We conducted a study to observe infants’ and toddlers’willingness to taste familiar and novel foods (e.g., cereal and bitter greenvegetable purees).

Methods: Caregiver-child (6–24 mo; n = 92, 47 boys, 45 girls)dyads were recruited via a university listserv, social media (e.g.,NextDoor, Facebook), and participant referrals. Caregivers completeddemographic questionnaires and then were video recorded, in alaboratory setting, offering up to 4 bites of a familiar food (infant cereal)and up to 8 bites of a novel food (kale purees) to their child. Thenumber of tastes (i.e., frequency) was computed for the familiar andthe novel food. A taste was operationally defined as when the foodentered the child’s mouth and was then tasted. For analysis, childrenwere divided into age categories [6–8.30 (i.e. 8 mo 30 d), 9–11.30,12–14.30, 15–17.30, and 18–24 mo]. ANOVA was used to examinedifferences in the number of cereal and kale tastes across age categories.Data were analyzed for sex differences and for associations with parentdemographics. Also, multivariate regression models were examined todetermine whether acceptance of the familiar food, as well as child age,predicted acceptance of the novel food.

Results:Caregivers were primarily mothers (90%), white (81%; 10%Hispanic), married (92%), college educated (90%) and employed (69%).The number of familiar and novel food tastes differed by child age(Fcereal = 9.86, P < 0.0001; Fkale = 12.62, P < 0.0001). Infants 6–14.30 moof age accepted significantly more tastes than children 15–24 mo of age.No sex differences or associations with demographics were observed.Both children’s tastes of the familiar food (P = 0.012) and their age(P < 0.0001) predicted tastes of the kale puree (R2 = 0.32).

Conclusions: Food acceptance appeared to decline at∼15mo of agein our cohort, irrespective of whether the food is familiar or is a novelbitter green vegetable. In addition to novelty, feeding challenges may berelated to developmental stage, and may begin earlier than previouslydescribed. Early introduction of a variety of foods prior to 15 mo maybe a good strategy to introduce children to a variety of flavors.

Funding SourcesThe project was funded by a research grant from The Sugar

Association.

Maternal Nut Intake in Pregnancy, Omega-3 Fatty Acids, andChild Neurodevelopment: A Population-Based Cohort Study inSpain (P13-071)

Jordi Julvez,1 Florence Gignac,2 and Dora Romaguera3

1Barcelona Global Health Institute (ISGlobal), Spain; 2ISGlobal; and3Imperial College, United Kingdom

Background: There is some scientific evidence on the protectiveeffects of nut intake against cognitive decline in elderly people; however,this positive association has been less well explored in children.

Objective: The aim of this study was to undertake a population-based birth cohort study (to the best of our knowledge, this is the first)and analyze the association of nut intake during pregnancy with severalneuropsychological outcomes among offspring up to 8 y old.

Methods: Our birth cohort comprised 2208 mother-child pairs.Neuropsychological examinations of children aged 1, 5, and 8 y werebased on the Bayley and McCarthy scales, the Attention Network test(ANT), and theN-Back test. Information about nut intake in pregnancywas collected through a standardized food frequency questionnaire,and multivariate linear regression models were used to assess suchassociations after controlling for previously selected maternal andchild characteristics. A potential mediation effect of the essentialfatty acids omega-3 was studied using standardized statistical analyseswith the combined cord blood concentrations of α-linolenic acid,eicosapentaenoic acid, and docosahexaenoic acid.

Results: Children born of mothers within the highest tertile ofpregnancy nut consumption (>32 g/wk) had an adjusted increase of2.37 points in theMcCarthy general cognitive scale (95% CI: 0.76, 3.98)compared with the first tertile (0 g/wk). A similar association patternwas observed with the other cognitive scores at the different child ages.Mediation analyses with maternal nut intake showed that ω-3 (n–3)concentrations explained by 16% the 8-y-old ANT association.

Conclusions:Nut intake during pregnancy is consistently associatedwith long-term child neurodevelopment, and ω-3 fatty acids partlyexplain the association. Future cohort studies and randomized clinicaltrials are needed to confirm this association pattern in order to furtherextend nutrition guidelines among pregnant women.

Funding SourcesThis study was funded by grants from Spanish Institute of Health

Carlos III-Ministry of Economy and Competitiveness (INMANetworkG03/176, CB06/02/0041, FIS-PI041436, FIS- PI081151, FIS-PI042018,FIS-PI09/0,2311, FIS-PI06/0867, FIS-PS09/00090, FIS-PI03/1615,FIS-PI04/1509, FIS-PI04/1112, FIS-PI04/1931, FIS-PI05/1079, FIS-PI05/1052, FIS-PI06/1213, FIS-PI07/0314, FIS-PI09/0,2647, FIS-PI13/1944 and FIS-PI13/2032), Generalitat de Catalunya-CIRIT1999SGR 00241, JCI-2011-0,9771-MICINN, Conselleria de SanitatGeneralitat Valenciana 1 (048/2010 and 060/2010), Universidadde Oviedo, Obra Social Cajastur, Department of Health of theBasque Government (2,005,111,093 and 2,009,111,069), the ProvincialGovernment of Gipuzkoa (DFG06/004 and DFG08/001), and theFundación Roger Torné. This study has been funded by Instituto deSalud Carlos III through the projects “CP14/00108 & PI16/00261”(Co-funded by the European Regional Development Fund “A Wayto Make Europe”). JJ holds a Miguel Servet contract (MS14/00108)awarded by the Spanish Institute of Health Carlos III-Ministry ofEconomy and Competitiveness.

Effect of Lipid-Based Nutrient Supplement along with HealthEducation on Reduction of Stunting in Children Aged 6–23 mo inThatta Sindh, Pakistan (P13-072)

Gul Nawaz Khan,1 Shabina Arrif,1 Cecilia Garzon,2 Ali AhmadKhan,2 and Sajid Soofi1

1Aga Khan University, Pakistan; and 2WFP


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Background: Chronic childhood malnutrition or stunting remainsa persistent barrier to optimal child growth and social development.In Sindh province, Pakistan, >48% of children aged <5 y are stunted.We aimed to get in-depth evidence on the effectiveness of nutrient-based interventions to prevent stunting among children aged <2 y incommunity settings by the government primary health care system inthe Thatta and Sujawal districts of Pakistan.

Methods: A cluster-randomized controlled trial was conducted anda total of 870 children aged between 6 and 18 mo were enrolled.Children in 6 intervention clusters received a daily dose of 50 g of lipid-based nutrient supplement (LNS), whereas children in 6 control clustersreceived routine health services. Primary outcomewas risk reduction instunting.

Results: After baseline adjustment, a significant risk reduction instunting (RR: 0.91; 95% CI: 0.87, 0.96; P = 0.001) and wasting (RR:0.80; 95% CI: 0.65, 0.99; P= 0.047) was noted in the intervention groupcompared with the control group. Initiation of breastfeeding within1 h (RR: 0.91; 95% CI: 0.86, 0.96; P= 0.001), minimummeal frequency(RR: 0.0.91; 95% CI: 0.86, 0.96; P = 0.001), diarrhea (RR: 0.0.91; 95%CI: 0.86, 0.96; P = 0.001), acute respiratory infection (RR: 0.0.91; 95%CI: 0.86, 0.97; P = 0.002), availability of soap and water in households(RR: 0.88; 95% CI: 0.83, 0.94; P = 0.000), and improved toilet facilities(RR: 0.95; 95% CI: 0.90, 0.99; P = 0.045) were significantly associatedwith stunting. A significant impact on anemia was also noted in theintervention group as compared with the control group (RR: 0.97; 95%CI: 0.94, 0.99; P = 0.006).

Conclusions: This study has confirmed the plausibility of achievingnutritional gains in the short term with LNS coupled with nutrition,health, and hygienemessages delivered through the primary health caresystem of the government. The statistically significant risk reduction instunting, wasting, and anemia among children aged 6–23mo shows thatan immediate improvement in nutrition indicators is indeed possibleand can be scaled up in similar settings.

Funding SourcesWorld Food Programme.

Role of Dietary Diversity in Ensuring Adequate Nutrient Intakeand Nutritional Status among Pregnant Women. Findings fromLaikipia County, Kenya (P13-073)

Willy K Kiboi, Judith Kimiywe, and Peter Chege

Kenyatta University, Kenya

Background: Pregnancy is a critical period during which adequatenutrition is considered an important factor that affects birth outcomeand the health of the mother. Maternal diets during pregnancy havethus been deemed critical, since the diet must meet the nutrientrequirements for both the child and the mother for a satisfactory birthoutcome.

Objective: The purpose of this study was to assess dietary diversity,nutrient intake, and nutritional status among pregnant women inLaikipia County, Kenya.

Methods: This was a cross-sectional analytic study. The studycomprised 254 pregnant women attending an antenatal clinic at theNanyuki Teaching and Referral Hospital.

Results: The study revealed that the mean ± SD Dietary DiversityScore (DDS)was 6.84± 1.46. Themean intakes of energy, carbohydrate,

protein, fat, zinc, iron, folate, and vitamin C were inadequate, whereasthose of vitamin A and calcium were adequate. Inadequate nutrientintake attributed to inadequate food consumption. The incidenceof morbidity was high (57.5%) among the pregnant women, andwas shown to influence their dietary diversity, nutrient intake, andnutritional status (P < 0.05). With regard to nutritional status, 19.3%were undernourished based on their midupper arm circumference,and 16.9% were anemic based on their hemoglobin concentration. Theresults further showed that dietary diversity was positively correlatedwith nutrient intake and nutritional status.

Conclusions: Dietary diversity is crucial in ensuring adequatenutrient intake and nutritional status among pregnant women. The sup-pression of morbidity incidence during pregnancy would substantiallyimprove nutrient intake during pregnancy.

Funding SourcesN/A.

Probiotic Supplementation Provides a Protective Mechanism tothe Fetus and Placenta in Midgestation of Mothers Fed a High-FatDiet (P13-074)

Danielle Krout,1 Michael R Bukowski,1 David Klurfeld,2 GloriaSolano-Aguilar,3 Mirjana Curic-Bawden,4 James N Roemmich,1and Kate J Claycombe-Larson1

1USDA-ARS Grand Forks Human Nutrition Research Center;2USDA-ARS Office of Human Nutrition National Program; 3USDA-ARS Beltsville Human Nutrition Research Center; and 4Chr. Hansen

Objectives: Maternal high-fat diets predispose offspring tometabolic syndrome, though the role of placenta l nutrient transport inaltered developmental programming is unclear. Furthermore, placentalconcentration of short-chain fatty acids (SCFAs), which have animportant role in maintaining immune and gut homeostasis, has yet tobe determined. The aims of the present studywere to clarify these issues.

Methods: Female C57BL/6mice, 2mo old, were fed diets containingeither 10% fat (normal fat, NF) or 45% fat (high fat, HF) for 8 wk,followed by 4 wk of probiotic (Bifidobacterium animalis subsp. lactisBB-12) supplementation. [The groups were NF, NF plus probiotic(NFP), HF, and HF plus probiotic (HFP).] Probiotic supplementationcontinued through mating with normal chow–fed males and gestation.Fetuses and placentas were harvested at either midgestation (days 12.5–13.5) or late gestation (days 18.5–19.5).

Results: HF-fed dams weighed more than NF-fed dams owing toincreased fat mass, whereas probiotic supplementation had no effect.Placenta length, width, andweight as well as fetal weight were decreasedat midgestation in the HF group. Probiotic supplementation in theHF diet was protective against these changes. However, the protectiveeffect of the probiotic was diminished at late gestation, as placentalength, width, andweight were increased and fetal weight was decreasedin both the HF and HFP groups compared with the NF and NFPgroups. Furthermore, placental efficiency (fetal wt:placental wt) wasincreased at midgestation in HFP compared with HF, whereas at lategestation no differences were observed between the HF and HFPgroups. Interestingly, placental concentration of the SCFA butyratewas increased at midgestation in NF and HFP compared with theNFP group, whereas at late gestation it was increased in NFP and HFcompared with the NF group.


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Conclusions: These findings suggest that a maternal HF diet altersplacental size and weight, as well as fetal weight, and that probioticsupplementation renders a protective effect against these changesat midgestation. Furthermore, diet and probiotic supplementationmodify placental butyrate concentration. Future studies will addresswhether placental immune homeostasis is altered as a result of butyrateconcentration and whether the protective mechanism of probioticsupplementation in midgestation has beneficial effects on offspringdevelopmental programming.

Funding SourcesThis work was supported by USDA Agricultural Research Service

Project #3062-51,000-052-00D.

Intrahousehold Bargaining of Women and Men, Role of FoodInsecurity, and Its Relationship with Child Nutritional Status(P13-075)

Shibani Kulkarni,1 Edward A Frongillo,1 Kenda Cunningham,2Spencer Moore,1 and Christine E Blake1

1University of South Carolina; and 2Helen Keller International,Nepal

Objectives: Women’s intrahousehold bargaining is an importantpredictor of child nutritional status, but more research is needed tounderstand howmen’s role is related to women’s bargaining power, andhow gendered intrahousehold bargaining influences child nutrition.The objectives of this study were to 1) understand how intrahouseholdbargaining of women and men is related to child height-for-age z score(HAZ), and 2) assess if household food insecurity mediates the relationbetween women’s and men’s intrahousehold bargaining and HAZ.

Methods: We conducted a cross-sectional analysis of the baselinedata from 2012 for an impact evaluation of the Suaahara programin rural Nepal with children aged 0–59 mo, their mothers, andtheir fathers or other male respondent involved in making majorhousehold economic decisions (n = 2164). Intrahousehold bargainingpower for women and men consisted of 5 domains: 1) ownership andcontrol of assets, 2) social participation, 3) workload, 4) householddecision-making ability, and 5) household headship.We usedmultilevelmodeling to assess the relation between HAZ and only women’sbargaining power, only men’s bargaining power, women’s and men’sbargaining power together, and the interaction between women’s andmen’s bargaining power. Generalized structural equation modeling wasused to test food insecurity as a mediator.

Results: Women’s asset ownership and control was positivelyassociated with HAZ, whereas decision-making ability was negativelyassociated in the only women’s bargaining model and in the model to-gether with men’s bargaining. Men’s social participation was positivelyassociated with HAZ in the only men’s bargaining model and in themodel together with women’s bargaining. No significant interactionswere found between men’s and women’s bargaining domains. Foodinsecuritywas a partialmediator such thatwomen’s asset ownership andcontrol and men’s social participation were negatively associated withfood insecurity, which, in turn, was negatively associated with HAZ.

Conclusions:Women’s asset ownership and control andmen’s socialparticipation are important to reduce food insecurity and improve childHAZ. Programs should perhaps target men or households given thepotential role of men’s engagement in reducing child undernutrition.

Funding SourcesN/A.

Maternal-Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Has No Effect on Blood Pressure at4–6 y in Ghanaian Children (P13-076)

Sika M Kumordzie,1 Seth Adu-Afarwuah,2 Rebecca R Young,1BriettaMOaks,3 MakuEOcansey,1 HarrietOkronipa,1 ElizabethL Prado,1 and Kathryn G Dewey1

1University of California, Davis; 2University of Ghana; and3University of Rhode Island

Objectives: Observational studies have suggested that higher birthweight may be related to lower blood pressure later in life. The iLiNS-DYAD trial in Ghana showed that small-quantity lipid-based nutrientsupplements (LNS) had a positive effect on birth weight and subsequentgrowth. The objectives of this study were to 1) examine the effect of theintervention on mean blood pressure at 4–6 y of age, and 2) identifymaternal and child factors related to blood pressure in this cohort.

Methods: The iLiNS-DYAD Ghana study was a partially double-blind, randomized controlled trial which assigned women (n= 1320) at≤20 wk gestation to 1 of 3 supplementation groups: 1) a daily iron andfolic acid tablet during pregnancy and a calcium tablet (placebo) for thefirst 6 mo postpartum, 2) a daily multiple micronutrient tablet duringboth periods, or 3) daily LNS during both periods, followed by infantLNS supplementation from 6 to 18 mo of age. At follow-up at 4–6 yof age (n = 858, 70% of live births), we determined the effect of theintervention (non-LNS vs. LNS) on child blood pressure. High bloodpressure was defined as systolic or diastolic blood pressure ≥90th per-centile based on the US National Heart Lung Blood Institute reference.We also examined whether blood pressure was related to several ma-ternal and child factors, including maternal blood pressure, householdasset score, weight-for-age z score (WAZ), and physical activity.

Results: There was no significant difference between the non-LNSand LNS groups in systolic [99.2 vs. 98.5 mm Hg (β = 0.71; 95% CI:–0.68, 2.09; P = 0.317)] or diastolic [60.1 vs. 60.0 mm Hg (β = 0.12;95% CI: –0.83, 1.07; P= 0.805)] blood pressure. The prevalence of highblood pressure was 30.4%. We observed a positive association betweenbirth weight and blood pressure in bivariate analysis, which was largelymediated through currentWAZ in a path model. ConcurrentWAZ andmaternal blood pressure were the factors most strongly related to childblood pressure.

Conclusions: Despite greater birth weight in the LNS group, therewas no difference in blood pressure between the intervention groups at4–6 y. In this preschool population at high risk for adult hypertensionbased onbloodpressure at 4–6 y, highmaternal bloodpressure and childWAZ were key factors related to blood pressure.

Funding SourcesThe Bill & Melinda Gates Foundation.

Maternal Plasma Folate and Vitamin B-12 in Relation to Aca-demic Readiness of Children at 48 mo of Age: The GUSTO Study(P13-077)

Jun Shi Lai,1 Shirong Cai,1 Keith M Godfrey,2,3 Peter DGluckman,4 Lynette Shek,5 FabianYap,6 KokHianTan,7 Yap SengChong,5 Michael J Meaney,8 Birit FP Broekman,9 and Mary FFChong10


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1Singapore Institute for Clinical Sciences, A*STAR; 2MRC Life-course Epidemiology Unit & NIHR Southampton Biomedical ResearchCentre, University of Southampton, United Kingdom; 3University Hos-pital Southampton NHS Foundation Trust, United Kingdom; 4LigginsInstitute, University of Auckland, New Zealand; 5Yong Loo Lin Schoolof Medicine, National University of Singapore and National UniversityHealth System; 6Duke-NUS Medical School, Singapore; 7KK Women’sand Children’s Hospital, Singapore; 8McGill University, Canada; 9VUMedical Centre, Netherlands; and 10National University of Singapore

Objective: The long-term impact of folate and vitamin B-12deficiencies during pregnancy on offspring cognitive developmentremains unclear. We examined the relations of maternal plasma folateand vitamin B-12 status with offspring academic readiness at 48 mo inthe Growing Up in Singapore Towards Healthy Outcomes study.

Methods: Maternal plasma folate and vitamin B-12 concentrationsat 26–28 wk of gestation were determined by competitive electro-chemiluminescence immunoassay. Children’s academic readiness wasassessed at 48 mo using 6 tests measuring number concepts, visual,and/or verbal working memory, receptive vocabulary, phonologicalawareness, and the ability to identify colors, shapes, numbers, andletters. Associations of maternal folate and vitamin B-12 with children’sacademic readiness were examined in 793 mother-child pairs using lin-ear regressions adjusted for maternal age, ethnicity, education, income,prepregnancy body mass index, antenatal depression and anxiety, andvitamin B-6, with mutual adjustment for folate and vitamin B-12.

Results:Therewere∼9%of themothers whowere folate insufficient(<6 ng/mL), whereas 15% were vitamin B-12 deficient (<200 pg/mL)and 41% were vitamin B-12 insufficient (200–299 pg/mL). Comparedwith children of folate-sufficient mothers, children of folate-insufficientmothers had lower scores in the number knowledge test (β =–1.34; 95%CI: –2.32, –0.37), the visual and verbal workingmemory test (β = –0.60;95% CI: –1.01, –0.18), and the tests of ability to identify numbers (β =–1.99; 95% CI: –2.98, –1.00) and letters (β = –3.66; 95% CI: –5.32,–2.00). No significant associationswere observedwithmaternal vitaminB-12 status.

Conclusions: Inadequate folate status during pregnancy may havea long-term detrimental impact on childhood cognitive development,subsequently affecting academic readiness. This further emphasizes theneed to improve folate status during pregnancy not only to preventneural tube defects, but also potentially to promote academic readinessin early childhood.

Funding SourcesThis research is supported by the Singapore National Research

Foundation under its Translational and Clinical Research (TCR)Flagship Programme and administered by the Singapore Ministryof Health’s National Medical Research Council (NMRC), Singapore-NMRC/TCR/004-NUS/2008 and NMRC/TCR/012-NUHS/2014.Additional funding is provided by the Singapore Institute for ClinicalSciences, Agency for Science Technology and Research (A*STAR), andNestec.

Association between Maternal Aflatoxin Exposure during Preg-nancy and Adverse Birth Outcomes in Mukono, Uganda (P13-078)

Jacqueline M Lauer,1 Christopher Duggan,2 Lynne M Ausman,1Jeffrey K Griffiths,3 Partick Webb,2 Edgar Agaba,4 NathanNshakira,5 and Shibani Ghosh1

1Friedman School of Nutrition Science and Policy, Tufts University,MA; 2Harvard THChan School of Public Health,MA; 3Tufts UniversitySchool of Medicine, MA; 4USAID Feed the Future Innovation Lab forNutrition at Tufts University, MA; and 5Uganda Christian University

Objective:Aflatoxins are toxic metabolites of Aspergillus molds andarewidespread in the food supply inAfrica. In utero and infant exposureto aflatoxin B1 (AFB1) have been linked to poor child growth anddevelopment. Our objective was to investigate the association betweenmaternal exposure to aflatoxin during pregnancy and adverse birthoutcomes in Uganda.

Methods: This was a prospective cohort study conducted inMukono, Uganda. A total of 258 pregnant women were enrolled attheir first prenatal visit. Maternal aflatoxin exposure was assessedat 17.9 ± 3.4 (mean ± SD) wk gestation by measuring serumconcentrations of AFB1-lysine adduct using HPLC. Birth outcomes(sex, gestational age, weight, length, and head circumference) for 220live infants were obtained within 48 h of delivery. Associations betweenmaternal exposure and birth outcomes were assessed usingmultivariatelinear regression models adjusted for confounding.

Results: The median maternal serum AFB1-lysine adductconcentration was 5.71 pg/mg albumin (range: 0.71–95.60 pg/mgalbumin). The mean ± SD infant birth weight, length, and headcircumference were 3.25 ± 0.43 kg, 48.68 ± 2.02 cm, and 35.19 ± 1.53cm, respectively. Elevations in natural log-transformedmaternal serumAFB1 concentrations were associated with lower weight (adjusted β =–0.07; 95% CI: –0.13, –0.002; P = 0.045), lower birth weight-for-agez score (WAZ) (adjusted β = –0.16; 95% CI: –0.30, –0.03; P = 0.021),and smaller head circumference (adjusted β = –0.27; 95% CI: –0.51,–0.03; P = 0.029) in infants at birth. No significant associations wereobserved between maternal AFB1 concentrations and infant length,length-for-age z score, or gestational age at birth.

Conclusions: Midgestation exposure to aflatoxin was significantlyassociated with lower birth weight, WAZ, and head circumference.These adverse outcomes, all indicators of poor prenatal development,predict poor long-term physical, motor, and cognitive development.Initiatives to reduce aflatoxin exposure in women of reproductive agemay result in improved birth outcomes and child development inLMICs.

Funding SourcesThe Feed the Future Innovation Lab for Nutrition at Tufts

University in Boston, MA is supported by the United States Agencyfor International Development (award AIDOAA-L-10–00006). CDwas supported in part by the NIH (grants K24DK104676 and 2P30DK040561).


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FIGURE P13-078-1 Correlation between maternal aflatoxin(AFB1) concentration and infant birth weight.

FIGURE P13-078-2 Correlation between maternal aflatoxin(AFB1) concentration and infant head circumference at birth.

Assessing Bile Acid Metabolism in Infants Consuming BreastMilk or Infant Formula at 3, 6, and 12 mo of Age (P13-079)

Haixia Lin, Lindsay Pack, Thomas M Badger, Aline Andres, andKelly Mercer

Arkansas Children’s Nutrition Center

Objective: The aim of this study was to determine if postnatal dietinfluences hepatic bile acid synthesis as measured by changes in fecalbile acid (BA) output and composition in infants receiving breast milk,or dairy-based or soy-based infant formula.

Methods: Infants were recruited based upon their postnatal diet ofbreast milk or infant formula prior to enrollment at age 3 mo. In theBM group, all infants were exclusively breastfed until 12 mo of age.Formula-fed infants consumed either dairy-based milk formula (MF)or soy-based formula (SF) until 12 mo of age. Solid food could beintroduced to infants in all diet groups by 4 mo of age. Infant fecalsamples were collected at 3 (BM, n = 16; MF, n = 9; SF, n = 15), 6 (BM,n = 17; MF, n = 20; SF, n = 17), and 12 (BM, n = 15; MF, n = 14; SF,n = 15) mo of age, and primary [cholic acid (CA), chenodeoxycholicacid (CDCA)] and secondary [deoxycholic acid (DCA), lithocholic acid

(LCA), ursodeoxycholic acid (UDCA)] bile acids (BAs) were quantifiedby LC-MS. The effect of diet and time, and the interaction thereof, onCA and its derivative DCA, CDCA and its derivatives LCA and UDCA,and total BAs were determined by 2-way ANOVA, followed by Student-Newman Keuls post hoc analysis.

Results:When compared with the BM group at 3mo, total BAs were2-fold lower in the MF group. In the SF group, total BAs were increasedby 2- to 4-fold relative to the BMandMFgroups, respectively (P< 0.05).At 6 mo, total BAs remained higher in the SF group relative to the BMand MF groups (P < 0.05), with no statistical differences in total BAsbetween the MF and BM groups. At 12 mo, total BAs between the BM,MF, and SF groups were similar, yet we observed a significant shift in thecomposition of the BA pool toward CDCA and its derivatives in boththe MF and SF groups relative to the BM group (P < 0.05).

Conclusions: Soy formula feeding increases fecal output of total BAsrelative to breastfed and dairy milk formula–fed infants at 3 and 6 moof age, suggesting increased hepatic bile acid synthesis in the SF group.At 12 mo, differences in total BAs normalize, yet there is a distinctshift toward bacterial-derived BAs in both formula groups, suggestingaltered microbial function relative to breastfed infants.

Funding SourcesUSDA-ARS Project 6026-51,000-010-05S.

Energy, Fat, and Carbohydrates from Complementary FeedingAre Correlated with Intestinal Barrier Function, and Immune andInflammatory Responses in Brazilian Children (P13-080)

Bruna LL Maciel,1 Priscila Costa,2 Aldo AM Lima,3 AlbertoM Soares,3 Richard L Guerrant,4 José Filho,3 Francisco Junior,3Claudia B Abreu,3 Ramya Ambikapathi,5,6 and Laura Caulfield7

1Federal University of Rio Grande do Norte, Brazil; 2Departmentof Nutrition, Federal University of Rio Grande do Norte, Brazil;3INCT – Instituto de Biomedicina do Semiárido Brasileiro (IBISAB),Federal University of Ceará, Fortaleza, Brazil; 4University of Virginia;5Fogarty International Center, NIH, MD; 6Department of GlobalHealth and Population, Harvard TH Chan School of Public Health,MA; and 7Department of International Health, The Johns HopkinsBloomberg School of Public Health, MD

Objective: The aim of this study was to assess the correlationbetween the intake of energy and macronutrients from habitualcomplementary feeding on biomarkers of intestinal barrier function,and immune and inflammatory responses.

Methods: Data from the Brazilian MAL-ED birth-cohort study,conducted in Fortaleza-Ceará with n = 233 children, were used.We assessed 24-h recalls from infants aged 9–15 mo to estimatehabitual intake of complementary feeding. The lactulose:mannitol(L/M) test was performed for the evaluation of intestinal barrierfunction. Fecal concentrations of myeloperoxidase, neopterin (NEO),and α-1-antitrypsin in nondiarrheal fecal samples were evaluated at15 mo, as biomarkers of neutrophil activity, T helper 1 cell (Th1)activity, and protein loss, respectively. Box-cox transformationwas usedto correct skewness and kurtosis of protein, lipids, carbohydrates, sugar,and energy intakes. These were then corrected for within- and between-person variance with ANOVA.Adjustment for the total reported energyintake was performed for macronutrients using the residual method.The Spearman test was used to evaluate the correlation between dietary


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intake and biomarkers of intestinal barrier function, and immune andinflammatory responses.

Results: The mean ± SD energy consumption was 870.3 ±165.8 kcal, from 119.2± 5.2 g of carbohydrates, 36.8± 2.0 g of proteins,28.2 ± 1.9 g of lipids, and 24.3 ± 4.6 g of sugars. The energy intake wasnegatively correlated with L/M z scores (r2 = –0.185; P = 0.015). Thecarbohydrate intakewas negatively correlatedwithNEO concentrations(r2 = –0.167, P = 0.044), whereas lipids presented a positive relationwith NEO concentrations (r2 = 0.197; P = 0.018).

Conclusions: Complementary feeding content of energy, carbohy-drates, and fat was correlated with intestinal barrier function repair,decreased intestinal inflammation, and increased local intestinal Th1immune response, respectively. Our data should lead to furtherdiscussion on the link between dietary intake and gut function.

Funding SourcesThe Etiology, Risk Factors and Interactions of Enteric Infections and

Malnutrition and the Consequences for Child Health andDevelopmentProject (MAL-ED) was a collaborative project supported by the Bill& Melinda Gates Foundation, the Foundation for the NIH, and theNIH/Fogarty International Center.

Impact of Maternal Fat Mass at 12–16 wk of Gestation onBreastfeeding Problems at 6 wk Postpartum (P13-081)

Nicole EMarshall, Bernard Lau, Kent LThornburg, and JonathanQ Purnell

Oregon Health & Science University

Objective: Women who are obese are significantly less likely toachieve exclusive lactation compared with women of normal weight.Besides physical and psychosocial issues, obesity-related metabolic

factors present during gestation may influence normal breast glandulardevelopment and milk production. Our goal was to determine whethermaternal body fat in early gestation was associated with breastfeedingproblems at 6 wk postpartum among women intending to exclusivelybreastfeed.

Methods: A total of 82 women of normal (n = 37), overweight(n = 27), and obese (n = 18) prepregnancy body mass indexunderwent BodPod (air displacement plethysmography) and skinfoldthickness measurement at 12–16 wk of gestation for determinationof percentage body fat percentage (%fat), which was divided intoquartiles. Breastfeeding problems were assessed via a modified versionof the Infant Feeding Practices Study II survey, which was completedonline at 6 wk postpartum. Breastfeeding exclusivity was determinedvia online survey response and/or confirmed via review of theelectronic medical record. Comparison by t test was undertakenbetween the first and fourth quartiles, with chi-square analysis forinterquartile groups.

Results: Women in the highest quartile for %fat were significantlymore likely to report “I didn’t have enough milk” than women in thelowest quartile (45.5% vs. 15%, P = 0.014). Increased %fat was alsosignificantly associated with starting infant formula supplementationby 6 wk postpartum (57.9% vs. 4.5%, P value not significant for breastdysfunction, too much milk, or infant feeding difficulty).

Conclusions: Elevated maternal %fat in early gestation is associatedwith increased risk of low milk supply and decreased rates of exclusivelactation at 6 wk postpartum. This suggests that elevated fat massin early pregnancy may reduce exclusive lactation success throughdecreased milk production.

Funding SourcesNIH NICHD K23HD069520 (to NEM).


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Overcoming Perceptions of Colic and Increasing Support toImprove Exclusive Breastfeeding Practices in Tanzania: HouseholdTrials with Mothers and Fathers (P13-082)

Cynthia RMatare,1 HopeCraig,1 Stephanie LMartin,2 RosemaryA Kayanda,3 Gina M Chapleau,1 Rachel Bezner Kerr,1 Kirk ADearden,3 Luitfrid P Nnally,4 and Katherine L Dickin1

1Cornell University, NY; 2University of North Carolina Chapel Hill;3IMA World Health, Tanzania; and 4Ministry of Health and SocialWelfare, Tanzania

Objective: In Tanzania, exclusive breastfeeding (EBF) declinessharply from 84% in the first 2 mo to 27% in months 5 and 6. EffectiveEBF promotion strategies are needed to improve child nutrition andsurvival. Our research explored barriers and facilitators to EBF inrural Tanzania and assessed parents’ willingness to adopt and supportrecommended breastfeeding practices.

Methods: Qualitative trials of improved practices (TIPs) wereconducted in 36 households with infants aged <6 mo in 2 regions.Fathers participated in preliminary focus group discussions on waysto support breastfeeding. Fathers and mothers were individuallyinterviewed 2 and 3 times, respectively, on willingness to try newbehaviors and their actual practice. Data were analyzed thematically toidentify barriers and facilitators to behavior change and strategies forengaging men to support improving breastfeeding practices.

Results: Common barriers to EBF were 1) parental concerns aboutcolicky infants, and use of commercial and/or traditional medicines totreat symptoms of crying or abdominal pain, 2) perceived thirst, forwhich infants were given water, and 3) women’s heavy workloads andtime away from their infants, limiting time available for EBF. Althoughseveral mothers expressed concerns about breastmilk sufficiency, fewwere giving other foods. After counseling, most mothers were EBFand breastfeeding more frequently. Fathers saw their roles as providingfood to mothers to ensure sufficient breast milk and to encouragerecommended trial practices. Even if willing to help with householdchores, fathers reported barriers, including normative gender roles andtheir work away from home. While a few fathers helped reduce theirwives’ workloads, most provided emotional support or encouragedothers to help with chores. Some fathers also soothed crying babies.Several couples reported that as a result of TIPs, their interpersonalcommunication had improved and helped support EBF.

Conclusions: Messages to promote EBF need to address concernsabout colic and crying, and help parents develop effective soothingtechniques and avoid use of nonprescribed medicines. Engaging menin EBF interventions is acceptable, and could help change social normsand facilitate men’s involvement in improving breastfeeding practices.

Funding SourcesFunded with UK aid from the UK Government through the

Department of International Development (DFID).

How Parents Communicate with their Family Child Care HomeProvider Regarding Foods Young Children Are Eating (P13-083)

Noereem Z Mena,1 Patricia Risica,2 Kim M Gans,3 IngridLofgren,1 Kathleen Gorman,1 Fatima Tobar,1 and Alison Tovar1

1University of Rhode Island; 2Brown University, RI; and 3Universityof Connecticut

Objective: Communication between child care providers andparents is important to support healthy eating habits in young children.However, there is limited evidence as to how parents communicate withchild care providers regarding what children are eating. The objectiveof this qualitative study was to explore how parents communicate withtheir family child care home (FCCH) provider about foods served andconsumed in the FCCH.

Methods: Five focus groups were held with caregivers (n = 25) ofpreschool-aged children attending Rhode Island FCCHs where foodwas provided. Participants were eligible to participate if they were atleast 18 y old, had a 2- to 5-y-old child attending an RI FCCH, and spokeEnglish or Spanish. Audio recordings were transcribed, and uploadedto Microsoft NVivo 11 to assist in the identification of themes by2 bilingual coders. Content analysis and axial coding were used foranalysis and theme extraction.

Results: The majority of participants were Hispanic (95%) andfemale (84%), and the average age was 33 y. Speaking over the telephoneand communicating in person during drop-off and pick-up werereported as the most common ways in which parents communicatedwith their FCCH provider. How parents received information on whatchildren were eating in the FCCH was inconsistent. Some reportedreceiving weeklymenus, others reported seeing themenu posted withinthe FCCH or asking their child what they ate. Parents who reportedawareness of the foods served in the FCCH said they found it easier topreparemeals at home, and stated that foods eaten at homewere similarto the foods served in the FCCH. Overall, parents felt the foods servedwere healthy, but usually only inquired if the child ate well, instead ofwhat the child ate. Most parents reported little concern over the typesof foods being served, stating that they trusted that what their providerswere serving was healthy, and in sufficient quantity. Limited time tospeak with the FCCH provider was reported. However, parents statedthat their FCCHprovider would always contact them if there were childconcerns.

Conclusions: Communication about the foods served and con-sumed in the FCCH is limited. Future studies should explore strategiesto foster consistent parent and provider communication about the foodsserved and consumed in FCCHs to support healthy eating habits inyoung children.

Funding SourcesResearch supported by theNationalHeart, Lung, and Blood Institute

of the NIH under Award Number R01HL123016.

Immune Status in Early Pregnancy Is Not Associated withDietary Protein, Fibre or Omega-3 Polyunsaturated Fatty AcidIntake in Normal or Overweight Women (P13-084)

Caroline J Moore,1 Naomi Fink,1 Valerie Bertram,1 MichelleMottola,2 and Stephanie Atkinson1

1McMaster University, Canada; and 2Western University, Canada

Objective: Pregnancy induces mild inflammation, which, whencombined with the chronic inflammation associated with excessadiposity, may exert a metabolic programming effect in utero. Evi-dence exists that diet [certain protein sources, fiber, and ω-3 (n–3)polyunsaturated fatty acids (PUFA)] plays a role in the regulation ofchronic inflammation. We aimed to explore whether dietary factors


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were associated with inflammation status in early pregnancy in normaland overweight women.

Methods: The Be Healthy in Pregnancy Study (BHIP:NCT01689961) recruited healthy pregnant women in Hamilton,Burlington, and London, Ontario, between 12 and 17 wk ofgestation. Nutrient intake was estimated from 3-d food recordsusing NutritionistProR (Version 5.2, Axxya Systems). Intakes werecompared with the dietary reference intakes. C-reactive protein (CRP)was measured by ELISA (Magnetic Luminex Assay, R&D Systems) inblood obtained at recruitment. Differences in dietary intakes betweengroups of women with a pregravid body mass index (pBMI) of normalweight (NW, 18.5–24.9 kg/m2), overweight (OW, >25–29.9 kg/m2),and obese (OB, ≥30 kg/m2) were assessed by ANOVA. Associationsbetween each dietary factor and CRP status were tested using multiplelinear regression, with pBMI and age included in the model.

Results: In 227 pregnant women, the mean ± SD baseline proteinintake (1.2 ± 0.4 g · kg–1 · d–1) exceeded the estimated averagerequirement and the dietary fiber intake (24.0 ± 8.6 g/d) was lowerthan the adequate intake. The protein source was predominantly dairy(23.0%) and meat (23.0%), as opposed to eggs and fish (8%), meatalternatives (6%), grains (16%), and fruits and vegetables (7%). OW andOB women had significantly lower average daily protein intakes thanNWwomen (1.1 and 0.97 vs. 1.4 g · kg–1 ·d–1,P< 0.001). Protein source,fiber and total ω-3 PUFA did not differ between the NW, OW, andOB groups, nor were they associated with circulating CRP in adjustedmodels (n = 147).

Conclusions: Women across weight categories consume relativelysimilar protein sources, dietary fiber and ω-3 PUFA in early pregnancy.However, OW and OB women consume significantly less total proteinthan NW women. These nutrients were not associated with systemicinflammation as measured by CRP, as has been shown in the nonpreg-nant population. Longitudinal assessments of the relation between thesenutrients and other markers of inflammation during pregnancy andpostpartum is a next step.

Funding SourcesFunded by Dairy Farmers of Canada, CIHR, and DFC/AAFC Dairy

Research Cluster; funded in kind by GayLea Foods & Ultima Foods.

Human Milk Feeding and Food Allergies, Allergic Rhinitis,Atopic Dermatitis, and Asthma in Offspring: A Systematic Review(P13-085)

Perrine Nadaud,1 Darcy Güngör,1 Concetta LaPergola,1 CarolDreibelbis,1 Yat Ping Wong,2 Nancy Terry,3 Steve Abrams,4Leila Beker,5 Tova Jacobovits,6 Kirsi M Järvinen-Seppo,7 Lau-rie Nommsen-Rivers,8 Kimberly O O’Brien,9 Emily Oken,10,11Rafael Pérez-Escamilla,12 Ekhard E Ziegler,13 and Joanne MSpahn2

1The Panum Group; 2USDA, Food and Nutrition Service; 3NIHLibrary; 4Dell Medical School at the University of Texas; 5US Foodand Drug Administration, retired; 6US Food and Drug Administration;7University of Rochester Medical Center, NY; 8University of CincinnatiCollege of Allied Health Sciences; 9Cornell University, NY; 10Divisionof Chronic Disease Research Across the Lifecourse, Department ofPopulation Medicine, Harvard Medical School and Harvard PilgrimHealth Care Institute, MA; 11Department of Nutrition, Harvard School

of Public Health, MA; 12Yale School of Public Health, CT; and13University of Iowa

Objective: The USDA and the Department of Health and HumanServices initiated the Pregnancy and Birth to 24 Months project toexamine important public health topics for these populations withsystematic reviews (SRs). The purpose of this SR was to examinethe relation between human milk feeding and food allergies, allergicrhinitis, atopic dermatitis, and asthma in offspring throughout thelifespan.

Methods: An SR team identified articles in PubMed, Cochrane,Embase, and CINAHL with a date range of January 1980 to March2016 thatmet a priori inclusion criteria. After dual-screening the searchresults, extracting data from the included studies, and assessing theirrisk of bias, the SR team synthesized the evidence by age group, drewconclusion statements, and graded the strength of the evidence.

Results: A total of 35 articles examined the duration of any humanmilk feeding, 1 examined the duration of exclusive humanmilk feedingprior to the introduction of infant formula, 45 examined never vs. everfeeding humanmilk, and no studies examined the intensity, proportion,or amount of human milk fed to mixed-fed infants or fed by breast vs.bottle. Most conclusion statements were graded as limited or grade notassignable. However, moderate evidence suggests that shorter vs. longerdurations of any human milk feeding are associated with a higher riskof asthma in childhood and adolescence. Also, never vs. ever being fedhuman milk may be associated with a higher risk of childhood asthma.

Conclusions:While there was some evidence of a relation betweenthe duration of any human milk feeding and never vs. ever feedinghuman milk and asthma, most of which was observational, additionalstudies are needed to confirm the findings and address the researchgaps related to other human milk–feeding practices and other atopyoutcomes. Researchers should address critical confounders and tem-porality, and all variables should be clearly defined and collected withvalidated methods.



Disparities in Body Size and Body Proportion of Children andAdolescents in aMultiethnic Community onGuatemala’s CaribbeanCoast (P13-086)

Chinonso Nduaguba,1 Liza Díaz,2 Noel W Solomons,2 andOdilia Bermudez1

1Tufts University School of Medicine, MA; and 2CeSSIAM

Background: Guatemala currently faces a double burden of mal-nutrition with a high incidence of stunting and increasing rates ofchildhood obesity. Stunting can originate in utero or immediately afterbirth. Linear growth status has been studied in various locations andcommunities throughout the country. There is, however, little informa-tion about Livingston, a village on the Caribbean coast of Guatemala.

Objective: In this study, we sought to examine the differencesin body size between Garifuna (Afro-Caribe) and non-Garifuna(Mayan and Ladino) children and adolescents through anthropometricmeasurement.


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Methods: Anthropometric measurements (weight, height, andarmspan length) of Garifuna (n = 121) and non-Garifuna (n = 84)youths were compared. We measured the weight of each subject tothe nearest tenth of a kilogram using a calibrated, digital bathroomscale placed on a level surface. The standing height of each subject wasmeasured to the nearest centimeter with a measuring-tape stadiometer.The armspan of each subject was measured to the nearest centimeterusing an inflexible measuring stick. Body mass index (BMI) percentilesfor age of individuals was obtained using the CDC child/adolescentonline BMI calculator. We calculated the armspan-to-height ratio. TheMann-WhitneyU test was used to compare distributions across groups,and the association between variables was tested with the Spearmanrank-order correlation coefficient.

Results: The overall (n = 205) Spearman rank-order coefficient ρ

for height vs. armspan was 0.958 (p. Garifuna adolescents had a greatermedian heightmeasurement, 159 vs. 149 cm, respectively, than the non-Garifuna, and also a greater median armspan length, 162 vs. 150 cm,respectively. Median weight in the former group (48.4 kg) was greaterthan in the latter (47.0 kg), but the median BMI percentile was a loweramong the Afro-Caribe than in the non-Garifuna youth, at 50.0 vs. 65.5,respectively. All intergroup differences were at p

Conclusions: Garifuna children and adolescents were longer thannon-Garifuna, as shown by the difference in both height and armspan.Garifuna children were significantly heavier by absolute weight (inkilograms), but were correspondingly leaner by relative weight (asshown by BMI).

Funding SourcesHarold William Scholarship Fund.

Armspan-to-HeightRatiosApproximate 1.0 inGuatemalanChil-dren and Adolescents across Ethnic Groups, but Ethnicity Remainsa Differential Determinant (P13-087)

Chinonso Nduaguba,1 Liza Díaz,2 Noel W Solomons,2 andOdilia Bermudez1


Background:The armspan is an anthropometricmeasurewhich canbe simply and accurately measured with a portable, mounted inflexiblemeasuring tape. Its application has been in elderly populations toestimate cumulative senescent height loss, assuming that the ratio ofarmspan to height at the age of peak stature is 1.0. Only limited infor-mation is available on the armspan to height ratio evolution throughchildhood on the way to the maximal stature in young adulthood.

Objectives: The aim of this study was to examine this process inmultiethnic juveniles on Guatemala’s Caribbean Coast.

Methods:We recruited 205 youths, boy and girls, with ages between9 and 16 y. Of these, 121 were of Garifuna descent and 84 wereof non-Garifuna descent. The standing height of each subject wasmeasured to the nearest centimeter with a measuring tape. Armspanwas measured with arms at 90° to the body from the longest finger ofthe one hand to the longest finger of the other hand. It was measuredto nearest centimeter using an inflexible measuring tape. Both of thesemeasurements were used to calculate the armspan-to-height ratio.Statistical analysis was performed using Student’s t test for differencebetween ethnicity, and Lin’s concordance correlation for correlationbetween height and armspan.

Results: The Lin’s concordance coefficient (LCC) for the associationof height with armspanwas r= 0.930 for all participants (n= 212), witha value of r= 0.938 for boys (n= 110) and r= 0.912 for girls (n= 102).The LCC was r = 0.900 and r = 0.953, respectively, for the Garifuna(n = 121) and non-Garifuna (n = 84). Expressed as the armspan-to-height ratio, calculated on an individual basis, the descriptive datashowed the overall mean ± SD was 1.019 ± 0.027 (median: 1.017),with a range from 0.958 to 1.083. The majority (78%) of all ratio valueswere between 0.960 and 1.040. The respective descriptive data for theGarifuna,1.026 ± 0.266 (1.026), with a range from 0.959 to 1.082, andnon-Garifuna, 1.009 ± 0.023 (1.008), with range from 0.959 to 1.056,were statistically different (P < 0.001).

Conclusions: As expected, height and armspan values are highlycorrelated in this unexplored age group. The armspan-to-height ratio isalready very close to the touted value of 1.00 in children and youths ofa multiethnic Caribbean coastal community in Guatemala. The ethnicfactor was a significant determinant of the ratio.

Funding SourcesHarold William’s Scholarship.

Lactating Guatemalan Women Have a Higher Body Fat Percent-age when Estimated by Bioelectrical Impedance as Compared withPredictive Equations from Body Mass Index (P13-088)

Ruijia Niu,1 Alejandra Zamora,2 Marta Escobar,2 AlejandraMaldonado,2 Rosario Garcia-Meza,2 Odilia Bermudez,1 andNoel W Solomons2


Objective:The aim of this study was to compare percentage body fat(%BF) as estimated by bioelectrical impedance analysis (BIA) and by 2predictive equations from the bodymass index (BMI) in urban lactatingwomen in the Western Highlands of Guatemala.

Methods: A total of 40 lactating women with infants between 37and 194 d old from the urban area of Quetzaltenango, Guatemalaparticipated in the study. Convenient sampling was used. Participationwas voluntary, and written consents were provided. Participants wereinterviewed to collect their demographic information. Weight, height,and abdominal circumference were measured by trained anthro-pometrists. BIA was conducted using a Medical Body CompositionAnalyzer SECA 525. The values of %BF from the BMI equations andfrom the BIAwere compared by paired t test. Linear regressionwas usedto investigate the association between the%BF values. Stata was used forstatistical analysis.

Results: The participants had an average age of 24.9 y (range:17–37 y). There were 4 women with postsecondary education and36 others with primary or secondary education. The mean waistcircumference was 86.5 cm (range: 69–110 cm). The participants hada mean BMI of 25.04 kg/m2 (range: 19.39–35.91 kg/m2). There were13 overweight women (25 ≤ BMI < 30 kg/m2) and 4 obese (BMI ≥30kg/m2), and none was underweight (BMI <18.5 kg/m2). The mean± SD %BF from BIA was 35.3% ± 6.7%, which is 17% higher thanthat from Deurenberg’s equation (30.4% ± 4.9%) and 11% higher thanthat from Gallagher’s equation (31.9% ± 4.9%). There were statisticallysignificant differences between the BMI-calculated %BF values and thevalue from BIA (P = 0.0001 for 2-paired t test). The linear associationcan be expressed as %BF (from Deurenberg’s equation) = 0.59 × %BF


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fromBIA+ 9.69 (P= 0.001,R= 0.79), and%BF (fromGallagher’s equa-tion)= 0.62×%BF from BIA+ 10.11 (P= 0.001, R= 0.83). The inter-correlation of the 2 prediction equation values wasR= 0.97, P< 0.0001.

Conclusions: The BF% generated by BIA gives ∼17% and 11%higher values than those calculated using Deurenberg’s and Gal-lagher’s BMI equation, respectively, among urban lactating women inGuatemala. BIA has the advantage of being independent of BMI, butfurther independent body-composition methods would be needed toassign validity among our estimates.

Funding SourcesN/A.

FIGURE P13-088-1 Scatter-plot of Percent Body Fat fromDeurenberg BMI Equation vs. BIA.

FIGURE P13-088-2 Scatter-plot of Percent Body Fat fromGallager BMI Equation vs. BIA.

Complex Associations of Human Hydration Status Measuredby Urinary Osmometry and Bioelectrical Impedance Analysis inLactating GuatemalanWomen (P13-089)

Ruijia Niu,1 Alejandra Maldonado,2 Marta Escobar,2 RosarioGarcia-Meza,2 Odilia I Bermudez,1 and Noel Solomons,2


Objective: The aim of this study was to determine the associationbetween hydration status measured from urinary osmometry andbioelectrical impedance analysis (BIA) in urban lactating women in thewestern highlands of Guatemala.

Methods: A total of 40 lactating women with infants between 37and 194 d of age from the urban area of Quetzaltenango, Guatemalawere recruited to participate in this study by convenience sampling.Participation was voluntary, with written consent. Participants wereasked to collect their urine samples on site. Weight, height, and waistcircumference were measured by trained anthropometrists using SECAequipment. BIA was conducted using a Medical Body CompositionAnalyzer SECA 525. Total body water (TBW) and fat free mass (FFM)were calculated by the Analyzer. The urine sample aliquots wereprepared and frozen in a –20°C freezer. All 40 urine sample aliquotswere defrosted at the final phase of the project and urine osmolality(Uosm) was tested using a Vogel-Löser model 815. Linear regressionwas used to test the association between Uosm and TBW/FFM%values. The chi-square test was used to determine the differences inhydration status categorization of the 2 measurements. Stata was usedfor statistical analysis.

Results: The participants had an average age of 24.9 y (range: 17–37 y). Levels of schooling were self-reported, and there were 4 womenwith postsecondary education and 36 others with primary or secondaryeducation. The mean ± SD TBW/FFM% was 73.9% ± 0.9%. The meanUosm was 599 ± 228 mOsm/kg. There was no linear associationbetween Uosm and TBW/FFM% (P = 0.21). When a Uosm cutoff of90–900 mOsm was used, 4 participants were classified as hypohydratedand 1 was hyperhydrated. Using a 700 mOsm cutoff, 16 women were inthe hypohydration category. For BIA, there were 3 women categorizedas hypohydration with a cutoff of TBW/FFM% of <73.2%. Therewas no statistically significant difference at the frequency level oncategorization of the 2 measurements if using the 90–900 mOsm cutoff(P= 0.50), but only 1 womanwere coclassified as hypohydrated by bothmethods.

Conclusions: At the individual level, the values of Uosm andTBW/FFM% from BIA were poorly related; however, their respectivecategorization of low hydration status prevalence yielded similar resultsin lactating women.

Confirmation of Associations of Body Composition with Breast-milk Fat Content by a New Constellation of Methods in LactatingGuatemalanWomen (P13-090)

Ruijia Niu,1 Alejandra Zamora,2 Marta Escobar,2 AlejandraMaldonado,2 Rosario Garcia-Meza,2 Odilia Bermudez,1 andNoel W Solomons2


Objective: The aim of this study was to assess the magnitude ofthe association between human milk fat content (MF) and percentagebody fat (%BF) as estimated by bioelectrical impedance analysis (BIA),compared with %BF from predictive equations calculated with bodymass index (BMI) in urban lactating women in the western highlandsof Guatemala.


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Methods: A total of 40 lactating women with infants aged between37 and 194 d from the urban area of Quetzaltenango, Guatemala wererecruited to this study by convenience sampling. Participation wasvoluntary, with written consent. At least 30 mL of breastmilk fromeach participant was collected using manual milk pumps by trainedresearchers. Weight, height, and waist circumference were measuredby trained anthropometrists. BIA was conducted with a Medical BodyComposition Analyzer SECA525. MF (measured in g/L) was measuredbyCreamatocrit using Lucas’s equation. The%BFwas determined using2 equations from the BMI (kg/m²) as well as direct reading from BIA.Separately, linear association was tested between the %BF values from 3estimations with MF.

Results: The participants had an average age of 24.9 y (range:17–37 y). The mean waist circumference was 86.5 cm (range: 69–110 cm). The participants had a mean BMI of 25.0 kg/m2 (range:19.4–35.9 kg/m2). There were 13 overweight women (25 ≤ BMI < 30kg/m2) and 4 obese (BMI≥30 kg/m2), and nonewas underweight (BMI<18.5 kg/m2). The mean ± SD %BFs from the BMI calculations were30.4% ± 4.9% and 31.9% ± 4.9% (from Deurenberg’s and Gallagher’sequation, respectively), and that from BIA was 35.3% ± 6.7%. Themean MF was 31.5 ± 16.7 g/L. The %BF values from Deurenberg’sandGallagher’s equations were linearly associated withMF, respectivelyexpressed as MF (g/L) = 0.105 %BF (R = 0.91, P < 0.0001) and MF(g/L) = 0.100 %BF (R = 0.91, P < 0.0001). This linear association wasalso found between the %BF from BIA and MF: MF (g/L) = 0.089 %BF(R = 0.90, P < 0.0001).

Conclusions:Althoughparticipation fromawider range of lactationstages is recommended for future studies, %BF generated from BMIequations and BIA could all be good predictors of human milk fatcontent between 37 and 194 postpartum days in Guatemalan mothers,confirming prior findings. This vouches for appropriate full-breastextraction and sample homogenization, as well as relative validity of all%BF approaches.

A Preliminary Randomized Trial of Metformin to Augment LowMilk Supply (P13-091)

Laurie Nommsen-Rivers,1 Amy Thompson,2 Sarah Riddle,3Laura Ward,3 Erin Wagner,1 and Eileen King3

1University of Cincinnati College of Allied Health Sciences;2University of Cincinnati College of Medicine; and 3Cincinnati Chil-dren’s Hospital Medical Center

Objective: Emerging clinical research is corroborating an importantrole for healthy insulin action in lactation. Metformin is a first-linedrug for improving insulin action and is considered safe to use duringlactation, but it has never been tested for efficacy in treating lowmilk supply. Our objective was to conduct a preliminary randomizedclinical trial (RCT) of metformin vs. placebo in women with low milkproduction and signs of insulin resistance.

Methods: The RCT inclusion criteria included: mother 1–8 wkpostpartum, with low milk production based on 24-h test weighingand ≥1 insulin resistance sign, and with a singleton, healthy terminfant. Exclusion criteria included identified cause of low milk supplyor contraindication to metformin. Eligible mothers were randomlyassigned 2:1 to the metformin or placebo group. Mothers received ahospital-grade pump and were instructed to augment breastfeeding ≥8

times a day with breast pumping. Milk production was remeasured 2and 4 wk postintervention.

Results: A total of 51 women were screened, and 15 met RCTeligibility. Median values at baseline in metformin (n = 10) vs. placebo(n = 5), respectively, were maternal age (33 vs. 36 y), body mass index(37.5 vs. 39.7 kg/m2), gestational diabetes (60% vs. 20%), infant age(20 vs. 40 d), breast emptying (18 vs. 15 times a day) and milk output(148 vs. 266 g/d). Milk output improved in 6 of 10 women in themetformin group (60%) vs. 1 of 5 on the placebo (20%, Fisher’s exacttext, P = 0.28). The median change from baseline was 8 vs. –56 g,respectively (Wilcoxon, P = 0.30).

Conclusions: A trend toward greater improvement in the met-formin group was mostly because of overall worsening of milkproduction in the placebo group, despite aggressive pumping andlactation support. More work is needed to develop interventions formetabolically at-risk mothers with low milk supply.

Funding SourcesNIH 5 K12 HD051953 (PI, Tsevat), Bridging Interdisciplinary

Research Careers in Women’s Health (BIRCWH award to LN-R).

Metabolic Syndrome Severity Score Identifies Persistently LowMilk Output (P13-092)

Laurie Nommsen-Rivers,1 Amy Thompson,2 Sarah Riddle,3Laura Ward,3 Erin Wagner,1 and Jessica Woo3

1University of Cincinnati College of Allied Health Sciences;2University of Cincinnati College of Medicine; and 3Cincinnati Chil-dren’s Hospital Medical Center

Objective: Maternal obesity is associated with shortened breast-feeding duration, but the mechanisms are unclear. Our objective wasto compare milk output according to metabolic health status in acohort of predominantly obese mothers striving to improve their milkproduction.

Methods: Eligible mothers were 1–8 wk postpartum, delivereda healthy term infant, and desired to improve their milk output. Atbaseline, we assessed metabolic syndrome features (fasting glucose,cholesterol, and triglycerides; blood pressure and waist circumference),and provided support in frequent and thorough breast emptying.Mothers test-weighed their milk production over 24 h at baseline, andat 2 and 4 wk postintervention. We defined maximum milk output(MMO) as the greater of week 2 or 4, and categorized MMO <300mL/24 h as persistently low milk output. The Metabolic SyndromeSeverity Score (MetScore) is a metabolic health z score relative toUS adults aged 20–64 y; we would expect a MetScore of ≤0.00 forreproductive-aged females. We compared MMO categories in theMet-Risk vs. Met-Healthy groups (MetScore >0.00 vs. ≤0.00). Theintervention included metformin for some (n = 10), but none changedcategories for MMO orMetScore, thus all were included in the analysis.

Results: At baseline, the Met-Risk (n = 14) and Met-Healthy(n = 16) groups were similar in age (34 ± 6 vs. 33 ± 5 y), infantage (29 ± 17 vs. 34 ± 15 d), and breast-emptying frequency (20 ± 7vs. 23 ± 8 total/24h). The Met-Risk group had marginally highergestational diabetes prevalence (GDM) (36% vs. 13%, P = 0.12), andthe groups were significantly different (all P < 0.001) in body massindex (41.7± 6.8 vs. 28.5± 4.0 kg/m2), all metabolic syndrome featuresexcept cholesterol, andMMO (162+ 75 vs. 460+ 241mL/24 h). MMO


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<300mLoccurred in 100% (14/14) of thewomen in theMet-Risk groupand 25% of those in the Met-Healthy group (4/16, P< 0.0001), and 2 ofthe latter 4 were GDM.

Conclusions: MetScore is a clinically accessible tool that holdspromise for identifying a vulnerable subset of women who are at veryhigh risk for persistently low milk output, but this should be confirmedin a longitudinal cohort with MetScore measured prenatally.

Funding SourcesNIH 5 K12 HD051953 (PI, Tsevat), Bridging Interdisciplinary

Research Careers in Women’s Health (BIRCWH award to LN-R).

Exposure to a Slightly Sweet Nutrient Supplement during EarlyLifeDoesNotChangePreference for orConsumptionof Sweet Foodsand Beverages by Ghanaian Preschool Children (P13-093)

Harriet Okronipa,1 Mary Arimond,2 Rebecca R Young,1 CharlesD Arnold,1 Seth Adu-Afarwuah,3 Sika Kumordzie,1 Maku EOcansey,1 Brietta M Oaks,4 and Kathryn G Dewey1

1University of California,Davis; 2Intake—Center forDietaryAssess-ment, FHI 360; 3University of Ghana; and 4University of Rhode Island

Objective: The aim of this study was to examine the impact ofsupplementation with a slightly sweet lipid-based nutrient supplement(LNS) early in life on the preference for or consumption of sweet foodsand beverages among 4- to 6-y-old children.

Methods: We conducted a follow-up (January–December 2016) ofchildren 4–6 y of age who participated in a nutrition supplementationtrial (2009–2014) in Ghana, in which LNS was provided to womenduring pregnancy and the first 6 mo postpartum, and to their infantsfrom age 6 to 18 mo (LNS group). Women in the control groups(non-LNS group) received either iron and folic acid during pregnancyor multiple micronutrients during pregnancy and the first 6 mopostpartum, with no infant supplementation. At follow-up at age4–6 y, we obtained data on children’s food and beverage preferenceand consumption (n = 985) via a questionnaire administered tocaregivers. For a randomly selected subsample (n = 624), we assessedpreference for sweet items using a photo game. For the photo gameand caregiver report of consumption variables, we examined groupdifferences using predetermined noninferiority margins equivalent toan effect size (difference divided by SD) of 0.2, which is relatively small.

Results: The median (q1, q3) reported consumption for all sweetitems (times in the past week) was 14 (8, 23) in the LNS group and 16 (9,22) in the non-LNS group. Reported consumption of sugar-sweetenedbeverages was 5 (3, 10) and 6, (2, 9) in the LNS and non-LNS group,respectively. In the photo game, the number of sweet items preferred(out of 30 food and beverage items) was 15 (11, 15) and 15 (11, 15) bychildren in the LNS and non-LNS group, respectively. The preferencescore for sweet items (total possible score= 30) based on the caregiver’sreport did not differ between the LNS and non-LNS groups [25 (21, 28)vs. 25 (21, 28),P= 0.901]. The upper level of the 95%CI of the differencebetween the LNS andnon-LNS groups did not exceed the noninferioritymargins for the sweet food and beverage preference and consumptionvariables, indicating that the preference or consumption of these itemswas not higher in the LNS group than in the non-LNS group.

Conclusion: In this setting, where sweets were frequently consumedby all children, supplementation with a slightly sweet LNS early in life

did not increase the preference for or consumption of sweet foods andbeverages at 4–6 y of age.

Funding SourcesFunded by a grant to the University of California, Davis and by the

Bill & Melinda Gates Foundation.

Prevalence and Determinants of Inadequate Gestational WeightGain among Pregnant Women in Zinder, Niger (P13-094)

Cesaire T Ouedraogo,1 Rebecca Young,1 K Ryan Wessells,1Thierno M Faye,2 and Sonja Y Hess1

1University of California, Davis; and 2Helen Keller International,Niger

Objective: The aim of this study was to determine the prevalenceand determinants of inadequate gestational weight gain (GWG) andnutritional status among pregnant women in Zinder, Niger.

Methods: A community-based survey was conducted among 1385pregnant women in the catchment areas of 18 health centers in theregion of Zinder, Niger. Women were interviewed at their homeregarding their pregnancy and health status, demographic character-istics and socioeconomic status, food security, dietary practices, andknowledge, attitudes and practices (KAP) related to pregnancy andantenatal care (visit 1). At visit 2, 1 mo later, the KAP interviewswere repeated and capillary blood was collected for hemoglobinconcentration. Symphysis-fundal height, weight, height, and midupperarm circumference (MUAC) were assessed at both visits. GWG wascalculated as the difference between measurements at visit 2 and visit 1.Factors associated with inadequate GWG (<0.36 kg/wk) and lowMUAC (<23 cm) were identified using logistic regression modelsadjusting for season and village.

Results: The median (IQR) age was 25.0 (20.7, 30.0) y and 16.3% ofpregnant womenwere adolescent (≤19 y). Themedian (IQR) GWGperweek and MUAC were 0.24 (0.00, 0.44) kg/wk and 24.1 (23.0, 26.0) cm,respectively. The prevalence of inadequate GWG per week was 64.6%and the prevalence of low MUAC was 25.7%. As height increased, theodds of inadequate GWG per week significantly decreased [OR: 0.95(0.92, 0.98), P = 0.0003], as did the odds of low MUAC [OR: 0.93(0.90, 0.96), P < 0.0001]. The odds of low MUAC were higher amongadolescents [OR: 3.3 (1.9, 5.5),P< 0.0001] and decreased as the numberof living children increased [OR: 0.86 (0.75, 0.99), P = 0.048].

Conclusions: There is a high prevalence of inadequate GWGand low MUAC among pregnant women in the Zinder region ofNiger, with increased odds among adolescents and women of shortstature. Considering the importance of adequate GWG for pregnancyoutcomes, interventions should be considered.

Funding SourcesFinancial support came from the Government of Canada through

Global Affairs Canada and Nutrition International, formerly theMicronutrient Initiative.

Gestational Folic Acid and 5-Methyltetrahydrofolate Differen-tially Affect Hepatic DNA Methyltransferases in Wistar Rat FemaleOffspring at Birth and Later Life Phenotype (P13-095)

Emanuela Pannia, Terry Sa, Rola Hammoud, Neil Yang, MandyHo, Diptendu Chatterjee, Ruslan Kubant, and G Harvey Ander-son


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University of Toronto, Canada

Background: Folic acid (FA, synthetic folate) intakes above require-ments during pregnancy lead to an increased risk of obesity in Wistarrat offspring postweaning (PW). High FA also associates with highunmetabolized FA in the circulation, indicating that it is not easilyconverted in the liver to its bioactive form. Folates are key componentsof the 1-carbon cycle, which produces the substrate required byDNAmethyltransferases (DNMTs) for methylation reactions, and thusperturbations in its metabolism may alter the methylation of key regu-latory genes involved in energy homeostasis. 5-Methyltetrahydrofolate(MTHF), the more bioactive form of folate, has recently becomeavailable as a dietary supplement. However, the long-term metabolicconsequences of different folate forms on offspring’s health have notbeen reported.

Objective: The aim of this study was to investigate the effectsof gestational folate form and dose on hepatic DNMT activity andexpression in female offspring at birth and long-term body weight andfood intake.

Methods: Pregnant Wistar rats were fed an AIN-93G diet withthe recommended amount of FA (1X, control, 2 mg/kg), 5X-FA,or equimolar concentrations of MTHF and then the control dietduring lactation. Upon weaning, female offspring were fed a high-fat (45% fat) diet until 19 wk. Hepatic DNMT activity and mRNAexpression of maintenance methyltransferase (Dnmt1) and de novomethyltransferases (Dnmt3a/b) were measured at birth in female pupsas an index of methylation potential, and PW body weight and foodintake were measured.

Results:A lasting and differential effect of gestational folate dose andformon female offspring phenotypewas observed. PWbodyweight waslower in 5X-FA female offspring comparedwith all other diet groups (by∼12%, P < 0.001), but food intake was only lower compared with the1X-MTHF offspring (P < 0.05). Offspring from the 1X-MTHF damsalso had higher hepatic Dnmt3a (P < 0.05) mRNA expression at birthcompared with the other diet groups, but Dnmt1/3b expression andtotal DNMT enzyme activity were not affected by gestational diet.

Conclusions: Gestational folate dose and form differentially affectlong-term body weight and food intake of the female offspring, but thisis not fully explained through DNMT activity and expression at birth.Other epigenetic mechanisms are currently being investigated to helpexplain these findings.

Funding SourcesCanadian Institute of Health Research, Institute of Nutrition,

Metabolism and Diabetes (CIHR-INMD), Reference MOP-130,286.

Lactation Duration and Long-Term Thyroid Function amongWomen with Gestational Diabetes (P13-096)

Pranati L Panuganti,1 Pranati Panuganti,1 Stefanie Hinkle,2Shristi Rawal,3 Louise G Grunnet,4 Yuan Lin,5 Aiyi Liu,2 AnneCBThuesen,6 SylviaHLey,7 Sjurdur FOlsen,6 andCuilin Zhang2

1Brown University, RI; 2NIH; 3Rutgers University, NJ;4Rigshospitalet, Denmark; 5Indiana University; 6SSI; and 7HarvardUniversity, MA

Objective: The aim of this study was to examine the associationbetween lactation duration and long-term thyroid function among

women with a history of gestational diabetes mellitus (GDM), a high-risk population for subsequent metabolic complications.

Methods: The study included 550 women who developed GDMin the Danish National Birth Cohort (1996–2002). During follow-up in the Diabetes & Women’s Health Study (2012–2014), womenreported their lactation duration for each of their pregnancies andfasting blood samples were collected. Thyroid biomarkers were assayed,including: thyroid stimulating hormone, free triiodothyronine (fT3),free thyroxine (fT4), thyroid peroxidase antibody (anti-TPO), andthyroglobulin antibody (anti-TG). We used generalized linear modelsto assess the associations between cumulative lactation duration andconcentrations of thyroid biomarkers. We used logistic regression toestimate ORs for positive anti-TG and anti-TPO. Multivariate modelswere adjusted for potential confounders measured at the baselineindex pregnancy, including prepregnancy body mass index. Additionalanalyses were limited to women with a single lifetime pregnancy to ruleout residual confounding owing to parity.

Results: Overall, the median cumulative duration of lactation was9 mo (interquartile range 4–15) after an average of one pregnancy(interquartile range 1–2). Women with longer cumulative lactationduration tended to have higher fT3 concentrations [adjusted β and95% CI for ≥12 mo vs. none: 0.19 (0.03, 0.36); P-trend = 0.05]. Whenrestricted to women with a single lifetime pregnancy to control for theparity impact (n = 70), women who lactated for >6 mo had higherfT3 concentrations [0.46 pmol/L (0.12, 0.80); P-trend = 0.02] and ahigher fT3:fT4 ratio [0.61 (0.17, 1.05); P-trend = 0.007] comparedwith women who never lactated. There was no significant associationbetween lactation duration and odds of anti-TG or anti-TPO positivity.

Conclusions: Our findings suggested that a longer duration oflactation may be related to greater serum fT3 concentrations andfT3:fT4 ratio 9–16 y postpartum among women with a history of GDM.The association was particularly pronounced among women who hadonly had one lifetime pregnancy.

Funding SourcesThis workwas supported by the Intramural Research Program of the

Eunice Kennedy Shriver National Institute of Child Health and HumanDevelopment at the NIH (contract numbers HHSN275201000020C,HHSN275201500003C, HHSN275201300026I, HSN275201100002I).Financial support for DNBC was received from: March of DimesBirth Defects Foundation (6-FY-96-0240, 6-FY97-0553, 6-FY97-0521,6-FY00-407), Innovation Fund Denmark (grant numbers 09-06,7124and 11-115,923, ‘Centre for Fetal Programming’), Danish Council forIndependent Research (grant numbers 9,601,842 and 22-03-0536), theHealth Foundation (11/263-96), and the Heart Foundation (96-2-4-83-22,450).

Milk Formula with Different Glycation Profiles and Fat BlendsInfluences Gastrointestinal Outcomes in Chinese Infants: Resultsfrom 2 (P13-097)

Panam Parikh,1 Sheng Xiaogyang,2 and Vanitha Buthmanaban1

1Friesland Campina; and 2Xinhua Hospital affiliated to ShangJiaotong University School of Medicine, China

Objectives: The aims of this study were to investigate the influenceof infant formulas (IFs) with different protein glycation profiles (Study


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1) and fat blends (Study 2) on stool characteristics, gastrointestinalsymptoms, and digestion parameters in formula-fed Chinese infants.

Methods: Healthy infants (ages 0–4 mo) were recruited fromShanghai, Beijing, and Shenyang into either Study 1 (n = 400) orStudy 2 (n = 400) based on the type of their current IF. Each cross-sectional study compared responses to 4 commercially available IFsover 1 wk duration. For Study 1, the glycation levels for the 4 IFs wereestablished based on blocked lysine analysis. The fat blend for the 4IFs in Study 2 was based on the label declaration. Caregivers recordedfeeding volumes, stool characteristics using the Amsterdam Stool Scale,and crying patterns using questionnaires or a diary. Stool samples werecollected during days 5–7 for analysis of protein and fat metabolites.Subjects continued with their usual feeding practice during both studyperiods.

Results: All recruited infants completed the study. In Study 1, theglycation level of the IFs ranged from∼8 to 18%. Reports of hard stoolsand gastrointestinal discomfort were greatest in infants fed the IF withthe lowest glycation level. Reports of hard stools and gastrointestinaldiscomfort were least in infants fed the IF with the ∼8% glycationlevel. Furthermore, caregivers also reported∼30min of less crying timein this group. Metabolite analysis revealed that infants in this groupshowed a trend of lower branched chain fatty acids as compared withthe other IFs, supporting the questionnaire-based observations. Study2 reported similarly favourable results for the IF with 20% milk fat forthe subjective assessments. Additionally, infants fed the IF with 20%milk fat also had a lower concentration of soaped fatty acids (albeit notsignificant) as compared with the other IFs. For both Study 1 and 2, theresults were consistent across 7 d of reporting.

Conclusions: This study suggests tha tIFs with low glycation levelsand/or with milk fat have a relevance for gastrointestinal comfortamongChinese infants. The results should, however, be interpretedwithcaution, as they are largely based on subjective reports. Further researchis warranted to establish the health benefits of IF with low glycationlevels and/or with milk fats.

Funding SourcesThe study was sponsored by Friesland Campina.

EnergyMetabolism IsAssociatedwithPostpartumWeightReten-tion (P13-098)

Leticia Pereira, Leticia Pereira, Sarah Elliott, Linda J McCargar,Rhonda Bell, Khanh Vu, Gordon Bell, Paula J Robson, and CarlaM Prado

University of Alberta, Canada

Background: Investigating energy metabolism during the postpar-tum (PP) period is crucial for better understanding weight regulation atthis life stage.

Objective: The aim of this study was to profile total energyexpenditure (TEE) and its components [resting energy expenditure(REE), exercise energy expenditure (EEE), sleep energy expenditure(SEE), and respiratory quotient (RQ)] of PP women, and to examinethe association between energy metabolism and PP weight retention(PPWR).

Methods: A total of 49 PP women participated in this longitudinalobservational study. At 3 mo PP, participants completed a 30-minREE test using whole-body calorimetry (WBC) and body composition

analyses [dual-energy X-ray absorptiometry (DXA)]. At 9 mo PP,24-h TEE, REE, EEE, SEE, and RQ were measured using WBC,DXA was performed, and maximal oxygen consumption (VO2 max)was predicted using the Modified Bruce protocol. Women werestratified as high (>4.8 kg) or low (≤4.8 kg) weight retainers basedon Dietary Reference Intake guidelines. Two-way mixed repeated-measures ANOVA and longitudinal regression models were applied,controlling for confounding factors. Statistically significant results arereported (P < 0.05).

Results: Fat mass (FM) and the FM to fat free mass (FFM) ratiowere lower in low vs. high retainers at 3 (FM: 27.53 ± 11.69 kg vs.37.43 ± 11.81 kg; FM:FFM ratio: 0.61 ± 0.23 vs. 0.83 ± 0.18) and9 mo PP (FM: 24.61 ± 11.44 kg vs. 37.40 ± 15.69 kg; FM:FFM ratio:0.54± 0.22 vs. 0.80± 0.25). REE was negatively associated with PPWR(β = –0.74). REE was 2 kcal/kg higher at 3 mo, and REE and TEEwere 3 kcal/kg higher at 9 mo in low retainers vs. high retainers. REEincreased by 8% from 3 to 9 mo PP in low retainers but did not changein high retainers. Additionally, VO2 max (36 ± 7 mL · kg–1 · min–1 vs.31 ± 6 mL · kg–1 · min–1) was higher in low vs. high retainers; and bothTEE (β = –0.09) and predicted VO2 max (β = –0.02) were negativelyassociated with PPWR.

Conclusions: Compared with high retainers, low retainers pre-sented a more favorable body composition and energy metabolismprofile at 3 and 9moPP, whichmay be associatedwithweight regulationand its trajectory during the PPperiod. This highlights the need for earlytargeted interventions for reducing PPWR.

Funding SourcesThis work is funded through an Alberta Innovates (AI) Col-

laborative Research and Innovation Opportunity Program grant(RES0017751). LCRP is supported by a Vanier Canada GraduateScholarship. SAE was supported by an AIHS postdoctoral fellowship.

Energy and Nutrient Intake in Children with and withoutIntellectual Disabilities (P13-099)

Jessica Perelli,1 Sarah Phillips,2 Aviva Must,3 Laura Jay,4 CarolCurtin,5 and Linda Bandini5,6

1Boston University, MA; 2Rivier University, NH; 3Tufts UniversityMedical School, MA; 4Boston Children’s Hospital, MA; 5University ofMassachusetts Medical School; and 6Boston University

Objective: Despite considerable research in typically developing(TD) children, little is known about the nutrient profiles of childrenwith intellectual disabilities (ID). We hypothesized that children withID would consume more calorie-dense, nutrient-poor foods, consumefewer fruits and vegetables, andhave amore limited food repertoire thanTD children, and that this would impact their nutrient intake. The aimof this study was to prove or disprove this hypothesis.

Methods: We assessed nutrient intakes in 55 children with ID and49 TD children, aged 3–8 y. Parents completed a 3-d food diary thatincluded 2 weekdays and 1 weekend day. Mean intakes extracted fromthe Nutrition Data Systems for Research were compared between the 2groups using t tests.

Results:Energy andmacronutrient intakes were similar between thegroups. Added sugar intake was slightly higher in the TD group than inthe ID group (49.1 g vs. 40 g), though this difference was of borderlinestatistical significance (P< 0.06). Overall, micronutrient intake did not


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differ statistically between the groups. Children in both groups met theestimated average requirement (EAR) for folate, thiamin, riboflavin,niacin, B6, phosphorus, magnesium, and iron. A small percentage ofchildren in both groups did not meet the EARs for vitamin A and Cand, in children with ID, a few (6%) did not meet the EAR for vitaminB-12. In addition, a substantial proportion of children in both groupsdid not meet the EARs for vitamins E, K, and D, and/or calcium. Only2 TD children met the adequate intake for potassium.

Conclusions: Although the nutrient intakes of TD children andchildren with ID were not statistically different, the fact that childrenin both groups showed inadequate intakes of several nutrients is ofconcern. We suggest that providers screen to identify children atrisk for micronutrient deficiencies and provide appropriate follow-upcare. Further research to investigate dietary patterns and nutritionaladequacy in this population is needed.

Funding SourcesHRSA/MCHB 1R40MC25678NICHD P30 HD004147-38,

HRSA/MCHB UA3MC25735.

Does Dietary Intake Have aMajor Influence on Vitamin D Statusin Early Pregnancy? Results from a Canadian Trial (P13-100)

Maude Perreault,1 Caroline Moore,1 Michelle Mottola,2 andStephanie A Atkinson1

1McMaster University, Canada; and 2Western University, Canada

Objectives: Suboptimal maternal vitamin D status in pregnancy isassociated with reduced fetal bone length and infant or child bonemass.To assess the adequacy of vitamin D status in Canadian women inearly pregnancy, we aimed to: 1)measure serum 25-hydroxyvitamin D[25(OH)D] for the D2 and D3 isomers, and 2) determine the majorcontributors to vitamin D status, including diet (especially milk),supplements, and season of the year.

Methods: Healthy pregnant women enrolled in the Be Healthyin Pregnancy (BHIP) randomized controlled trial (Southern On-tario, Canada) (NCT01689961) were assessed for vitamin D status -25(OH)D2 and D3 by LC-MS/MS] and intake (3-d diet and supplementrecord analyzed by Nutritionist Pro) at 12–17 wk gestation.

Results: Of the 191 mothers included [94% Caucasian, meanprepregnancy body mass index 25.8 kg/m2 (range 17.4–39.6 kg/m2)],91% had adequate vitamin D status (defined as >50 nmol/L), with amean ± SD of 71.9 ± 17.6 nmol/L. The 25(OH)D2 isomer was notdetected in 92% of the population and averaged 0.5 ± 2.3 nmol/Lin 15 subjects. Mean total vitamin D intake was 807 ± 1001 IU/d(range 32–11,062 IU/d), with 80% of subjects having intakes above theestimated average requirement (EAR) for vitamin D (400 IU/d) and2% above the upper limit (4000 IU/d). Prenatal vitamin supplementscontributed 70% of the intake; 20% of subjects also consumed a separatevitamin D supplement. Among the food sources, milk contributed39% of the intake of vitamin D, natural sources contributed 30%, andfortified foods 19%. In a regression analysis, nonmilk dairy productconsumption (e.g., cheese and cream, r2 = 0.12, P = 0.05) and seasonof blood draw at recruitment (r2 = 0.12, P < 0.001) were significantlyassociated with maternal vitamin D status in early pregnancy.

Conclusions:Most women achieved normal vitamin D status, withintakes above the EAR. The observed reliance on prenatal and othersupplements during pregnancy as a source of vitamin D suggests a

lack of nutritional balance. In this healthy pregnant population, seasonappears to be a stronger factor than vitamin D intake in achievingadequate vitamin D status, likely owing to sunshine exposure.

Funding SourcesSupported by Dairy Farmers of Canada, CIHR and DFC/AAFC

Dairy Research Cluster; in-kind by GayLea Foods & Ultima Foods.MP is supported by a CIHR-Vanier scholarship and a Canadian ChildHealth Clinical Scientist Program award.

Trends in Hospital Provision of Breastfeeding Education toNurses, United States, 2007–2015 (P13-101)

Cria Perrine and Jennifer Nelson

Centers for Disease Control and Prevention

Objective: The Ten Steps to Successful Breastfeeding are evidence-based guidelines designed to help maternity care facilities provideoptimal infant feeding care. Step 2 focuses on training facility staffin the knowledge and skills necessary to support the breastfeedingmother-infant dyad. The aim of this study was to examine trends in theamount of breastfeeding education provided by maternity care facilitiesin the United States to new and current nurses, and whether nurses areassessed annually for breastfeeding competency.

Methods: Every other year from 2007 to 2015, CDC conductedthe Maternity Practices in Infant Nutrition and Care (mPINC) surveyamong all birth facilities in the United States and Territories (n= 2573–2725; response rate >80%). Hospitals were asked to categorize theaverage hours new and current nurses spent on breastfeeding education,the proportion of current nurses receiving breastfeeding education inthe past year, and how often nurses were assessed for competency inbreastfeeding management and support.

Results: The percentage of hospitals reporting that “most” (≥90%)nurses received breastfeeding education in the past year increased from37.9% in 2007 to 61.4% in 2015, whereas the percentage reporting that“few” (<10%) nurses received breastfeeding education decreased from17.7% to 10.0%.

The percentage of hospitals reporting that nurses were assessed forcompetency in breastfeedingmanagement and support at least once peryear increased from 43.6% in 2007 to 59.9% in 2015. Training for newnurses has also increased; the percentage of hospitals reporting that newnurses received at least 18 h of breastfeeding education increased from5.6% in 2007 to 24.0% in 2015.

Conclusions:More hospitals are providing breastfeeding educationto their nurses and are annually assessing their level of competency inbreastfeeding management and support. However, many new nursesare not receiving the extensive breastfeeding training outlined in Step 2of the Ten Steps. Hospitals may consider examining the breastfeedingeducation of their new and current nurses to ensure that they areadequately trained to provide optimal infant feeding care.

Funding SourcesCenters for Disease Control and Prevention.

Relationships of Parental FeedingPractice, Child Self-Regulationin Eating and Child Nutritional Status in Indonesia: A MediationAnalysis (P13-102)

Digna N Purwaningrum,1 Jayashree Arcot,2 Hamam Hadi,3Rasita Hasnawati,4 Odilia Mayasari,4 and Rohan Jayasuriya1


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1The School of PublicHealth andCommunityMedicine and 2Schoolof Chemical Engineering, University of New South Wales, Australia;3AlmaAtaUniversity, Indonesia; and 4The Centre forHealth Policy andManagement, Universitas Gadjah Mada, Indonesia

Objective: This study aimed to investigate the role of child eatingbehaviour (CEB) in mediating the relations between parental feedingpractice (PFP) and nutritional status of children in a setting whereundernutrition is prevalent.

Methods: A cross-sectional study was conducted in the SpecialRegion of Yogyakarta, Indonesia in 2017. A total of 379 motherand child dyads participated in the household surveys. The PFP andCEB were measured using validated instruments. Initial univariateanalysis of sociodemographic factors revealed that only mother’s bodymass index (BMI) was associated with child’s BMI. Coercive feedingpractices [pressure to eat (PE) and restriction (RH)] and structuralfeeding practices [monitoring (MN) and child control (CC)] wereused as predictors of child nutrition status. CEB measures [satietyresponse (SR), food responsiveness (FR), slowness in eating (SE), andfood fussiness (FF)] were specified as mediators between PFP andchild nutrition status, controlling for child gender and mother’s BMI.Mediation analysis was performed using the PROCESS macro in SPSSversion 24. Bias-corrected bootstrapping with 2000 resamples was usedto estimate 95% CIs for direct, indirect, and total effects.

Results:Among the children in the study, 35%were undernourishedand 10%were overweight or obese. SR significantly mediated the effectsof PE [β = –0.0823 ± 0.0342 (mean ± SE); 95% CI: –0.1607, –0.0224);RH (β = –0.0708 ± 0.0316; 95% CI: –0.1420, –0.0185); MN (β = –0.0466 ± 0.0273; 95% CI: –0.1099, –0.0030) and CC (β = –0.1113 ±0.0510; 95%CI: –0.2264, –0.0310) on child BMI. None of the other CEBmeasures (FR, SE, and FF) mediated the effects of the PFP measureswith child BMI, with the single exception that SE mediated the effectof PE (β = –0.0485 ± 0.0251; 95% CI: –0.1071, –0.0095). Consideringall these results, child’s satiety response seems to be the main CEB thatmediates PFP. However, the effects sizes are small and are similar tothose found in other studies. The effect of PFP on child nutrition isinfluenced by other covariates (e.g., mother’s BMI) than observed CEB.

Conclusions: We find partial support for the hypothesis that CEBmediates the effect of PFP on child nutrition in this group. These resultsare consistent with the findings of other researchers. There is a need forfurther research using longitudinal studies.

Funding SourcesDNP was supported by the Australia Awards Scholarship for her

PhD program at the University of New South Wales, Australia. TheUNSW-Indonesia Seed Grant 2017 partially funded the data collectionin Indonesia.

Total and sn-2 Fatty Acid Profiles of Breast Milk at DifferentLactation Periods fromWomen inWuxi, China (P13-103)

Ce Qi,1 Jin Sun,1 and Renqiang Yu2

1School of Food Science and Technology, Jiangnan University,China; and 2Wuxi Maternity and Child Health Care Hospital, China

Objective: The fatty acid (FA) composition and positional distri-bution in triacylglycerols (TAGs) are key factors in determining thenutritional value of infant formula. The optimal composition of TAGs

in formula remains unknown. Our aim was to elucidate the maincharacteristics of the FA profile and sn-2 positional distribution of FAsin breast milk from women of Wuxi in the Yangtze Delta area. It ishelpful for the development of region-specific infant formulas.

Methods: The study group comprised 103 healthy women volun-teers from Wuxi. The study protocol was approved by the MedicalResearch Board of Jiangnan University and the Wuxi Maternity andChild Health Care Hospital. Breast milk was collected at approximatelydays 1–5 (colostrum), days 6–15 (transitional milk), and after day15 (mature milk) after birth. Total lipids were extracted and sn-2monoacylglycerol were prepared. After methylation, GC-MS was usedto quantify the FAs.

Results:Multicomponent analysis showed FAprofiles to be lactationperiod specific. Mean percentages of major FAs were 88.78%, 91.11%,and 91.23% in colostrum, transitional milk, and mature milk, respec-tively. Cluster analysis revealed that transitional and mature milk wereenriched with 6:0, 8:0, capric acid, 11:0, lauric acid, 13:0, myristic acid,16:1n–7, α-linolenic acid (ALA), and γ -linolenic acid. Colostrum wasmainly high in polyunsaturated fatty acid s, including adrenic acid anddocosahexaenoic acid. Linoleic acid (LA), mostly located at the sn-1, 3positions of TAGs, was more common in the milk of Chinese womenthan in that of women in European countries and the United States. Themajority of the breast milk did not meet the standard for the ratio ofLA to ALA in infant formula. FAs associated with brain development,mainly at sn-2 in TAGs, were enriched in colostrum. Capric and lauricacids were enriched in transitional and mature breast milk, and capricacid showed sn-1, 3 selectivity in TAGs.

Conclusions:Wevisualized the different breastmilk FAprofileswithmultivariate pattern recognition. We identified core total and sn-2 FAs.AsWuxi is a developed city inChinawith improved infant development,the data in this study can provide important guidance for amother’s dietand the development of special lipids for formula production.

Funding SourcesNational key R&D program “Modern Food Processing and Food

Purchasing and Transport Technology and Equipment on Spe-cial of China”, No. 2017YFD0400600; Fund of BINC “Nutritionand Care of Maternal and Child Research Funding Program”, No.2017BINCMCF34.

Dietary Patterns before and during Pregnancy and Risk ofGestational Diabetes Mellitus: A Systematic Review (P13-104)

Ramkripa Raghavan,1 Carol Dreibelbis,1 Brittany L James,1 YatPing Wong,2 Barbara Abrams,3 Alison Gernand,4 Kathleen MRasmussen,5 Anna Maria Siega-Riz,6 Jamie Stang,7 Kellie OCasavale,8 Joanne M Spahn,9 and Eve E Stoody9

1The PanumGroup; 2USDA, Food andNutrition Service; 3School ofPublic Health, University of California, Berkeley; 4Pennsylvania StateUniversity; 5Division of Nutritional Sciences, Cornell University, NY;6University of Virginia School of Nursing; 7University of MinnesotaSchool of Public Health; 8US Department of Health and HumanServices, Office of Disease Prevention and Health Promotion; and9USDA, Food and Nutrition Service

Objective: Gestational diabetes mellitus (GDM) has an estimatedprevalence of 9.2% in the United States. However, the importanceof preconception and prenatal dietary patterns (DP), an important


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modifiable risk factor for GDM, has not been thoroughly explored.As part of the USDA-Department of Health and Human Services’Pregnancy and Birth to 24 Months project, a systematic review wasinitiated to assess the relation between maternal DP before and duringpregnancy and risk of GDM.

Methods: Nine databases, including PubMed, Embase, Cochrane,and CINAHL, were searched from January 1980 to January 2017 forpeer-reviewed articles related to dietary patterns and pregnancy andbirth outcomes. Using a priori inclusion and exclusion criteria, articleswere dual-screened, relevant information was extracted, and risk of biaswas assessed. The data were quantitatively synthesized, a conclusionstatement was drafted, and the evidence was graded. Finally, researchrecommendations were identified.

Results: Of the 9103 studies identified, 11 studies, including apilot randomized control trial and 10 prospective cohort studies, withsample sizes ranging from 12 to 15,254 subjects, met the criteria. Themethods used across the studies were heterogeneous, and low-incomeand minority women were under-represented. Of the 6 studies thatused an index or score method, 4 found an inverse association betweenadherence to a DP (e.g., Healthy Eating Index, modified/alternateHealthy Eating Index, Mediterranean-type diet) and risk of GDM. Ofthe 5 studies using data-driven methods, 4 found an inverse associationbetween greater adherence to a DP (e.g., Mediterranean-style, prudent)and risk of GDM. All studies that examined DP before pregnancy and 3of the 5 studies that assessed DP during pregnancy found an associationwith risk of GDM.

Conclusions: Limited but consistent evidence suggests that DPbefore pregnancy are associated with a reduced risk of GDM. Theseprotective DP are higher in vegetables, fruits, whole grains, nuts,legumes, and fish, and lower in red and processed meats. Most of theresearch was conducted in healthy Caucasian women with access tohealth care. Evidence is insufficient to estimate the association betweenDP during pregnancy and risk of GDM. Additional research on diverseUS populations is recommended.



Freshwater Fish from Selenium-Poor Regions BioaccumulateMore Mercury and May Be More Toxic to Subsistence ConsumerPopulations than Is Generally Recognized (P13-105)

Nicholas VC Ralston and Laura Raymond

University of North Dakota

Objective: The aim of this study was to establish a more reliableindex of mercury-exposure risks in relation to its adverse effects onselenium-dependent enzyme activities in the brain—the US EPA–supported development of the Health Benefit Value (HBV). Thiscriterion is simple to calculate [HBV= ((Se –Hg)/Se)× (Se+Hg)] andeasy to understand, being positive when Se is present in molar excess ofHg, but negative if Hg exposure is high enough to impair Se transportand activities. The Se and Hg contents of freshwater fish are far morevariable than those of ocean fish, potentially exposing subsistence fishconsumers in certain regions of theworld to far greater risk than currentHg guidelines predict. This study examined freshwater fish Hg, Se, andHBVs to establish criteria for protecting consumers from Hg-exposurerisks.

Methods: Selenium and Hg data from >14,000 individual oceanand freshwater fish gathered by federal, state, and other organizationswere used to calculate the HBV ranges of>100 fish species. Commonlyconsumed North American varieties—Perca flavescens (yellow perch),Sander vitreus (walleye), Esox Lucius (northern pike), Microopterussalmoides (largemouth bass), Lepomis machrochirus(bluegill), andIctalurus punctatus (channel catfish)—were included in the currentanalysis.

Results: Because Se is homeostatically controlled, its concentra-tions in fish are largely independent of fish size. In contrast, Hgbioaccumulation in freshwater fish increased in direct relation withincreasing body weights (P < 0.001). However, it is important tonote that Hg bioaccumulation was inversely related to Se availabilityin all species assessed (P < 0.05). For walleye, northern pike, andlargemouth bass, samples from low-Se areaswere found to have negativeHBVs.

Conclusions:The inverse relations betweenHg and Se in freshwaterfish confirm findings reported by prior studies. Because Hg bioaccumu-lation and Hg toxicity risks both tend to increase when Se availability ispoor, there is an urgent need to assess HBVs of fish in regions wheresubsistence freshwater fish consumers and their children may be atgreater risk than would be predicted by criteria based on Hg alone.The SAMPLLE (Selenium Assessments in Mercury Polluted Lentic andLotic Ecosystems) Program is organizing international research reamcollaborations.

Funding SourcesThis project, “Fish Selenium-Health Benefit Values in Mercury

Risk Management,” was funded by grant EPA-G2009-STAR-B1 to theUniversity of North Dakota.


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FIGURE P13-105-1 Fish Hg in relation to Se concentrations.

Mortality Owing to Suboptimal Breastfeeding Practices amongMexican Children <5 y Old: Findings from the Global Burden ofDisease Study 2016 (P13-106)

Christian Aspacia Razo Garcia,1 Ivonne Ramírez-Silva,1 MonicaMazariegos,1 Mishel Unar,1 Teresita González de Cosío,2 RafaelLozano,3 and Ashkan Afshin3

1National Institute of Public Health, Mexico; 2UniversidadIberoamericana, Mexico; and 3Institute for Health Metrics andEvaluation, University of Washington

Objective: The aim of this study was to quantify the mortality ofchildren aged <5 y attributable to suboptimal breastfeeding practicesin Mexico from 1990 to 2016.

Methods: Using data from the Global Burden of Disease Study(GBD) 2016, which was conducted by the Institute for Health Metricsand Evaluation (IHME) at the University of Washington, we reportthe estimates of the mortality of children aged <5 y attributable tosuboptimal breastfeeding practices in the 32 states of Mexico from1990 to 2016. Suboptimal breastfeeding was defined as a behavioral riskcomposed of 2 categories: nonexclusive breastfeeding (the proportionof children <6 mo old who were not exclusively breastfed andreceived predominant, partial, or no breastfeeding) and discontinuedbreastfeeding (the proportion of children aged 6–23 mo who didnot receive any breastmilk). To estimate attributable mortality, wecompared actual breastfeeding practices to a minimum exposure

pattern consisting of exclusive breastfeeding for infants <6 mo of ageand continued breastfeeding for children aged 6–23 mo. Consideredoutcomes were deaths owing to diarrheal disease and lower respiratorytract infections, and deaths owing to all causes.

Results: In 2016, 987 (95% CI: 779, 1217) deaths of childrenaged <5 y were attributed to suboptimal breastfeeding practices. Thisnumber represents 3% (95% CI: 2.2%, 3.4%) of all-cause mortalityobserved in this age group. Most of these deaths (80%) occurredduring the postneonatal period, and were caused by lower respiratoryinfections (53%). Moreover, 34% (95% CI: 28%, 40%) of deaths owingto diarrheal diseases and 15% (95% CI: 10%, 19%) of deaths occa-sioned by lower respiratory infections were attributed to suboptimalbreastfeeding. In the last 26 y, all-cause and cause-specific mortality ofchildren aged <5 y attributed to suboptimal breastfeeding decreasedby ∼90%. However, suboptimal practices did not improve over thesame period of time. With few exceptions, southern states hadhigher attributable all-cause mortality than states in the north ofthe country.

Conclusions: Breastfeeding is the standard reference of infantfeeding and does not require an extensive health-system infrastructure.Improvements in breastfeeding practices can contribute to the reduc-tion of child mortality in Mexico.

Funding SourcesThe Bill andMelinda Gates Foundation funded the global burden of

disease study.


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Infant Feeding Practices and Perceived Food Allergy (P13-107)

Elisha Reichling, Christine Tangney,MaryMullen, andChristineSharp

Rush University Medical Center, IL

Objective: The aim of this study was to investigate associationsbetween infant feeding practices (IFPs) and caretaker- and physician-perceived food allergy.

Methods: This was a prospective observational study using aconvenience sample of infants (n= 39) from outpatient pediatric clinicsof a largeMidwestern urbanmedical center. Food allergymeasures wereassessed by caretakers using a paper questionnaire adapted from theInfant Feeding Practices and Growth Performance II survey (IFPSII)under the Food and Drug Administration and Centers for DiseaseControl and Prevention. Modifications and content validity of themodified IFPSII were made to enhance relevance and comprehensionby the diverse urban population the medical center serves.

Results: Preliminary analysis revealed caretaker respondents were35.9% African American, 17.9% Hispanic or Latino, and 38.5%Caucasian. Infants were an average age of 9.2 ± 1.1 mo (mean ± SD).Themajority of infants were ever breastfed (82.1%), and 41% continuedto be breastfed at the time of the survey’s completion. Complementaryfeeding introduction occurred at 5.4 ± 1.0 mo of age. The highest rateof caretaker-perceived food allergy was observed in infants of Hispanicor Latino (14.3%) and African American (14.3%) race, although noassociation was found between ethnicity and caretaker-reported foodallergy (P = 1.00). Caretaker-reported infant food allergy (12.8%) washigher than current estimates of infant food allergy prevalence (6.3%).The reported prevalence was higher than the food allergy prevalenceconfirmed by physician diagnosis (2.6%).

Conclusions: Further analysis is needed to identify IFPs that mayinfluence caretaker- and physician-perceived infant food allergy risk.

Funding SourcesRush University Medical Center.

Bacterial Composition of Expressed Human Milk Collectedunder 2Real-LifeConditions:ARandomized,ControlledTrial (P13-108)

Sarah M Reyes,1 Dainelle Allen,1 Michelle K McGuire,2 Mark AMcGuire,3 Anthony G Hay,1 and Kathleen Rasmussen1

1Cornell University, NY; 2Washington State University; and3University of Idaho

Objective: Women use a wide range of practices for pumping,handling, and storing their milk. The effects of these practices on thebacterial composition of the milk are unclear. Our objective was tocharacterize and compare the bacterial composition of human milkpumped under 2 real-life conditions.

Methods: We conducted a randomized trial (Milk in Life Con-ditions) comparing bacterial communities in milk expressed using2 pump and collection kit setups. Lactating mothers (n = 52)fully expressed the same breast in 2 consecutive pumping sessionsat home, once with their own pumps and collection kits (“own”supplies) and once with a hospital-grade pump (Medela Symphony)and sterile collection kits (“sterile” supplies). Randomization was usedto determine which pump setup the participants used first. A 30 mL

sample of milk was retained for analysis. Bacterial composition wasassessed by aerobic culturing and deep sequencing of the V1–V3 regionof the bacterial 16S rRNA gene amplified fromDNA extracted from thismilk.

Results: Milk collected with mothers’ own supplies contained∼5.6 times more total culturable aerobic bacteria than milk collectedwith sterile supplies (8.1 × 104 vs. 1.4 × 104 cfu/mL, respectively;P < 0.0001). Growth on selective media for Streptococcus, Staphylococ-cus, and gram-negative aerobic bacteria accounted for ∼100% of totalcultured aerobes in milk collected with sterile supplies, but only ∼55%of cultured aerobes collected with mother’s own supplies. Analysis of16S rRNA sequences revealed an effect of pump and collection kit setupon the relative abundances of several taxa. Proteobacteria were 4.75times more (P < 0.0001) and Firmicutes were 1.6 times less abundant(P< 0.0001), respectively, inmilk collectedwith own vs. sterile supplies.At the genus level, Acinetobacter and Enterobacterwere 68 (P< 0.0001)and 20 (P= 0.02) timesmore abundant, respectively, and Staphylococcusand Streptococcus 1.7 (P = 0.008) and 1.9 (P = 0.003) times lessabundant, respectively, in milk collected with own vs. sterile supplies.

Conclusions: The bacterial composition of milk collected withmothers’ own pumps and collection kits is significantly different fromthat of milk collected with hospital-grade pumps and sterile collectionkits. Whether these differences influence infant health requires furtherstudy.

Funding SourcesFunded in part by NIH T32-DK007158, USDA/Hatch NYC-

399,346, a travel grant from the Larsson-Rosenquist Family Foundation,McNair Scholars Program, NIGMSNIH P30GM103324, and the IdahoAgricultural Experiment Station.

Dietary Intake of Infants and Toddlers:WhatWe Eat in America,NHANES 2011–2014 (P13-109)

Donna Rhodes,1 John Clemens,1 Meghan Adler,1 SuzanneMorton,2 and Alanna Moshfegh1

1USDA, Agricultural Research Service; and 2American Society forNutrition

Objective: Beginning with the 2020–2025 edition, the DietaryGuidelines for Americans will include dietary recommendations forchildren aged 0–24 mo. The What We Eat in America, National Healthand Nutrition Examination Survey (WWEIA, NHANES) collectsdietary intake on a nationally representative sample of all individuals;however, data release and analysis have mainly focused on Americansaged ≥2 y.

Methods: This research reports nutrient and food intakes forchildren from birth to 24 mo old. Using day 1 dietary data fromWWEIA, NHANES 2011–2014, nutrient intakes were estimated forchildren aged <24 mo (n = 1139). The 5-step USDA AutomatedMultiple-Pass Method was used to collect a 24-h recall from a proxyknowledgeable about the child’s intake. Breastmilk (BM), not quantifiedduring the recall, was reported by 22% of the sample and includesindividuals who reported any breast milk on the recall day. For thisresearch, BM volumes were assigned using assumptions based onamounts typically consumed per day for infants (0–11.9 mo old) or perbreastfeeding occasion for toddlers (12–23.9 mo old).


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Results:Mean daily energy ± SE intake for younger infants <6 moold (n = 333) was 613 ± 8 kcal. Breast milk, formula or other milk(FM), and other foods (OF) contributed 214± 20, 377± 23, and 22± 4kcal, respectively, to daily energy. Energy intake increased to 802 ± 21kcal/d for older infants aged 6–11.9 mo (n = 381); BM, FM, and OFcontributed 94 ± 14, 405 ± 20, and 303 ± 16 kcal, respectively, to dailyenergy. Older infants who were breastfed (n = 80) reported less dailyenergy fromOF compared with those whowere not breastfed (230± 25vs. 329 ± 20 kcal). Overall, for older infants, baby food items wereconsumed by 88%; nonbaby food snacks and sweets were consumed by22%. Total daily energy intake for toddlers was 1193± 26 kcal, of which880 ± 22 kcal came from other foods. Snacks and sweets, consumedby 85% of toddlers, contributed 12% to total daily energy. Juice andsweetened beverages, consumed by 71%, contributed 8% to totalenergy.

Conclusions: This research adds to the literature describing thedietary intakes of US infants and toddlers, and highlights the consump-tion of snacks and sweets at an early age.

Funding SourcesUSDA, ARS.

Factors Associated with Biomarkers of Insulin Resistance and In-creased Concentration of Insulin-Like Growth Factor-1 in PretermInfants (P13-110)

Enrique Romero-Velarde,1 Alejandro Rios-Aguirre,1 Edgar MVasquez-Garibay,1 Liuba M Aguirre-Salas,2 and Jose L FarfanCovarrubias,2

1Universidad de Guadalajara, Mexico; and 2Hospital Civil deGuadalajara, Mexico

Objective: The aim of this study was to identify factors associatedwith biomarkers of insulin resistance (IR) and concentrations of insulin-like growth factor-1 (IGF-1) in preterm infants.

Methods: In a cross-sectional study, 80 infants, 6 mo of age, witha history of prematurity who were born at the Hospital Civil deGuadalajara “Dr. Juan I. Menchaca” were included, in the period fromJanuary to July 2016. Infants of either sex, apparently healthy, withoutunderlying pathology or who had not been critically ill at birth, withbirth weight ≥1000 g and gestational age ≥30 wk, were included in thestudy with the consent of their parents. Infants whose mothers reportedchronic diseases and/or diseases related to pregnancy (e.g., type 2diabetes mellitus, gestational diabetes, eclampsia) were not included.Nonprobabilistic sampling was performed, including consecutive casesthat met the selection criteria. A questionnaire was completed by theparents. anthropometry parameters were measured and the serumvalues of lipid profile, glucose, insulin, and IGF-1 were determined. De-scriptive statistics were performed, as were correlation analyses betweeninsulin concentrations, homeostasis model assessment (HOMA), andIGF-1 concentrations with anthropometric and laboratory variables.Factors potentially associated with IR were compared between subjectswith insulin, HOMA, and IGF-1 values >90th percentile.

Results: The mean ± SD age of the infants was 198.4 ± 53.5 d; 39were male and 41 female. The frequency of deficit of weight for agewas high (43%), as was the deficit of length for age (33%). A positivecorrelation between insulin and HOMA index with values of birth

weight and triceps skinfold was identified, and also with laboratoryparameters such as triglycerides, glucose, and IGF-1.

Conclusions: Insulin resistance biomarkers are related to adiposityindicators in infants with a history of prematurity. It is likely that thegreatest gain of adipose tissue at this stage of life could be a risk factorfor future metabolic alterations.

Funding SourcesConsejo Nacional de Ciencia y Tecnología and Universidad de

Guadalajara.

The Power of Marketing: Parents Perceive Unhealthy Baby andToddler Food as Healthy (P13-111)

Maria J Romo-Palafox and Jennifer Harris

UConn Rudd Center for Food Policy & Obesity, CT

Objective: A report from the Rudd Center for Food Policy andObesity found that baby and toddler food products and the marketingmessages used to promote them do not always support experts’recommendations for feeding babies and toddlers. The objectives ofthis study were to determine: 1) if parents of 6- to 36-mo-old childrenrecognized that snack foods marketed for babies and toddlers arenutrient-poor, and 2) if they perceive these products to be healthier thancomparable foods marketed for older consumers.

Methods: A total of 8 baby and 9 toddler snack foods highin fat, sugar, and/or salt that are marketed to parents to servebabies or toddlers were selected (e.g., Gerber animal crackers, PlumOrganics cereal bar, Happy Baby yogurt covered fruit), together withcomparable food items not marketed specifically for babies or toddlers(e.g., Stauffer’s animal crackers, Kashi cereal bar, Sun-Maid yogurtcovered raisins). The products were matched on overall nutrition(based on a nutrient profile score), texture, and use in the diet.An online panel of parents of babies and toddlers viewed picturesof the baby and toddler food packages, respectively, along with thecomparable foods, and rated them from extremely unhealthy (1) toextremely healthy (7).

Results: Respondents (n = 1766) were mostly female (79%), anddiverse in socioeconomic status and race or ethnicity. Parents ofbabies rated all baby snacks as “somewhat healthy” (means rangedfrom 5.16 to 5.29) compared with ratings ranging from somewhatunhealthy (3.18) to somewhat healthy (4.97) for comparable snacks.Parents of toddlers also rated all toddler snacks as “somewhat healthy”(means ranged from 5.01 to 5.28) compared with ratings ranging fromsomewhat unhealthy (3.09) to somewhat healthy (5.40). On average,parents rated foods marketed for babies (5.26 ± 0.97, mean ± SD)and toddlers (5.20 ± 0.95) to be healthier (P + 1.19 and 4.62 ± 0.99,respectively).

Conclusions: Parents are not aware that foods commonly marketedfor babies and toddlers are unhealthy, and perceive them to be healthierthan comparable foods not specified for babies or toddlers. Thesefindings raise concerns about the long-term impact on young children’staste preferences and diet if parents regularly serve these nutritionallypoor products and perceive them to be healthy.

Funding SourcesRobert Wood Johnson Foundation.


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TABLE P13-111-1


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TABLE P13-111-2

Can Hourly Breast Expression Be Used to Detect Change in MilkProduction Rate? (P13-112)

Dayna M Roznowski,1 Erin Wagner,1 Laurie Nommsen-Rivers,1and Sarah W Riddle2

1University of Cincinnati; and 2Cincinnati Children’s HospitalMedical Center, University of Cincinnati

Objective: A protocol for estimating milk production rate (MPR,in g/h) in lactating women from hourly breast emptying has beenproposed. The objectives of our pilot study were to determine: 1) thevalidity in estimating MPR from hour 2 (h2) and hour 3 (h3) of milkoutput, and 2) if increased breast emptying for 48 h will increase MPR.

Method: We enrolled mothers at 6–8 wk postpartum who wereexclusively breastfeeding their healthy infant. At baseline, the mothers

emptied their breasts at a morning session (h0) and then hourly for3 h (h1, h2, h3). All of the milk output was weighed, and the infantwas fed only with milk expressed after h0. The mothers increased theirbreast emptying over the next 48 h, and we conducted follow-up MPRmeasurements. For objective 2, left and right breast outputs at h2 and h3were summed and divided by the exact time to determine the averageMPR. Change was examined with a paired t test.

Result: We intended to enroll 12 mothers, but only enrolled 6because of significant unexpected results. Onemother did not completethe study because her infant refused to take a bottle; thus, n = 5 for thepaired results. At baseline, MPR at h2 and h3 were similar (mean± SD,51 ± 11 vs. 49 ± 17 g/h; change: –2 ± 11 g/h; P = 0.67). In the 24h prior to baseline, breast emptying was 15 ± 2/d (each side countedseparately); over the next 48 h, breast emptying increased to 21 ± 2/d


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(Change:+6± 1/d;P= 0.0004). The averageMPR (h2+ h3) at baselinewas 50 ± 13 g/h, and this significantly declined at follow-up (43 ± 16g/h; change: –7 ± 5 g/h; P = 0.02). In the 2–3 wk prior to baseline, therate of infant weight gain was 43± 14 g/d, and this rate significantly de-clined at follow-up (17± 15 g/d; change: –27± 9; P= 0.003). All moth-ers reported resumption of normal feeding patterns following the study.

Conclusions: We did not observe a significant difference in MPRbetween h2 and h3, indicating that a steady state was reached. After 48 h

FIGURE P13-112-1 Milk Production Rate from Baseline to Follow-up.

of increased breast emptying, theMPR declined, and this was consistentwith a decrease in the rate of infant weight gain, suggesting a declinein milk availability to the infant. Further study is needed to determinewhy the MPR declined from baseline to follow-up, and how much timeis needed to detect an increase in MPR with increased breast emptying.

Funding SourcesNo external funding.


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FIGURE P13-112-2 Infant Weight Gain related to Milk Production Rate.

Maternal Lymphocytic Epigenetic Mark as DNA Methylationof Long Interspersed Nuclear Element-1 at First Term PregnancyPredicts Newborn Birth Growth (P13-113)

Rwei-Fen S Huang,1 Kuang-Ta Huang,1 Yu-Li Shen,1 Chien-Nan Lee,2 Kuan-Yu Chu,1 Chin-Pao Cheng,2 Wei-Chi Ku,1 andChieh-Yu Liu1

1Fu Jen Catholic University, Republic of China; and 2NationalTaiwan University Hospital, Republic of China

Objective: The aim of this study was to exam early fetaldevelopment-mediators, the maternal one-carbon donor nutrients andepigeneticmarks at first-term pregnancy, in relation to newborn growthparameters.

Methods: In total, 116 healthy first-term pregnant women wererecruited from multiple birth centers and hospitals in Taiwan, andthe paired maternal and newborn growth data were collected from2015 to 2017. Periconceptional maternal nutrient intakes were assessedby a semi-quantitative food frequency questionnaire and the plasmabiochemical markers of one-carbon donor nutrients such as folate,choline, betaine and vitamin B12 were measured by LC-MS andfluorescent immunoassay. Epigenetic marks in the maternal peripheralmononuclear lymphocyte (PBMC) were measured as the percentageof 5-methyl cytosines (%5mC) at the long interspersed nuclearelement-1 (LINE-1) locus and the imprinted H19/IGF2 differentialmethylation region (H19/IGF2 DMR). Growth mediator of plasmaIGF2 concentrations were measured by ELISA.

Results: By hierarchy and stepwise regression analysis, maternalprepregnancy weight (β = 0.35, P = 0.003), plasma folate (β = 0.29,P = 0.024), and PBMC LINE1 methylation (β = 0.25, P = 0.043) werethe significant predictors for newborn birth weight. After adjustmentfor periconceptional one-carbon nutrients intake and H19/IGF2 DMRepigenetic marks, maternal IGF2 concentration was an independentpredictor that accounted for 45% of newbornweight variance (β = 0.45,P = 0.003). After adjustment for the newborn birth weight mediators,

maternal PBMC LINE1 methylation independently accounted for38% of the chest circumference variance of newborn infant (β =0.388, P = 0.002). Collectively, the maternal LINE1 epigenetic mark atthe early stage of pregnancy predicted the newborn weight and chestcircumference.

Funding SourcesN/A.

Factors Associated with the Evolution of Nutritional Statusin Children with intestinal Failure Followed Up in an IntestinalRehabilitation Center in Brazil (P13-114)

Giovana Sabio, Simone Perentel, Erica Silva, Keila Uchoa, AndreDavid, Maria Fernanda Camargo, and Heitor Leite

Hospital Samaritano of São Paulo, Brazil

Objective: The aim of this study was to identify factors associatedwith the evolution of the anthropometric nutritional status in childrenwith intestinal failure (IF) followed up at a center for intestinalrehabilitation.

Methods: In a prospective cohort study, children with IF receivinghospital and home parenteral nutrition, admitted between 2015 and2017, were followed up during an 11-mo period (interquartile range:5.4–21.9 mo) with regard to their growth and nutritional status.The most frequent cause of IF was necrotizing enterocolitis (55.5%).Anthropometric z scores of weight for age, height for age, bodymass index for age, arm circumference, triceps skinfold, and headcircumferencewere collected at 2-wk intervals. The datawere comparedwith theWHOreference standards. The effects of the potential exposurevariables (length of follow-up, gestational age, presence of intestinalfailure associated liver dysfunction, necrotizing enterocolitis) on theanthropometric z scores during the follow-up period were analyzedusing generalized estimating equations.

Results: A total of 9 children (7 males and 2 females), with mean± SD current age of 18.2 ± 11.1 mo, were included. The mean energy


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supply by parenteral nutrition was 72 ± 18 kcal · kg–1 · d–1. Of thepatients. 8 were receiving enteral nutrition, with a median energyintake (peptide-based or free amino formula) of 15.4 (interquartilerange: 1.7–31.0) kcal · kg–1 · d–1. There were significant increases inanthropometric z scores of all anthropometric parameters during thefollow-up. The median weight-for-age z score increased significantly,from –4.13 to –1.39 (interquartile ranges: –4.99 to –2.66 and –2.64to 0.52, respectively), and the height-for-age z score increased from–2.96 to –1.8 (interquartile ranges: –5.67 to –2.63 and –2.98 to 0.66,respectively). The frequency of malnutrition (based on weight for age)had decreased from 100% to 33% by the last assessment. The lengthof follow-up was associated with increasing weight for age (coefficient:0.12; 95% CI: 0.03, 0.20; P = 0.01) and height for age (coefficient: 0.14;95% CI: 0.05, 0.23; P = 0.003).

Conclusions: There were significant increases in all anthropometricparameters. The length of follow-up was associated with increasingweight and height for age in children with IF during the follow-upperiod at the intestinal rehabilitation center.

Funding SourcesN/A.

Can ‘Becoming Breastfeeding Friendly’ Impact BreastfeedingProtection, Promotion and Support in Mexico? A Qualitative Study(P13-115)

Cara Safon,1 Gabriela Buccini,2 Isabel Ferré Eguiluz,3 TeresitaGonzález de Cosío,3 and Rafael Pérez-Escamilla2

1Yale University School of Public Health, CT; 2Yale University, CT;and 3Universidad Iberoamericana, Mexico

Objective: The Becoming Breastfeeding Friendly (BBF) initiativeincludes a guide that helps countries worldwide assess their readiness

to scale up national breastfeeding programs. Country committees ofbreastfeeding experts across government, academia, and civil societyengage with BBF by applying the BBF Toolbox, which includes: 1)the BBF Index (BBFI) to measure and score a country’s breastfeedingenvironment, 2) case studies that illustrate how countries have createdenabling environments for breastfeeding, and 3) a 5-meeting process,during which country committees develop policy recommendationsintended to improve breastfeeding based on the BBFI scores. This studysought to understand how the application of the BBF Toolbox impactedplans to improve the enabling environment for breastfeeding inMexico.

Methods: Semistructured interviews were conducted with Mexico’s11 country committee members about the 5-meeting process betweenMay and June 2017. Audio recordings were transcribed, andwere codedand analyzed using a grounded theory approach.

Results: Three major themes emerged: 1) the unique enablingenvironment for breastfeeding consisted of obstacles and opportunitiesfor improvement, 2) favorable country committee member dynamicspositively affected the utility of the BBF Toolbox, and 3) BBF revealedand shaped country committee members’ shared vision of change thatlaid the foundation for a shared public policy agenda.

Conclusions: In a country where breastfeeding promotion, pro-tection, and support activities have not historically been highlightedfrom a policy perspective, BBF became a lens through which committeemembers were able to expand their knowledge about the enablingenvironment for breastfeeding. BBF can generate multisectoral breast-feeding champions who can advance the public policy agenda toimprove breastfeeding outcomes at the national level.

Funding SourcesThis work was supported by the Family Larsson-Rosenquist Foun-

dation.

FIGURE P13-115-1 Conceptual Model of BBF Factors Contributing to “Breastfeeding Friendly” Environment in Mexico.


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Social Norms and Perceptions Related to Infant and Young ChildFeeding in Nigeria: Alive & Thrive Baseline (P13-116)

Courtney H Schnefke,1 Valerie Flax,1 Obinna Daniel,2 ComfortKaliyad Boman,1 and Frederick Ubanhmen3

1RTI International; 2University of North Carolina-Chapel Hill; and3TNS RMS Nigeria Limited

Objective: As part of the Alive & Thrive (A&T) Nigeria impactevaluation, we used qualitative data frommothers, fathers, grandmoth-ers, and community stakeholders at baseline to document social normsrelated to infant and young child feeding (IYCF), and facilitators andbarriers to adoption of optimal IYCF practices.

Methods:We collected data in January and February 2017 in 8 A&Tintervention local government areas across Lagos and Kaduna States.We conducted in-depth interviews with 32 community stakeholdersand 16 focus group discussions each with mothers, fathers, andgrandmothers of children under 2 y of age, and used thematic contentanalysis to analyze the transcripts.

Results: Although respondents recognized the health benefits ofbreast milk, several barriers keep mothers from breastfeeding earlyand exclusively. Misconceptions about colostrum being harmful andtraditional and religious practices inhibit early initiation. Exclusivebreastfeeding for 6 mo is seen as ideal, but mixed feeding is not

considered harmful, and the perceived need for water contributes toits early introduction. Other milks, formula, and foods are introducedfrom 2 to 4 mo of age because of perceptions about insufficient breastmilk, the child seeming ready to start eating, and these foods alsocontributing to health. Children are fed a variety of foods as they age,but green leafy vegetables, other than ewedu soup, are not commonlyfed because they are perceived to cause diarrhea in young children.Meat is not considered appropriate for children because it is perceivedto be too difficult to chew and digest, it may cause worms (Lagos),and it spoils children (Kaduna). Fish and eggs are more favoredanimal-source foods. Respondents generally agreed feeding too muchand too often are detrimental because they can lead to poor growth,a dull brain, and a greedy child. Mothers are responsible for childfeeding, grandmothers support IYCF by offering advice and physicalhelp, and fathers provide money for food. Poverty is considered abarrier to optimal IYCF practices, particularly feeding a variety offoods.

Conclusions: These findings point to social norms and beliefsrelated to IYCF that could be targeted for interpersonal andmass mediacommunication in A&T Nigeria’s intervention.

Funding SourcesFHI 360.

TABLE P13-116-1 Food commonly consumed by Children In Lagos and Kaduna States.


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The Influence of Dietary Factors on Child Food Allergies(P13-118)

Jessica Shaw, Ruth Reilly, and Sherman Bigornia

University of New Hampshire

Objective:This study aimed to determine whether there is a relationbetween timing of introduction to the 8 most common food allergensand the development of a food allergy in the general population (notjust children at high risk).

Methods: A total of 177 biological mothers of school-aged NewHampshire children completed our online Qualtrics survey, but somewere excluded owing to answering <50% of the survey or not givingconsent to participate. This left data on 101 participants, and thenumber of participants then varied between the various food allergens.

Results:Out of the 22 children with a milk allergy, 10 children wereintroduced to milk when they were <12 mo old and 12 children wereintroduced at ≥1 y old. Of those introduced at <12 mo of age, 59%developed a milk allergy, whereas only 17% of those introduced at ≥12mo of age developed a milk allergy (P = 0.00). Of the 55 participantsthat developed a peanut or tree nut allergy, 12 were introduced topeanuts or tree nuts before the age of 12 mo and 43 were introducedafter. Thismeans that 63% of those introduced at<12mo old developedan allergy, whereas only 33% introduced later developed an allergy(P = 0.01). Although not significant, the results for egg, wheat, andpeanut also demonstrated that earlier introduction may be associatedwith an increased risk of an allergy to that food. When only one childper family was considered, to exclude genetic confounders, the onlysignificant value was for a milk allergy, in which 64% of childrenintroduced at <12 mo old developed a food allergy, whereas only 18%of children introduced at≥12mo old developed one (P= 0.00). Resultswere similar even after the exclusion of children 1 and 2.

Conclusions: The results of this study concur with the recom-mendation to introduce milk ≥1 y of age, but do not support earlierintroduction to other food allergens in the general population.

Funding SourcesNo funding was used in this research.

Comparison between the Concentrations of Macronutrients inthe Colostrum Collected by Hand Expression and with a BreastPump (P13-119)

Camila Barros Melgaço. Silva,1 Alan Vieira,1 Maria el Moreira,2Arnaldo C. Bueno,1 and Yasmin NV Amaral2

1Universidade Federal Fluminense, Brazil; and 2Instituto FernandesFigueira, Brazil

Objective: To evaluate whether the method of collection of breastmilk influences the concentration of macronutrients in the colostrum.

Methods: A prospective, randomized, cross-over study was con-ducted from March 2017 to January 2018. Colostrum was collectedfrommothers with excess milk production. The samples were collectedup to the seventh day postpartum, in the same puerperal woman, si-multaneously by the twomethods: in one breast by hand extraction andin the other breast by breast pump, chosen by randomization method.Macronutrients were analyzed using mid-infrared spectroscopy. It isimportant to note that the milk was collected from the same puerperalwoman at the same time and the same volume in each breast, so the

only difference between the samples was the method of collection.Differences were considered statistically significant for p values < 0.05.The calculated n sample was based on a difference in macronutrientsconcentrations of 0.5g/%, alpha error of 10% and beta error of 20%. Theresults were described withmeasures of central tendency and themeansmacronutrient concentrations of the colostrum were compared by thetest for paired measurements of Wilcoxon, using the SPSS16.0 softwarepackage (SPSS Inc., Chicago, IL). The study protocol was approved bythe Ethics Committee and written informed consent has been obtainedfrom the mothers before the collection of the colostrum.

Results: Eighty six samples of human milk collected by breastpump and hand expression were analyzed. There was a differencebetween lipid concentrations (p = 0.001), significantly higher inmilk collected by hand expression (2.4 vs 1.9g/%). There was nostatistical difference between the carbohydrate (p = 0.152) and protein(p = 0.937) concentrations between the samples collected.

Conclusions: Protein and carbohydrate concentrations are notaffected by themethod of collection of breast milk. However, colostrumcollectedwithmanual extraction presents higher concentration of lipidscomparatively to those collected with electric breast pump.

Funding SourcesNo funding sources.

Macronutrients and Bioactive Components in Breast Milk fromNormal Weight, Overweight, and Obese Mothers (P13-120)

Clark Sims, Donald Turner, Thomas M Badger, Kartik Shankar,and Aline Andres

Arkansas Children’s Nutrition Center, University of Arkansas forMedical Sciences

Objective: The aim of this study was to characterize the differ-ences in macronutrients and bioactive components in breast milkbetween normal weight [NW; body mass index (BMI): 18.5–24.9kg/m2), overweight (OW; BMI: 25–29.9 kg/m2), and obese (OB; BMI:30–35 kg/m2) mothers.

Methods: Mothers in the GLOWING study were instructed tocollect breast milk during the second feeding of the day by fullyexpressing a breast. Samples were obtained at 0.5, 3, and 6 mopostpartum from NW (n = 78, 65, and 57, respectively), OW (n = 58,52, and 41, respectively), and OB mothers (n = 22, 18, and 11,respectively). Samples were stored at –70°Cprior to processing. Protein,fat, carbohydrate, and energy content were measured using a HumanMilk Analyzer (MIRIS AB). Leptin, insulin, C-reactive protein (CRP),interleukin-6 (IL-6), IL-8, and IL-13 concentrations were measuredusing multispot assay kits (Meso Scale Diagnostics).

Results: At 2 wk postpartum, milk from OB mothers had a lowercarbohydrate content (6.9 ± 0.09 vs. 7.1 ± 0.03 g/100 mL; P = 0.014)and 1.2-fold higher fat, 3.5-fold higher leptin, and 1.6-fold higherinsulin concentrations (P < 0.05) compared with NW mothers. At 3mo postpartum, both leptin and insulin concentrations were higher inOB compared with NW women’s milk (4.6- and 1.6-fold, respectively;P < 0.05). Interestingly, at 6 mo postpartum, fat and energy contentswere 1.4- and 1.2-fold higher, respectively, and carbohydrate contentwas lower (7.1 ± 0.08 vs. 7.3 ± 0.03 g/100 mL), in milk from OBmothers compared with NW mothers (P < 0.05). Leptin and insulinconcentrations were higher in the OB women compared with the NW


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women (4.8- and 1.6-fold, respectively; P< 0.05). At 6 mo postpartum,CRP, IL-6, IL-8, and IL-13 were all increased >2-fold in OB mothers’milk compared with milk from NW mothers (P < 0.005). For eachof the measured metabolites, the concentrations in OW women’s milkwere numerically between the values of those measured in NW and OBwomen’s milk, although not always significantly.

Conclusions: These findings demonstrate that breast milk com-position of OB women differs significantly from that of NWwomen up to 6 mo postpartum. Such results warrant furtherstudies on the impact of such differences on infant growth anddevelopment.

Funding SourcesSupported by USDA-ARS Project 6026-51,000-010-05S.

Effect of Fatty Acids on Postnatal Gut Development inWild Typeversus Fat-1 Transgenic Mice (P13-121)

Pratibha Singh, Xinting Yu, Pedro Ochoa Allemant, GeorgePerides, Joanne Brown, Steven Freedman, and Camilia R Martin

Beth Israel Deaconess Medical Center, MA

Objective: We hypothesized that long-chain polyunsaturated fattyacids (LCPUFAs) play an important role in postnatal gut development.The aimof this studywas to test this hypothesis by examiningmarkers ofgut development in Fat-1 transgenic vs. wild-type (WT) C57BL/6 miceon postnatal days 3, 14, and 28.

Methods:WTand Fat-1 C57BL/6 transgenicmice were fed the samediet high in ω-6 (n–6) LCPUFAs (AIN-76A with 10% corn oil), whichin Fat-1 mice leads to an enrichment of ω-3 fatty acids (FAs) fromω-6 precursors. Distal ileum sections were collected from Fat-1 andWT mice on days 3, 14, and 28. Quantitative reverse transcriptase-polymerase chain reaction, histology, and fatty acid analyses wereperformed. Fold changes in gene expression were quantified in Fat-1 mice relative to WT on each postnatal day and were consideredsignificant if a >2-fold reduction or increase was noted with a P valueof <0.05.

Results: In Fat-1 compared with WT mice, ileum docosahexaenoicacid concentrations (mol%) increased by 2-fold on days 14 and 28.Similarly, eicosapentaenoic acid increased by 28-fold on days 3 and 14,and by 43-fold on day 28 (P < 0.05). There was a reciprocal 2-folddecrease in arachidonic acid (ω-6 fatty acid) on days 3 and 28 (P< 0.05).The ω-3 to ω-6 ratio was significantly higher in Fat-1 compared withWT mice for all ages (P < 0.05). Histologic analyses showed a reducednumber of goblet cells in Fat-1 compared with WT mice on days 3and 28 (P < 0.0001). Moreover, Fat-1 mice relative to WT showed a>2-fold reduction in the expression of the innate immunity markersTLR9 (day 3; P = 0.003) and CAMP (days 3, 14, and 28; P = 0.005); a>2-fold increase in gene expression of Wnt receptor Fzd5 and EphB2,which is linked to Paneth cell differentiation (day 3, P< 0.001); and>2-fold increased expressions of I-FABP and FABP6, important regulatorsof fatty acid transport, cell growth, and cell differentiation (day 3,P < 0.001).

Conclusions: The Fat-1 transgenic mouse model provides animportant tool to study the effect of ω-3 FAs on gut development. Thismodel allows for well-controlled studies, without the interference ofpotential confounding factors from the diet. These data demonstrate

that LCPUFAs act as a potential regulator for early gut development bymodulating the expression of several gut development markers. Futureexperiments using Fat-1 transgenic mice in inflammatory states such asnecrotizing enterocolitis may elucidate the role of LCPUFAs in diseaserisk and pathogenesis.

Funding SourcesCharles H and Judy Hood Family Infant Health Research Program

NIH R01 DK104346.

Dietary Intakes of Fat and Fatty Acids by 1- to 5-y-Old Childrenin Korea: 2013–2015KoreaNational Health andNutrition Examina-tion Survey (P13-122)

SuJin Song1 and YounJoo Baek2

1Hannam University, South Korea; and 2Korea National OpenUniversity, South Korea

Objective: Although dietary fat and fatty acids play an importantrole in healthy growth and development for young children, there havebeen few studies assessing fat and fatty acid intakes in Korean children.Therefore, the aim of this study was to examine intakes of total fat andfatty acids and their food sources among 1- to 5-y-old Korean children.

Methods:A total of 1041 children aged 1–5 y were selected from the2013–2015 Korea National Health and Nutrition Examination Survey.Dietary intake data were obtained by a single 24-h dietary recall andused to estimate total fat and fatty acid intakes. Food sources of totalfat and fatty acids were identified based on the amounts of total fat andfatty acids consumed in each food. Total fat and fatty acid intakes andtheir food sources were presented by age group (1–2 y old, n = 401;3–5 y old, n = 640). Total fat and fatty acid intakes were also evaluatedby living area, household income, and mother’s education level.

Results: The mean intake of total fat was 27.1 g in children aged1–2 y and 35.5 g in children aged 3–5 y, and ∼23% of energy wasobtained from total fat in both age groups. Themean intake of saturatedfatty acids (SFAs) in the children aged 3–5 y was significantly higherthan in those aged 1–2 y (12.7 g vs. 10.5 g), whereas children aged 1–2 yhad higher energy from SFA than children aged 3–5 y (9.2% vs. 8.3%).The mean intake of polyunsaturated fatty acids (PUFAs) was 6.3 g inchildren aged 1–5 y, with 0.8 g of n–3 (ω-3) fatty acids and 5.5 g of n–6fatty acids. The percentages of energy from PUFAs, n–3 fatty acids, andn–6 fatty acids were higher in the children aged 3–5 y than in those aged1–2 y.Milk, pork, and eggweremajor food sources of total fat, SFAs, andmonounsaturated fatty acids. Soybean oil was the main contributor toPUFA intake in both age groups, providing 14.3% and 21.6% of PUFAsin children aged 1–2 y and 3–5 y, respectively. In the group of childrenaged 1–2 y, children living in a rural area had significantly higher intakesof PUFAs and n–3 fatty acids than those living in an urban area.

Conclusions: Our findings provide current information on dietaryintakes of fat and fatty acids, and their food sources, among youngchildren inKorea. This work could be used to establish dietary strategiesfor young children and to investigate the relation of dietary fat and fattyacids to childhood health.

Funding SourcesThis work was supported by a National Research Foundation of

Korea (NRF) grant funded by the Korea Government (MSIT; Ministryof Science and ICT) (Grant No. 2017R1C1B5017637).


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Effectiveness of Wheat Soya Blend on Weight Gain duringPregnancy and Improvement inNutritional Status in Infants at 6moin Thatta and Sujawal Sindh, Pakistan (P13-123)

Sajid Soofi,1 Gul Nawaz Khan,1 Shabina Ariff,1 Cecilia Garzon,2and Ali Ahmad Khan2

1Aga Khan University, Pakistan; and 2World Food Programme

Objective: The objective of the study was to assess the effect ofnutrient-based interventions on reduction of low birth weight, weightgain during pregnancy, and improvement in nutritional status in infantsat 6mo of age in community settings by the government primary healthcare system in the Thatta and Sujawal districts of Pakistan.

Methods: A cluster-randomized controlled trial was conducted inthe Thatta and Sujawal districts of Pakistan during 2014–2017. A total of2030 pregnant womenwere enrolled during pregnancy and infants werefollowed until 6 mo of age. Pregnant women received a monthly rationof 5 kg (i.e., 165 gram/d) of wheat soya blend (WSB) during pregnancyand during the first 6 mo of the lactation period.

Results: There was a significant difference in weight gain duringpregnancy between the intervention and control groups (326 vs.307 g/wk, P = 0.05). The reduction of low birth weight was notsignificantly different in both the intervention and control groups(34.1% vs. 33.8%, P = 0.90). A significant risk reduction in stunting(RR: 0.85; 95%CI: 0.73, 0.98; P= 0.02), wasting (RR: 0.78, 95%CI: 0.66,0.94;P= 0.00), and underweight (RR: 0.79, 95%CI: 0.70, 0.90; P< 0.00)was noted in infants at 6 mo of age in the intervention group comparedwith the control group. The compliance with the recommended intakeof WSB as per the design protocol was around 70%, and 68% of womenreported sharing the WSB with family members. Early initiation ofbreast feeding (RR: 0.85, 95% CI: 0.73, 0.99; P = 0.03), maternal height(RR: 0.86, 95%CI: 0.76, 0.97;P= 0.01), diarrhea (RR: 0.85, 95%CI: 0.74,0.99; P = 0.03), and acute respiratory infection (RR: 0.86, 95% CI: 0.74,0.98; P = 0.02) were associated with reduction in stunting in infants at6 mo of age.

Conclusions: Improving the nutritional status of pregnant womenduring pregnancy and the lactation period may have an impact on theinfant’s nutritional status. Interventions that reduce the risk of not onlystunting but also wasting and underweight in children at 6 mo of agemay be a potential factor that can guide the government and fundingagencies in nutrition investments.

Funding SourcesWorld Food Programme.

RepeatedExposure toFoods andFoodAcceptability in Infant andToddlers: A Systematic Review (P13-124)

Maureen K Spill,1 Kirsten Johns,1 Yat PingWong,2 Leann Birch,3Maureen Black,4 Ronette Briefel,5 JohnCook,6 Myles Faith,7 JulieMennella,8 Sara Benjamin-Neelon,9 and Kellie O Casavale10

1The Panum Group; 2USDA; 3University of Georgia; 4Universityof Maryland; 5Mathematica Policy Research; 6Boston Medical Center,MA; 7University at Buffalo, NY; 8 Monell Chemical Senses Center, PA;9Johns Hopkins University, MD; and 10US Department of Health andHuman Services

Objective: The USDA and the Department of Health and HumanServices initiated the Pregnancy and Birth to 24 Months project to

examine topics of public health importance for these populationsthrough systematic reviews. The purpose of this systematic review wasto examine the relation between repeated exposure to foods and foodacceptability in infants and toddlers.

Methods: A strategy was developed then used to search peer-reviewed literature published from January 1980 to July 2017 from12 databases (including CINAHL, Cochrane, Embase, PsycNET, andPubMed). References (n = 10,844) were dual-screened and includedor excluded based on a priori criteria. Extracted data were qualitativelysynthesized, and potential bias for individual studies was assessed usingthe Nutrition Evidence Library (NEL) Risk of Bias Assessment Tool.Conclusion statements were developed, and the body of evidence wasgraded using the NEL Grading Rubric.

Results: A total of 21 articles (19 controlled trials, 2 longitudinalcohort studies), published between 1980 and 2015, examined repeatedexposure to foods and food acceptability in infants and toddlers.Moderate evidence indicates that tasting a single vegetable or fruit, ormultiple vegetables or fruits, once per day for ≥8 d (exposures) is likelyto increase acceptability (indicated by an increase in food intake orfaster rate of feeding) of the exposed food, as well as a new food withinthe same food category (fruit or vegetable), in infants and toddlers4–24 mo old. Insufficient evidence is available to address the effectof repeated exposure of foods beyond fruits and vegetables on foodacceptability in infants and toddlers 4–24 mo old.

Conclusions: For generally healthy children, 4–24 mo old, theevidence suggests that 8 or more exposures to fruits or vegetableswill lead to an increase in at least one measure of food acceptability.Findings are predominantly based on the effects of repeated exposureto vegetables, with some findings on repeated exposure to fruits.Limitations in this body of evidence include heterogeneity of studymethods related to number, frequency, and duration of exposures.Research is needed using more diverse foods and textures, with specificfocus on the transition to table foods.



Caregiver Feeding Practices and Child Weight Outcomes: ASystematic Review (P13-125)

Maureen K Spill,1 Myra Shapiro,1 Emily H Gower,1 JoanneSpahn,2 Yat PingWong,2 Leann Birch,3 Maureen Black,4 RonetteBriefel,5 John T Cook,6 Myles S Faith,7 Julie Mennella,8 SaraBenjamin-Neelon,9 and Kellie O Casavale10

1The Panum Group; 2USDA; 3University of Georgia; 4Universityof Maryland; 5Mathematica Policy Research; 6Boston Medical Center,MA; 7University at Buffalo, NY; 8Monell Chemical Senses Center, PA;9Johns Hopkins University, MD; and 10US Department of Health andHuman Services

Objective: The USDA-Department of Health and Human Services’Pregnancy and Birth to 24 Months project examined topics of publichealth importance to these populations. The aim of this systematicreview was to examine the relation between caregiver feeding practices


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and child weight, growth, and body composition from birth to age24 mo.

Methods: A literature search of 4 databases (CINAHL, Cochrane,Embase, and PubMed), searched from January 1980 to January 2017,identified 8739 references. These were dual-screened using a prioriinclusion and exclusion criteria. Extracted data were qualitativelysynthesized, and potential bias for individual studies was assessed usingthe Nutrition Evidence Library (NEL) Risk of Bias Assessment Tool.Conclusion statements were developed, and the body of evidence wasgraded using the NEL Grading Rubric.

Results: A total of 27 articles (8 controlled trials, 19 longitudinalcohort studies) examined the relation between caregiver feedingpractices and child weight, growth, and body composition. The studieswere published from 1982 to 2016 in the United States, Australia,the United Kingdom, the Netherlands, and China. Studies includedchildren from birth to 22 mo of age at initial assessment and up to6 y of age at final assessment.

Conclusions:Moderate evidence fromcontrolled trials suggests thatproviding responsive feeding guidance to teach mothers to recognizeand respond appropriately to a child’s hunger and satiety cues can leadto “normal” weight gain and/or “normal” weight status in children≤2 yold compared with children whose mothers did not receive responsivefeeding guidance. Moderate evidence from longitudinal cohort studiesindicates that restrictive feeding practices are associated with increasedweight gain and higher weight status, and that pressuring feedingpractices are associated with decreased weight gain and lower weightstatus; evidence suggests that mothers’ feeding practices are relatedto concerns about their childrens’ body weight. Limitations in thisbody of evidence include generalizability; heterogeneity of exposureassessment, interventions, and outcome assessment; and the use ofparental report of feeding practices in observational cohorts. Researchis needed in more diverse populations using consistent methodologicalapproaches and objective measures.



Household-Level Factors Associated with Relapse following Dis-charge from Treatment for Moderate Acute Malnutrition (P13-126)

Heather Stobaugh,1 Beatrice Rogers,2 Patrick Webb,2 Irwin HRosenberg,2 KennethMaleta,3 Indi Trehan,4 andMark JManary4

1RTI International; 2Tufts University, MA; 3University of Malawi;4Washington University in St. Louis

Objective: Factors associated with relapse to acute malnutritionamong children who are discharged after reaching a threshold denotedas “recovered” from moderate acute malnutrition (MAM) are not wellunderstood. The aim of this study was to identify factors associatedwith sustained recovery, defined as maintaining a midupper armcircumference (MUAC) ≥12.5 cm with no edema for 1 y followingrelease fromMAM treatment.

Methods:Weanalyzed data from an in-depth household survey on asubsample of participants within a larger cluster-randomized controlledtrial (cRCT) that followed children for 1 y following recovery from

MAM. Surveys included indicators related to socioeconomic status,household food security, infant and young child feeding practices, andwater, sanitation, and hygiene.

Results: Out of 1497 children participating in the cRCT, a subsetof 315 participated in this substudy. Controlling for other factors,households with fitted lids on water storage containers was a significantpredictor of sustained recovery (P = 0.004). In addition, caregiversobserved to have clean hands (P = 0.053) and the use of an improvedsanitation facility (P = 0.083) were marginally significant predictors ofsustained recovery. In contrast, socioeconomic status and infant andyoung child feeding practices at the time of discharge and householdfood security throughout the follow-up period were not significantlyassociated with sustained recovery.

Conclusions: We hypothesize that improved water, sanitation, andhygiene conditions, in tandem with management of MAM throughsupplemental feeding programs, has the possibility to decrease relapsefollowing recovery from MAM. Furthermore, the absence of associa-tions between relapse and nearly all household-level factors indicatesthat causal factors of relapse may be related mostly to the child’sindividual underlying health and nutrition status.

Funding SourcesThis research was funded under a subaward funded by Fam-

ily Health International under Cooperative Agreement/Grant No.AIDOAA-A-12-0005, funded by USAID.

Branched-Chain Fatty Acids inHumanBreastMilk Is Specific forLactation and Gestational Age (P13-127)

Jin Sun,1 Ce Qi,1 and Liang Jie2

1School of Food Science and Technology, Jiangnan University,China; and 2Jiangnan University, China

Objectives:Branched-chain fatty acids (BCFAs) are present in breastmilk but not in most formulas intended for preterm infants. We aimedto determine the composition of BCFAs in the breast milk of motherswith preterm infants, and to understand the impact of gestational age atbirth and stage of lactation on BCFA content.

Methods: All experiments with human subjects were approvedby the Ethics Committee of Jiangnan University, China. Colostrum(4 ± 3 d postpartum), transitional milk (11 ± 3 d), and mature milkat 3 times postpartum (30 ± 3, 60 ± 3, and 90 ± 3 d) were sampledfrom 68mothers. Total lipids were extracted and sn-2monoacylglycerolwas prepared. After methylation, weakly polar GC columns were usedto quantify BCFAs in breast milk by GC-MS.

Results: The main BCFAs in preterm breast milk were iso-14:0,iso-15:0, anteiso-15:0, iso-16:0, iso-17:0, and anteiso-17:0. Breast milkBCFAs as a percentage of total fatty acids (g/100 g, %) were significantlydifferent across lactation stages, with the highest concentration incolostrum, followed by transitional and mature breast milk (median:0.41%, 0.31%, and 0.28%, respectively; P< 0.05). BCFAs increased withpregnancy duration, which is particularly significant in the colostrum,whereas, with increased lactation time, the differences in BCFA contentbetween preterm and term breast milk gradually decreased. Total BCFAcontent in the term colostrum groupwas significantly higher than in theearly preterm group (means: 0.55% and 0.37%, respectively; p. Iso-15:0and anteiso-15:0 were at their lowest concentrations in early pretermmilk, and increased at each subsequent stage of pregnancy. However,


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this increase only dramatically happened between early preterm andterm. The iso-16:0, iso-17:0, and anteiso-17:0 concentrations were sig-nificantly higher at term compared with other gestational ages. BCFAswere mainly in the sn-2 position (52–65%), similar to palmitic acid.

Conclusions: Overall, preterm and term breast milk BCFAs weresimilar and showed specific concentration patterns, resembling 16:0with respect to sn-2 positional distribution. BCFAs were reduced withlactation stage, similar to highly unsaturated fatty acids.

Funding SourcesNational key R&D program “Modern Food Processing and Food

Purchasing and Transport Technology and Equipment on Spe-cial of China”, No. 2017YFD0400600; Fund of BINC “Nutritionand Care of Maternal and Child Research Funding Program”, No.2017BINCMCF34.

CordBloodVitaminDConcentrationsAreAssociatedwithCordBlood Insulin and C-peptide in 2 Cohorts of Mother-Newborn Pairs(P13-128)

Karen M Switkowski,1 Carlos Camargo,2 Patrice Perron,3 SherylRifas-Shiman,1 Marie-France Hivert,1 and Emily Oken1

1Harvard Pilgrim Health Care Institute/Harvard Medical School,MA; 2Massachusetts General Hospital; and 3Université de Sherbrooke,Canada

Objective: Gestational vitamin D status may contribute to prenatalprogramming of the insulin axis and glucose regulation, and lowmaternal vitamin D has been linked to impaired fetal growth, adversepostnatal growth patterns, and insulin resistance in the offspring. Fetalgrowth is also positively associated with cord blood insulin and c-peptide concentrations. We hypothesized that maternal circulating25-hydroxyvitamin D [25(OH)D] during pregnancy and cord blood25(OH)D would both be positively associated with cord blood insulinand c-peptide. The aim of this study was to test this hypothesis.

Methods: We studied mother-infant pairs enrolled in Project Viva(n= 862; Boston,MA) andGenetics of Glucose Regulation inGestationand Growth (Gen3G; n = 660; Sherbrooke, Canada). Both cohortscollected blood samples and other data frommothers during pregnancyand umbilical cord blood samples at birth.We examined associations ofmaternal and cord blood 25(OH)Dwith log-transformed cord blood in-sulin and c-peptide concentrations usingmultivariable linear regressionmodels and generalized additive models with nonlinear splines.

Results: Mean ± SD maternal 25(OH)D concentrations were 59 ±20 and 64± 20 nmol/L and cord blood concentrations were 46± 19 and53 ± 18 nmol/L in Project Viva and Gen3G, respectively. Correlationsbetween maternal and cord blood 25(OH)D concentrations were 0.58in Project Viva and 0.37 in Gen3G. In both cohorts, a higher maternalprepregnancy body mass index (BMI) was associated with lowermaternal and cord blood 25(OH)D and higher cord blood insulinand c-peptide. After adjusting for season, child sex, maternal race orethnicity, age at enrollment, parity, smoking, and prepregnancy BMI,each 10-nmol/L increase in cord blood 25(OH)D was associated witha 3.6% (95% CI: 0.0%, 7.3%) higher cord blood insulin concentrationand a 3.2% (95% CI: 0.8%, 5.6%) higher c-peptide concentration inProject Viva, and with a 2.2% (95% CI: –0.2%, 4.5%) higher cordblood insulin concentration and a 3.6% (95% CI: 1.0%, 6.3%) higherc-peptide concentration in Gen3G. Maternal 25(OH)D appeared to

have nonlinear, inverse U-shaped associations with the cord bloodhormones, with higher insulin and c-peptide among mothers with25(OH)D in the range of ∼50–90 nmol/L.

Conclusions: Vitamin D may play a role in regulating fetal insulinsecretion, with a potential long-term impact on postnatal glucoseregulation and growth.

Funding SourcesProject Viva is funded by the NIH (grants R01 HD034568, UG3

OD023286). Gen3G is funded by Fonds de Recherche en Santé duQuébec (grant #20,697) and the Canadian Institute of Health Reseach(grant #MOP 115,071).

Low-Calorie Sweetener Use among Pregnant Women in theUnited States (P13-129)

Allison C Sylvetsky,1 Janet Figueroa,2 Kristina Rother,3 MichaelGoran,4 and Jean Welsh2

1GeorgeWashington University, DC; 2Emory University, GA; 3NIH;4Keck School of Medicine, University of Southern California

Objectives: The aims of this study were 1) to describe temporaltrends in low-calorie sweetener (LCS) consumption among pregnantwomen in the United States from 1999 to 2014, and 2) to compareLCS consumption prevalence across sociodemographic subgroups andproduct category.

Methods: Data were collected from pregnant women aged 20–39 y(n = 1265) who participated in the NHANES from 1999–2000 through2013–2014. Prevalence of LCS consumption was assessed using two24-h dietary recalls. Data from the 2007–2014 cycles were combined toapproximate the sample size in each of the previous 2-y cycles, in whichpregnant women were oversampled. Data were weighted to providenational estimates, and frequency procedures for complex survey designwere used to determine prevalence of LCS use. F-tests were used tocompare consumption prevalence across sociodemographic subgroups,and survey-weighted logistic regression was used to examine trends inLCS use over time.

Results: The prevalence of LCS consumption among pregnantwomen increased by∼50%between 1999–2000 (16.4%) and 2007–2014(24.0%) (P= 0.012), with the highest prevalence observed in 2005–2006(33.8%). This trend appears to have been driven by significant increasesin LCS beverage consumption (9.2% in 1999–2000, 18.3% in 2007–2014; P = 0.004), whereas LCS food and packet use were unchanged.LCS consumption among pregnant women in NHANES 2005–2014was highest in non-Hispanic white women (37% vs. 18% and 16%in Mexican American and non-Hispanic black mothers, respectively;P< 0.0001) and those with a college degree (37% vs. 24% in those with-out a high-school diploma, P = 0.02). Prevalence of LCS consumptiondid not differ by prepregnancy weight status or trimester of pregnancy.

Conclusions:Approximately one-quarter of pregnant women in theUnited States reported daily consumption of LCS, with the highestprevalence reported among highly educated and non-Hispanic whitewomen. Despite this widespread LCS use, little is known about effectsof LCS use during pregnancy onmaternal or fetal and infant health. It istherefore critical to elucidate potential effects of prenatal LCS exposureon offspring taste preferences, weight trajectory, and metabolic health.

Funding SourcesNo funding received.


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Late Age at Introduction of Solid Food and Obesity throughoutthe Life Course (P13-130)

Muna J Tahir,1 Karin Michels,2 Walter CWillett,3 and Michele RForman4

1The University of Texas at Austin; 2University of California, LosAngeles; 3Harvard University, MA; and 4Purdue University, IN

Objective: Obesity has until recently been increasing at alarmingrates, with early life diet potentially influencing development of thecondition. Limited studies have assessed the association between age atsolid food introduction and childhood obesity with equivocal results,and few have tracked the consequence of this exposure into lateadolescence or adulthood. This study aimed to examine the associationbetween age at solid food introduction and body somatotype or fatnessat ages 5 and 10 y and body mass index (BMI) at 18 y of age and inadulthood.

Methods: Among 31,816 mother-nurse daughter dyads participat-ing in the Nurses’ Mothers’ Cohort Study and the Nurses’ Health StudyII, information on age at solid food introduction, somatotype at ages5 and 10 y (a 9-level pictogram, with a somatotype ≥5 classified as“obese”) and BMI at 18 y of age and in adulthood was collected.Binomial logistic regression models were computed to estimate theadjusted ORs (aORs) and 95% CIs for obesity in childhood, lateadolescence, and adulthood, with adjustment for parental and nursedaughter characteristics.

Results: A total of 29% of the mothers reported introducing solidfoods at <3 mo of age, 45% at 3–6 mo, 19% at 6–9 mo, and 7% at>9 mo. Of the nurses, 6% reported a somatotype ≥5 at 5 y of age.Nurses who were introduced to solid foods at >9 mo of age had higherodds of obesity at age 5 y in age-adjusted (aOR: 1.19; 95% CI: 1.00,1.41) and covariate-adjusted models (aOR: 1.19; 95% CI: 1.00, 1.41),compared with those fed solid foods at 3–6 mo of age. Age at solidfood introduction was not related to the odds of obesity at ages 10 and18 y. In adulthood, the odds of obesity were higher in age-adjustedmodels (aOR: 1.17; 95% CI: 1.01, 1.35) among those introduced to solidfoods late (>9 mo, compared with 3–6 mo), but this association didnot remain significant after further adjustment for parental and nursecovariates.

Conclusions: Introduction of solid foods after 9 mo of age wasassociated with higher odds of obesity at age 5 y, but the associationdid not persist at later ages.

Funding SourcesThe Nurses’ Mothers’ Cohort Study was funded by the National

Cancer Institute (Research Contract N02-RC-17,027). The Nurses’Health Study II was supported by award number UM1CA176726 fromthe NIH.

Quality of Protein in Early Complementary Foods InfluencesGrowth and Serum Amino Acids, Trimethylamine N-Oxide andAcylcarnitines through 24 mo in Formula-Fed Infants (P13-131)

Minghua Tang, Alexandra Palacios, Audrey Hendricks, andNancy F Krebs

University of Colorado Denver

Objective: High protein intake from infant formula has beenassociated with rapid weight gain early in life. However, the effect of

protein on infant growth from complementary foods has not beenprospectively evaluated. The objective of this study was to test theeffect of a complementary diet with protein primarily from 2 commonsources, meat or dairy, in formula-fed infants during the first 2 y ongrowth and serum biomarkers.

Methods: Healthy, term formula-fed infants were randomized to acomplementary diet of meat or dairy as the main protein source from6 to 12 mo of age. Protein-based foods and a standard, cow-milk basedformula were provided.Monthly assessments of growthwere conductedfrom5 to 12mo, and an observational follow-up visit was done at 24mo.Blood samples were collected at 5, 12 and 24 mo.

Results: A total of 64 infants completed the 7-mo intervention(Meat, n = 32; Dairy, n = 32). At 24 mo, the retention rate was 83%.The average total protein intake (g · kg–1 · d–1) increased from 2.1± 0.1at 5 mo to 3.4 ± 0.1 at 12 mo and 4.9 ± 0.4 at 24 mo. Energy intake(kcal · kg–1 · d–1) did not change from5mo (90± 19) to 12mo (90± 19),but increased at 24 mo (115 ± 10). There was no difference betweengroups at any time points.

The weight-for-age z score (WAZ) significantly increased from 5to 12 mo, and this increased remained at 24 mo for both groups. Thelength-for-age z score (LAZ) increased in the Meat group and declinedin the Dairy group from 5 to 12 mo. At 12 mo, the LAZ was 0.14± 0.90and –0.60 ± 0.91 for Meat and Dairy, respectively. This difference wasattenuated at 24 mo (Meat: 0.19 ± 0.62; Dairy: –0.37 ± 0.90), butremained significant.

TrimethylamineN-oxide significantly increased only inMeat from 5to 12 mo, and this increase remained at 24 mo. BCAA increased from 5to 12 mo for both groups, with no difference at 24 mo. AcylcarninesC2, C10, and C10:1 decreased from 5 to 24 mo in both groups. C4decreased only in Dairy from baseline to 24 mo, but there was a higherconcentration of C4 in Meat at 24 mo.

Conclusions: For this group of formula-fed infants, a dietaryintervention of different protein sources during late infancy had apersistent effect on linear growth 1 y after the intervention. Fatty acidβ-oxidation also appeared to be affected. Whether these changes wereassociated with the observed linear growth pattern warrants furtherinvestigation.

Funding SourcesSupported by NIH (NIDDK), American Heart Association, Abbott

Nutrition, Colorado Clinical and Translational Sciences Institute,Leprino Foods, National Cattlemen’s Beef Association and the NationalPork Board.

Metabolomic Profiling Reveals Metabolites Correlating with α-Tocopherol Concentrations in the Frontal Cortex of Human InfantBrain (P13-132)

Jirayu Tanprasertsuk,1 Matthew Kuchan,2 Adam D Kennedy,3and Elizabeth J Johnson4

1Tufts University, MA; 2Research and Development, AbbottNutrition; 3Metabolon Incorporated; and 4Jean Mayer USDA HumanNutrition Center on Aging, MA

Background: α-Tocopherol (αT) is a potent antioxidant that isessential for the developing brain. However, αT may have other rolesbeyond its antioxidative function. Metabolomic profiling in pediatric


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brain tissues with varied αT concentrations would be a useful tool toinvestigate the roles of αT in neural development during infancy.

Objective: The objective of this research was to compare themetabolomics profiles of pediatric brain tissues with varied concentra-tions of αT.

Methods: Brain tissue from the frontal cortex was acquired from29 infants (age 111 ± 74 d) who had no brain and/or systemicpathologies at death. Total αT concentrations were measured byHPLC coupled with fluorescence detection. Metabolomic profilingwas performed by GC-MS and LC-MS. Pearson’s partial correlationanalysis (univariate analysis), adjusting for age, sex, and race, andpartial least-squares discrimination analysis (multivariate analysis)were performed to identify themetabolites that correlated with total αTconcentrations.

Results: Total αT concentrations ranged from 6.28 to 43.50 μmol/gbrain tissue. Among the 402metabolites detected by GC-MS or LC-MS,32metabolites were identified to be statistically correlated with total αTconcentrations by both univariate (P< 0.05) and multivariate analyses.They included antioxidative metabolites (ascorbate, dehydroascorbate,homocarnosine), amino acid metabolites, derivatives of cholesterol,phospholipids, arachidonic acid, and other fatty acids.

Conclusions: αT may have essential roles in the developing brainbeyond its antioxidative function. Discovery of novel roles in neuraltissue may support the essentiality and requirement of αT duringinfancy.

Funding SourcesAbbott Nutrition USDA 8050-51,000-095-01S.

TABLE P13-132-1 Thirty two metabolites statistically correlate with α-tocopherol (αT) concentrations in the frontal cortex of infants (n =29) as identified by both Pearson’s partial correlation analysis adjusted for age, sex, and race (p < 0.05), and partial-least squaresdiscrimination analysis. Metabolites in bold are positively correlated with αT concentrations while those in italics are negatively correlated.


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Validating a Prenatal Feeding Beliefs Questionnaire amongPregnant African AmericanWomen (P13-133)

Amanda L Thompson, Heather Wasser, and Margaret Bentley

University of North Carolina at Chapel Hill

Objectives: Parental feeding beliefs and practices have been as-sociated with weight gain in infants and young children. However,when these styles develop and their stability across infancy andchildhood remain unclear. This study aimed to validate a scale, thePrenatal Feeding Beliefs Questionnaire (PnFBQ), to assess feedingbeliefs during pregnancy among African American women, and totest whether the feeding belief constructs (laissez-faire, restrictive,responsive, pressuring, and indulgent) are associated with maternalcharacteristics previously associated with less optimal infant feedingpatterns and weight gain.

Methods: The PnFBQ was completed by 427 pregnant womenenrolled in the baseline 28-wk gestation visit of theMothers and OthersStudy, a family-based randomized control trial to support healthy infantfeeding and prevent obesity. Confirmatory factor analysis (CFA) wasused to test the fit of 5 a priori feeding constructs. Models were testedand modified iteratively to determine the best fitting model for eachconstruct. Construct scores were created by averaging the remainingitems. External validity was assessed through bivariate tests (chi-squareand t tests) of association with maternal characteristics.

Results:CFAvalidated 4 feeding belief constructsmeasured through8 subconstructs and 1 single-item construct (responsive). Reliabilitycoefficients ranged from 0.38 for restrictive amount to 0.73 forpressuring. Goodness-of-fit indices for all models indicated a goodfit, with comparative fit indices ranging from 0.97 to 0.99 and rootmean square errors of approximation from 0.00 to 0.06. Severalconstruct scores, including laissez-faire, pressuring, and indulgent sub-constructs, differed significantly by maternal depressive symptoms,obesity, and income.

Conclusions: The PnFBQ may be used to assess feeding beliefspreviously associated with obesity in infants and young children,and provide a preliminary tool for tracking the development of andintervening with feeding beliefs in this high-risk population.

Funding SourcesThis work was supported by the National Institute of Child Health

and Human Development, grant number R01HD073237.

Newly Developed Infant Gut Simulator Model for Human MilkOligosaccharide Fermentation (P13-134)

Kirsti Tiihonen,1 Krista Salli,1 Johanna Hirvonen,1 AshleyHibberd,1 Ilmari Ahonen,2 Markku Saarinen,1 Heli Putaala,1Johanna Maukonen,1 Arthur Ouwehand,1 Johanna Hirvonen,1Johanna Hirvonen,1 Johanna Hirvonen,1 Johanna Hirvonen,1Johanna Hirvonen,1 and Johanna Hirvonen1

1DuPont Nutrition and Health; and 2Vincit Turku Oy

Objective: Human milk oligosaccharides, a structurally diversegroup of carbohydrates from human breast milk, shape the evolvinginfant gut microbiota by serving as a fermentable energy source. Theaim of this study was to develop an infant colon fermentation modelto examine the effect of 2′-fucosyllactose (2′-FL) on the infant gutmicrobiota.

Methods: The EnteroMIX colon simulator model with sequentiallyconnected vessels represented different parts of the colon. The simu-lations were performed to investigate how 2′-FL, lactose, and galacto-oligosaccharides (GOS) affected the infant microbiota composition andmetabolites during the 48 h simulations. A medium without addedcarbohydrates was used as the control. From the fecal donors, 5 werebreastfed and 4 were mostly formula-fed, with age variation from 0.5to 8 mo. Total bifidobacteria was quantified by real-time quantitativepolymerase chain reaction and overall microbial composition wasanalyzed by 16S rRNA amplicon sequencing. Microbial metaboliteswere analyzed by chromatographic methods.

Results: 2′-FL, as well as GOS and lactose, increased the amount oftotal bifidobacteria, but owing to the high variation between the simu-lations, no differences were found between feeding types of the donorswhen simulations were combined. The predominant taxa detectedby sequencing were Bifidobacterium, Lactobacillus, Enterobacteriaceae,and Veillonella. α-Diversity was lower in simulations with breastfeddonors compared with formula-fed donors, and β-diversity clusteringshowed significant effects of donor, feeding type, and carbohydrate. Theconcentrations of short-chain fatty acids and lactic acid were highest inthe lactose and GOS simulations and lowest in the control simulations(being intermediate in the 2′-FL simulations).

Conclusions:Owing to individual variations, the impact of 2′-FL onthe infant microbial metabolism activity was on average intermediatebetween the control and the highly fermentable GOS and lactose. Thissuggests that the slower fermentation of 2′-FL might be more suitablefor the immature infant gut. In further infant colon simulator studies,selecting a narrower age range for fecal sample donors could decreasethe variation and enable the detection of differences in the microbialmetabolism of breastfed and formula-fed infants.

Funding SourcesDuPont Nutrition and Health.

Utilization of Human Milk Oligosaccharide 2′-Fucosyllactose byProbiotic Strains and Characterization of Genes Involved in HumanMilk Oligosaccharide Metabolism by Bifidobacterium longum ssp.infantis Bi-26 (P13-135)

Kirsti Tiihonen, Johanna Hirvonen, Krista Salli, Bryan Zabel,Sinikka Latvala, Heli Putaala, and Arthur Ouwehand

DuPont Nutrition and Health

Objective: Human milk oligosaccharides (HMOs) are not digestedby infants but are metabolized by beneficial bacteria, such as Bifi-dobacterium species. B. longum ssp. infantis and B. bifidum are themajor HMO consumers found in breastfed infant feces. The aim ofthis study was to evaluate the ability of various species of such generaas Lactobacillus, Bifidobacterium, and Bacteroides to ferment HMO2′-fucosyllactose (2′-FL), glucose, lactose, or galacto-oligosaccharides(GOS) as a sole carbon source. Since there is limited knowledge of howspecific Bifidobacterium strains use individual HMOs, we performedtranscriptomics analysis of B. longum ssp. infantis Bi-26 strain duringgrowth with 2′-FL.

Methods: Bacterial growth was monitored by measuring theabsorbance at 600 nmevery 30min for 24 hwith an automatic BioscreenC system under anaerobic conditions in optimal culture media foreach bacterial strain containing 1% 2′-FL, glucose, lactose, or GOS as


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the sole carbon source. Transcriptomic data were obtained by growingB. longum ssp. infantis Bi-26 in modified Bifidobacterium Media 58(DSMZ) containing 1% 2′-FL, lactose, or GOS. Samples were taken atearly phase (A600 0.25), at midlog (A600 0.5–0.7), and at late log (A600

0.9–1.1), centrifuged, and suspended in trizole. After RNA isolation andtreatment, samples were sequenced via HiSeq2500 (Illumina) with aread length of 76 bp (paired ends). Genomic analysis was performedwith DNASTAR.

Results: Only certain bifidobacteria, such as B. longum ssp.infantis and B. bifidum, as well as Bacteroides fragilis and Bacteroidesthetaiotaomicron strains, used 2′-FL as a sole carbon source, whereasalmost all tested strains of bacteria were able to consume glucose,lactose, and GOS. The results revealed that several novel gene clusterswere involved in the breakdown and transport of 2′-FL, and that themetabolism of 2′-FL is a complex process involving multiple geneclusters throughout the genome compared with the lactose and GOScontrols.

Conclusions: These results show the selectivity in 2′-FL utilizationbetween different Bifidobacterium strains, and the mode of action of 2′-FL metabolism by Bi-26. These data could be used to further determinethe genetic and functional properties of probiotic-HMO interactions.

Funding SourcesDuPont Nutrition and Health.

Predictors of Feeding Practices among Family Child Care HomeProviders (P13-136)

Alison Tovar,1 Amber Vaughn,2 Sara Benjamin-Neelon,3 ReganBurney,2 Truls Ostbye,4 and Dianne Ward2

1University of Rhode Island; 2University of North Carolina; 3JohnsHopkins University, MD; and 4Duke University, NC

Objective: The aim of this study was to explore predictors of familychild care home (FCCH) providers’ food practices.

Methods: Data from a cluster-randomized trial were used for theseanalyses. FCCH provider feeding practices were assessed over 2 dusing a modified version of the Environmental Policy AssessmentObservation (EPAO) tool (adapted for use in FCCH with expandedassessment of feeding practices). The EPAO captures the nutrition andphysical activity environments in child care (e.g., provisions, practices,and policies); however, only the feeding practices items recorded duringmeals were used in these analyses. Three feeding factors from a previousexploratory factor analysis were used: 1) coercive control and indulgentfood practices, 2) autonomy supportive practices, and 3) unhealthy rolemodeling practices. Providers completed a sociodemographic surveyand a food frequency questionnaire. A modified Healthy Eating Index(HEI) score was created for providers. Relations between the 3 feedingpractice factors and sociodemographic and HEI scores were assessedusing correlations and ANOVA.

Results:All FCCHproviders were female (n= 164) and themajority(74%) were African American. The coercive controlling and indulgentfactor was positively correlated with provider age (r = 0.2, P < 0.001).Providers with lower HEI scores (<70) had higher coercive controllingand indulgent than those with higher HEI scores (2.7 vs. 2.4, P = 0.02).Providers taking care of >6 children vs. fewer, and who were AfricanAmerican vs. other races, had lower autonomy supportive scores (0.55vs. 0.71, P = 0.002, 0.59 vs. 0.76, P = 0.003, respectively).

Conclusions: Age, diet quality, race, and number of children infamily child care homes may influence providers’ feeding of youngchildren. Understanding these factors can help develop and tailorinterventions to improve feeding practices in this setting.

Funding SourcesFunding for this researchwas provided by early career diversity grant

funds, 3R01HL108390-03S1, from the NIH.

Prevalence of Sugar-Sweetened Beverage Consumption amongInfants: Findings from the Nurture Observational Birth Cohort(P13-137)

Alison Tovar,1 Maya Vadiveloo,1 Truls Ostbye,2 and SaraBenjamin-Neelon3

1University of Rhode Island; 2Duke University, NC; and 3JohnsHopkins University, MD

Objective:Few studies have examined the proportion of infants con-suming sugar-sweetened beverages (SSB), especially racial minoritieswho suffer higher rates of childhood obesity. Therefore, the goal ofthis study was to descriptively explore SSB consumption by race duringinfancy (4–12 mo old) in the Nurture cohort.

Methods: Pregnant women fromDurham,NC enrolled their infantsin the study shortly after birth from 2013 to 2015 and were surveyedevery 3 mo through their infant’s first year (n= 666). Mothers reportedsociodemographics and how frequently (never, just to try, sometimesbut less than once a day, or at least once a day) their infants consumeddifferent beverages, including 100% fruit or vegetable juice (juice), andall SSBs including juice drinks, soda, and sweet tea. Frequencies weredichotomized into never or just to try and sometimes or at least once aday. The prevalence of SSB consumption at each time point across race(African American vs. other races) was analyzed in a subsample of 223–331 infants with available data. Chi-square analysis tested differencesbetween SSB consumption and race.

Results: On average, mothers were 28 y old; 65% were AfricanAmerican and 59% were on a low income. By 4 mo of age, 21.2% ofAfrican American mothers vs, 12.3% of other races reported that theirinfants had juice at least once a day (P = 0.06), and 5.3% of AfricanAmerican vs. 4.9% of other races reported that their infants had SSB atleast sometimes (P = 0.39). By 7 mo of age, 58.7% of African Americanmothers vs. 35.3% of other races reported that their infants had juiceat least sometimes (P < 0.001), and 16.9% of African American vs.5.6% other races reported that the infants had SSB at least sometimes(P = 0.02). By 12 mo, 75.8% of African American mothers vs. 56.3%of other races reported that their infants had juice at least sometimes(P = 0.004), and 38.4% of African American vs. 15.5% other racesreported that the infants had SSB at least sometimes (P < 0.001).

Conclusions: The prevalence and frequency of SSB consumption inthe first year of life differ among African American and non–AfricanAmerican mothers. Early SSB consumption may be contributingto child obesity risk. Future efforts to promote healthy beverageconsumption during the first year of life are needed.

Funding SourcesThis study was supported by a grant from the NIH (R01DK094841).


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Relationship between Newborn Health Status and Early Initia-tion of Breastfeeding in Rural Bangladesh (P13-138)

Md Barkat Ullah,1 Malay Mridha,1 Charles D Arnold,1 SusanaL. Matias,1 Mokbul Hossain,2 Rina Rani Paul,3 and Kathryn GDewey1

1University of California Davis; 2BRAC James P Grant School ofPublic Health, BRAC University, Bangladesh; and 3Care Bangladesh

Objective:The aimof this studywas to examine the relation betweenperceived newborn health status and early initiation of breastfeeding(EIBF).

Methods: We used data from the Rang-Din Nutrition Study, acluster-randomized controlled trial in rural Bangladesh. Women wereenrolled at ≤20 wk of gestation (n = 4011) and followed up to 24mo postpartum. They were interviewed in the home or at the placeof delivery within 48 h after childbirth to collect information on thedelivery (e.g., mode of delivery, presence of birth attendants) and thenewborn’s health status. Time to put the infant to the breast wasrecorded and subsequently categorized as early (≤1 h) or late (>1 h).Good newborn response was defined as crying (normal or loud) andmovement (normal or forceful) within 1 min after birth. Women wereasked about the overall condition of the infant immediately after birth(healthy or sick), and whether the infant was able to suckle when put tothe breast for the first time. Attendance by a medically trained providerwas coded “yes” if any medical doctor, paramedic, nurse, skilled birthattendant, family welfare visitor or assistant, midwife, or health ormedical assistant provided delivery care. Associations between EIBFand the above variables were tested using mixed-model multivariablelogistic regression.

Result: Data for 3602 infants were analyzed, from a total of 3664live births. Nearly half (47.0%) of the deliveries occurred at home, and81.2% of the newborns were put to the breast or fed breastmilk within 1h after birth. The odds of EIBFwere significantly higher if the infant wasperceived as healthy by the mother (83.6% vs. 72.3%; OR: 2.08; 95% CI:1.46, 2.97), the newborn response was good (83.5% vs. 76.7%; OR: 1.52;95%CI: 1.28, 1.82), or the newborn was able to suckle immediately afterbirth (82.1% vs. 77.7%; OR: 1.35; 95% CI: 1.10, 1.66). The odds of EIBFwere significantly lower if the birth was attended by a medically trainedprovider (77.3% vs. 86.2%; OR: 0.49; 95% CI: 0.41, 0.59), or if the infantwas delivered by cesarean delivery (53.6% vs. 82.2%; OR: 0.16; 95% CI:0.13, 0.20) or by the use of episiotomy, forceps, or ventouse (77.6% vs.82.2%; OR: 0.33; 95% CI: 0.22, 0.47) as compared with normal vaginaldelivery.

Conclusions: EIBF was more likely among infants whose healthstatus immediately after birth was perceived as good. Interventions toimprove EIBF among newborns with poorer perceived health status areneeded.

Funding SourcesFunding was provided by the United States Agency for International

Development (USAID) through the Food and Nutrition TechnicalAssistance III Project (FANTA), managed by FHI 360.

The Associations of Healthy and Unhealthy Food Scores in theFirst Year with Weight-for-Length z scores at 12 mo: Findings fromthe Nurture Observational Birth Cohort (P13-139)

Maya Vadiveloo,1 Alison Tovar,1 Truls Østbye,2 and SaraBenjamin-Neelon3

1University of Rhode Island; 2Duke University Medical Center, NC;and 3Johns Hopkins Bloomberg School of Public Health, MD

Objective: The first year is a critical period for obesity ontogeny, yetwe know little about the impact of diet quality on obesity during thistime. As infants transition from a milk-based diet to solid foods, it isunclear how the diet quality of foods introducedmay affect early obesityrisk. This study prospectively examined associations between a healthyfood score (HFS) and an unhealthy food score (UnHFS) during infancy(4–12 mo old) and weight-for-length (WFL) z scores at 12 mo of age.

Methods: Data are from the Nurture cohort. Mothers 20–36 wkpregnant in NC, from 2013 to 2015, were surveyed and had infantanthropometrics measured every 3 mo through their infant’s first year(n= 666). Mothers reported sociodemographics and the frequency perday that their infants consumed fruits and vegetables (used to computethe HFS) and sweets, French fries, snacks, and ice cream (used tocompute UnHFS). Frequencies (0–5 times a day) for each food at eachof the three 3-mo periods were averaged to compute the mean HFSand UnHFS. The HFS and UnHFS were divided into quartiles (Q) andgeneralized linear models with Tukey adjustment tested associationsbetween food scores andWFL z score, controlling for infant birthweightand prepregnancy body mass index (BMI) (n = 449). Exploratoryanalyses compared 4 groups of infants with high (≥2 times a day) andlow (<2 times a day) HFS and low (<1 times a day) and high (≥1 timesa day) UnHFS.

Results: On average, mothers were 28 y old, with a prepregnancyBMI of 30.5 kg/m2; 65% were non-Hispanic black and 59% were ona low income. Mean HFS and UnHFS were 2.39 (range: 0–7.4) and1.79 (range: 0–9.9), respectively. HFS was not associated with WFL zscore, but infants in the highest UnHFS quartiles (i.e., least healthy) hadhigher WFL z scores (0.73–0.75 ± 0.1, mean ± SD) than infants in thelowest UnHFS quartile) (0.37± 0.1). Infants with a high HFS (i.e., mosthealthy) and high UnHFS (i.e., least healthy) had higher WFL z scores(0.74 ± 0.1) than infants with a low HFS and low UnHFS (0.33 ± 0.1),but were similar to those with a high HFS and low UnHFS or low HFSand high UnHFS.

Conclusions: Infants with the highest UnHFS (i.e., least healthy)between 4 and 12 mo had a higher WFL z score at 12 mo; exploratoryanalyses suggest that infants with a high HFS and high UnHFS havesimilarWFL z scores as infants with a lowHFS and highUnHFS, under-scoring the importance of reducing UnHFS exposures in the first year.

Funding SourcesThis study was supported by a grant from the NIH (R01DK094841).

Age of Introduction of Complementary Food and BreastfeedingPractices in Mexican Toddlers Aged 15–24 mo Differ According toSex and Age Group (P13-140)

Edgar M Vasquez Garibay,1 Lilia Perales Huerta,1 AlfredoLarrosa-Haro,1 Enrique Romero Velarde,1 Enrique RomeroVelarde,1 Diana Duarte Martinez,2 and Raul Cervantes Medina3

1Institute of Human Nutrition, University of Guadalajara, Mexico;2University of Guadalajara, Mexico; and 3Nuevo Hospital Civil deGuadalajara, Mexico


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Objective: The aim of this study was to demonstrate differences ofcomplementary feeding practices of Mexican children of low-incomefamilies aged 15–24 mo according to age strata and sex.

Methodology: In an analytic cross-sectional study, 211 apparentlyhealthy children aged 15–24 mo attending the outpatient clinic ofpediatrics at the New Civil Hospital of Guadalajara were included.Feeding practices were evaluated using a questionnaire speciallydesigned for the study which included complementary feeding andlactation variables. ANOVA, Student’s t test, and the Mann-Whitney Utest were all used, and ORs were obtained.

Results: Of the total sample, 34% were female and 66% weremale. Mothers breastfed the males for longer, consequently the onsetof formula feeding was delayed beyond that of the females. Theintroduction of cow’s milk was earlier for the children aged 15–18 mothan for the older children. The mothers of the 15–18 mo age groupshowed a lower average lactation than those of the 22–24 mo age group(P= 0.001) and the 19–21mo age group (P= 0.005). The age of onset ofhumanmilk substitutes (HMS) was significantly lower in the 15–18 moage group than in the 19–21mo age group (P= 0.023) and the 22–24moage group (P= 0.025). The duration of HMSwas lower in the 15–18mogroup than in the 19–21mo age group (P= 0.018) and the 22–24mo agegroup (P = 0.008). The age of HMS suspension was lower in toddlersaged 15–18mo than those in the 19–21mo age group (P= 0.004) or the22–24 mo age group (P = 0.011). The age of onset of cow’s milk con-sumption was lower in the 15–18 mo age group than in the 19–21 moage group (P = 0.003) and the 22–24 mo age group (P = 0.021). Theonset of HMS was 89% higher in females than in males (OR: 1.89; 95%CI: 1.03, 3.47; P = 0.038). Toddlers in the 15–18 mo age group were 2.6times more likely to start HMS at <6 mo old than toddlers in the 22–24 mo age group and 75% more likely to receive HMS than toddlersin the 19–21 mo age group. There was a 2-fold greater probabilityof early onset of HMS in the 15–18 mo age group than in the olderchildren.

Conclusions: There are significant differences in the age of intro-duction of complementary food and breastfeeding practices inMexicantoddlers from 15 to 24 mo of age according to sex and quarterly agegroup. It is interesting to observe how dynamic feeding practice changesare, even in this short interval of age, in families of low socioeconomicstatus of Guadalajara, Mexico.

Funding SourcesNational Council of Science and Technology (CONACYT).

Macronutrients Intake in Toddlers 15–24mo of AgeDiffer by Sexand Quarterly Age Group. Preliminary Data (P13-141)

Edgar M Vasquez Garibay,1 Lilia Perales Huerta,2 Alfredo Lar-rosa Haro,2 Enrique Romero Velarde,2 Diana Duarte Martínez,2and Raul Cervantes Medina3


Objective: The aim of this study was to demonstrate that differencesin macro- and micronutrient intake and percentage of adequacy intoddlers from 15 to 24 mo of age differ by sex and quarterly age group.

Methodology: In an analytic cross-sectional study, 211 apparentlyhealthy children aged 15–24 mo attending the outpatient clinic of

pediatrics at the New Civil Hospital of Guadalajara, Mexico wereincluded. Feeding practices were evaluated using a questionnairespecially designed for the study which included complementary feedingand lactation variables, in addition to a food frequency dietaryassessment and 24-h recall dietary assessment of how much energyand what macro- andmicronutrients were obtained. ANOVA, Student’st test, and the Mann-Whitney U test were all used, and ORs wereobtained.

Results: Of the total sample, 34% were female and 66% were male.There was an increase in energy (P = 0.05), protein (P = 0.011), andcarbohydrate (P = 0.08) consumption as the toddlers progressed inage. Macronutrient intake and the percentage of adequacy accordingto the Recommended Dietary Allowances (RDA) were higher in energy(143%), proteins (222%), fats (118%), and carbohydrates (144%) in thewhole sample. The probability of energy intake being<80%of adequacywas 4.4 times higher in toddlers in the 15–18mo age group than in thosein the >18 mo age group (OR: 4.4; 95% CI: 1.39, 14.1; P < 0.007). Thepercentage of toddlers in the 15–18 mo age group with fat intake being<80% of adequacy was 2.2 times higher than of those in the 19–21 moage group (OR: 2.2; 95% CI: 1.02, 4.67; P= 0.043) and 3.3 times greaterthan in males aged 22–24 mo (OR: 3.3; 95% CI: 1.36, 8.29; P < 0.007).Sugar consumption was 6 times higher than recommended and washigher in toddlers in the 15–18 age group than in older toddlers; 92%of the total sample consumed sugar in excess of 200% of the RDA. Fiberconsumption covered just 66% of the RDA, and this was <80% of therecommended intake in 75% of the study population. The percentagewho received adequacy of sodium was higher in the 22–24 mo agegroup than in the 15–18 mo age group (P = 0.021). The adequacy rateof sodium intake of <80% was 4 times greater in toddlers aged 15–18 mo than in the 22–24 mo age group (OR: 4.0; 95% CI: 1.45, 11.2;P = 0.005).

Conclusions: Macronutrients and sodium intake are generallyadequate in Mexican toddlers at 15–24 mo of age; however, there aredifferences by sex and quarterly age group. There was a trend to higherconsumption of energy, protein, fat, and carbohydrates.

Funding SourcesNacional Council of Science and Technology (CONACYT)

Complementary Feeding Practices in Mexican Toddlers 15–24mo of Age by Sex and Quarterly Age Group. Preliminary Data(P13-142)

Edgar M Vasquez Garibay,1 Lilia Perales Huerta,2 Alfredo Lar-rosa Haro,2 Enrique Romero Velarde,2 Diana Duarte Martinez,2and Raul Cervantes Medina3


Objective: The aim of this study was to demonstrate differences incomplementary feeding practices of Mexican toddlers of low-incomefamilies aged 15–24 mo according to age strata and sex.

Methodology: In an analytic cross-sectional study, 211 apparentlyhealthy toddlers aged 15–24 mo of age attending the outpatient clinicof pediatrics at the New Civil Hospital of Guadalajara were included.Feeding practices were evaluated using a questionnaire speciallydesigned for the study which included complementary feeding and


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lactation variables, in addition to a food frequency dietary assessmentand 24-h recall dietary assessment of how much energy and whatmacro- andmicronutrients were obtained. ANOVA, Student’s t test, andthe Mann-Whitney U test were all used, and ORs were obtained.

Results: Of the total sample, 34% were female and 66% were male.Introduction of soft drinks and sweets occurred at ∼12 mo of age. Thenatural water consumed (380 mL/d) was lower than the recommendedintake. Sugar consumption was 6 times higher than recommended. Themean consumption of sweetened beverages was 320 mL/d (5 times aweek), andwas significantly higher inmales than in females (P= 0.014).The frequency of cereal consumptionwas 2.4 times higher inmales thanin females (OR: 2.4; 95% CI: 1.0, 5.6; P= 0.034), and juice consumptionwas also higher in males (OR: 1.9; 95% CI: 0.92, 4.09; P = 0.078).The addition of sugar to foods was frequent (93%). The probability ofenergy intake being<80% of adequacy was 4.4 times higher in toddlersbetween 15 and 18 mo of age than in those in the >18 mo age group(OR: 4.44; 95% CI: 1.4, 14.1; P < 0.007). The percentage of toddlersaged 15–18 mo with fat intake <80% of adequacy was 2.2 times higherthan that of toddlers in the 19–21 mo age group (OR: 2.2; 95% CI: 1.02,4.67; P= 0.043) and 3.3 times higher than inmales aged 22–24mo (OR:3.3; 95% CI: 1.36, 8.29; P< 0.007). Fiber consumption was<80% of therecommended intake in 75% of the population studied.

Conclusions: There are deviations in the complementary feedingpractices of Mexican toddlers aged 15–24 mo of low-income families.The consumption of sugar, sweetened beverages, and sodium areassociated with sex and quarterly age groups.

Funding SourcesNacional Council of Science and Technology (CONACYT).

Nutritional Status and BodyComposition of Low-Income FamilyMexican Toddlers Aged 15–24 mo Differ by Sex and Quarterly AgeGroup (P13-143)

Edgar M Vasquez Garibay,1 Lilia Perales Huerta,2 Alfredo Lar-rosa Haro,2 Enrique Romero Velarde,2 Diana Duarte Martínez,2and Raul Cervantes Medina3


Objective: The aim of this study was to demonstrate differences innutritional status and body composition of Mexican children of low-income families aged 15–24 mo according to age strata and sex.

Methodology: In an analytic cross-sectional study, 211 apparentlyhealthy children aged 15–24 mo attending the outpatient clinic ofpediatrics at the New Civil Hospital of Guadalajara were included.The nutritional status was evaluated by the following anthropometricmeasurements: weight, length, cephalic circumference, midupper armcircumference (MUAC), tricipital skinfold (TSF), and subscapularskinfold (SSF). Weight for age (W/A), length for age (L/E), weightfor length (W/L), and body mass index (BMI) z scores were alsodetermined according to the WHO measurements. ANOVA, Student’st test, and the Mann-Whitney U test were all used, and ORs wereobtained.

Results: Of the total sample, 34% were female and 66% were male.The mean monthly family income was 2.8 times the minimum salary,equivalent to $392. The monthly expenditure on family food was $196

and the expenditure on food per capita per day was $1.33. Weightand cephalic circumference were significantly higher in boys thanin girls (P < 0.015 and P < 0.001, respectively). ANOVA showedsignificant differences by age (15–18, 19–21, and 22–24 mo) in all ofthe anthropometric indicators and indices except MUAC (P < 0.01).The difference in the W/L index was more pronounced in the childrenaged 22–24mo. TheW/A,MUAC, TSF, and SSF differences also becamegradually more pronounced with age. The L/A index showed a greaterdifference in the groups aged 19–24 mo. Acute malnutrition (W/L andBMI <-2z) was more frequent in girls than in boys (OR: 3.02; 95%CI: 1.03, 8.9; P = 0.036 and OR: 3.47; 95% CI: 0.98, 12.30; P = 0.042,respectively). There were a 2.8 times greater probability of overweight(subscapular skinfold >2z) in girls than in boys (OR: 2.8; 95% CI: 1.07,7.31; P= 0.03). The BMI deficit (<–1z vs≥–1z) was higher in childrenaged 22–24 mo than in those aged <22 mo (OR: 2.08; 95% CI: 0.99,4.34; P= 0.049). The L/A>1z vs. 18 mo (OR: 3.95; 95% IC: 1.04, 15.06;P = 0.032).

Conclusions: There are significant differences in the anthropomet-ric and fat reserve indicators in Mexican toddlers aged 15–24 mo whenthey are stratified by sex and quarterly age periods. It is probable thattoddlers belonging to families of low socioeconomic status show thegreatest effects of nutritional status as age advances.

Funding SourcesNacional Council of Science and Technology (CONACYT).

Costing a Maternity Leave Cash Transfer to Support Breastfeed-ing among Informally Employed MexicanWomen (P13-144)

Mireya VIlar-Compte,1 Graciela Teruel,2 Diana Flores,2 Grace J.Carroll,3 Gabriela Buccini,3 Rafael Perez-Escamilla,3

1EQUIDE, Universidad Iberoamericana, Mexico; 2UniversidadIberoamericana, Mexico; and 3Yale School of Public Health, CT

Objective: Breastfeeding is in need of strong support in Mexico,where maternity leave is only available for women working in theformal sector (12 fully paid weeks). However, among economicallyactive women, more than half work in the informal sector. The presentresearch aimed to estimate the costs associated with the introductionof a maternity leave cash transfer for working women in the informalsector, an essential step for supporting breastfeeding in Mexico.

Methods: The cost estimation is based on: 1) the size of the cashtransfer, 2) the duration of maternity leave, 3) the probability of awoman working in the informal sector having a child, considering herage, education level, and region, 4) the actual population of womenbetween 18 and 49 y of age working in the informal sector, and 5)the administrative costs of establishing the program. Estimations werecomputed using the National Survey of Demographic Dynamics, theNational Occupation and Employment Survey, and administrative data.The cash transfer was operationalized in 3 ways: two-thirds of theminimum wage, two-thirds of the food and nonfood basket, and thecomplete food and nonfood basket. Estimations were performed formaternity leave durations of 12 wk (the equivalent of formal workers’maternity leave), 14 wk (the International Labour Organization’srecommendation), 16 wk (what is being discussed by stakeholders inMexico), and 26 wk (the exclusive breastfeeding period recommendedby the WHO).


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Results: Establishing the cash transfer for informal workers’ mater-nity leave for 12 wk ranges between $73 million and $130 million peryear, and each additional week costs from $6 million to $10 million(depending on the size of the cash transfer and including administrativecosts of $892,000). Hence, for 14, 16, and 26 wk, the costs are $85–151million, $97–173 million, and $158–280 million, respectively. The percapita monthly cash transfers would range between $78 and $157.

Conclusions: Supporting maternity leave among informal workersis an important step to protect breastfeeding, as their economicpressures and lack of income security do not allow mothers to reducetheir workload after childbirth. The additional cash transfer needed isaffordable for Mexico’s social protection system.

Funding SourcesFunded by the Family Larsson-Rosenquist Foundation.

Caregiver’s Underestimation of Child Nutritional Status Is Asso-ciated with Authoritarian Feeding (P13-145)

Marcela C Vizcarra,1 María José Stecher,2 Nicole Fermandois,3Liliana Aguayo,1 and Andiara Schwingel1

1University of Illinois at Urbana-Champaign; 2JUNJI, Chile; and3Hospital Clínico, Universidad de Chile

Objectives:Underestimation of child weight status (CWS) can affectchild-caregiver interactions in feeding contexts, which may furtherimpact children’s developing eating habits. This study’s objectives wereto 1) examine caregivers’ perceptions of the weight status of childrenbetween 3 and 5 y old, and 2) investigate whether these perceptions areassociated with caregivers’ feeding styles (FS) in Chile.

Methods: In 2017, 87 caregiver-child dyads were recruited from7 child care settings serving low- and middle-income families in

Santiago, Chile. Data collection included caregiver questionnaires, andweight and height was measured for both children and caregivers. TheCaregiver Feeding Style Questionnaire was used to categorize FS (per-missive: authoritative and authoritarian; nonpermissive: indulgent anduninvolved); parents indicated their perceptions of CWS (underweight,normal, overweight, and obese). For actual CWS, children’s weight andheight were compared with the 2006 WHO Child Growth Standard.

Agreement between actual and perceived CWS by sex was comparedthrough chi-square tests. A logistic regression was conducted toascertain the association between caregiver’s perception of CWS(independent variable) and permissive or nonpermissive FS (dependentvariable). The significance level was set to 0.05 in the statistical analyses.

Results: Almost half of the children had normal weight status(48.3%), 35.6% were overweight, and 15.4% were obese. The agreementbetween the actual and perceived CWS was 52.9%. Caregivers under-estimated CWS (46.9%). There were no caregivers who overestimatedCWS. Agreement between actual and perceived CWS by sex was notsignificant (P = 0.82). Caregivers who underestimated CWS were 4.7times more likely to have permissive FS (OR: 4.7; 95% CI: 1.6, 13.2;P < 0.05).

Conclusions: The underestimation of CWS was highly prevalentamong caregivers and was linked to permissive patterns of feeding. Thisresearch is a vital preliminary exploration for further understandingof modifiable cultural factors associated with feeding practices andCWS, which may impact developing eating habits and weight-relatedoutcomes in the crucial stage of early childhood.

Funding SourcesTinker Fellowship granted by CLACS UIUC.

TABLE P13-145-1


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TABLE P13-145-2

Effect of Maternal Vitamin D Status on Sphingolipid Composi-tion in Milk Fat Globule Membranes (P13-146)

Carol L Wagner, John Baatz, and Danforth Newton

Medical University of South Carolina

Background: Signaling proteins are associated with sphingolipid-rich microdomains on membranes, and both the proteins and sphin-golipids and/or metabolites are involved in immunity, inflammation,cell differentiation, and several other protective signaling cascades. Pre-vious studies have shown that diet affects the sphingolipid compositionin milk fat globule membranes (MFGM).

Objective: Since sphingolipid [sphingomyelin (SM) and ceramide(Cer)] composition inMFGMhas been shown to be affected by diet, theaimof this studywas to test the hypothesis that SMandCer compositionis also dependent upon maternal vitamin D status, as measured bymaternal blood hydroxyvitamin D [25(OH)D].

Methods:Whole breast milk samples were obtained from 8mothersfrom 1 to 4 mo postpartum. LC-MS was used to analyze long chain(C14-C18) and very long chain (C20-C26) acyl SM species normalizedto total milk lipid inorganic phosphate.

Results: Analysis of LC-MS data revealed that concentrations ofvery long chain sphingomyelin species (C22-SM, C24-SM, and C24:1-SM) increased dramatically with increasing maternal 25(OH)D, withother species (C14, C20, and C26-SM) being in very low concentrationsindependent of vitamin D. Similar results were found for C22-Cer andC24-Cer (data not shown).

Conclusions: The findings are consistent with previous reports inother cells and organs that vitamin D regulates sphingolipid synthesisvia vitamin D receptor-responsive genes affecting MFGM sphingolipidcomposition, especially sphingomyelin and ceramide.

Funding SourcesFunded by SC Translational Research Center UL1 TR000062 and

MUSC Children’s Hospital.

FIGURE P13-146-1 Dependence of Milk Fat SphinggomyelinAcyl Chain Length on Maternal 25(OH)D Concentration.Abundance of very long chain sphngomyelin species (C22- &C24-M) in milk increases with increasing maternal blood 25OHDconcentrations.

MilkFatGlobuleMembrane andAdjusted Iron in Infant FormulaSupports Growth and Normal Iron Status at 1 y (P13-147)

Kelly R Walsh,1 Michael Yeiser,2 Cheryl L Harris,1 Jennifer LWampler,1 and Steven Wu1

1Mead Johnson Nutrition; and 2Owensboro Pediatrics

Objective: The aim of this study was to evaluate growth andiron status in infants receiving cow’s milk–based formula with whey


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protein–lipid concentrate [5 g/L, a source of milk fat globule membrane(MFGM)] and adjusted iron.

Methods: The American Academy of Pediatrics (AAP) 2010guidelines recommend iron status evaluation at 12 mo of age. Inthis multicenter, double-blind, controlled, parallel, prospective study,infants were randomized to receive 1 of 2 formulas through 365 d ofage: marketed infant formula (iron, 1.8 mg/100 kcal; control: n, 191)or investigational formula (iron, 1.2 mg/100 kcal and whey protein–lipid concentrate, 5 g/L; INV-MFGM: n, 182). Blood markers of ironstatus were evaluated at day 365 (control: n, 141; INV-MFGM: n, 127).Hemoglobin (Hb) and hematocrit (Hct) measured the adequacy of thered cell mass; serum ferritin (SF) indicated the relative body iron stores.Per protocol, values were compared with local laboratory referenceranges. Post hoc analysis included comparison to the AAP 2010guidelines. Growth rates through 120 d and achieved anthropometricsthrough 365 d of age were analyzed by gender using ANOVA.

Results:No significant group differenceswere detected inHborHct.SF was significantly higher in the control, although similar proportionsof participants (≥84%) in both groups fell within the laboratoryreference ranges for all 3 markers. No significant group differencewas detected using the AAP 2010 Hb cutoff for anemia evaluation(≥11.0 g/dL) (control, 91%; INV-MFGM, 87%). No significant groupdifferences were detected for growth rates from 14 to 120 d of age.With the exception of weight in female infants at day 365, no significantgroup differences were detected for mean achieved anthropometrics bygender (all study time points).Mean achievedweight remained betweenthe 25th and 75th reference percentiles of the WHO growth standardthrough day 180 and tracked near the 75th through day 365 for femaleinfants in the control group; all other group means plotted within the25th and 75th percentiles (all study time points).

Conclusions: MFGM and adjusted iron (1.2 mg/100 kcal) in aroutine cow’s milk–based infant formula supported normal growth andiron status in healthy infants at 12 mo of age, with no increased riskfor anemia as determined using laboratory references or the AAP 2010guidelines.

Funding SourcesMead Johnson Nutrition.

Long-Term Effects of Preschool Fruit Juice Consumption onAdolescent Diet Quality: The Framingham Children’s Study (P13-148)

LiWan, Phani Jakkilinki,MarthaR Singer, LoringMBradlee, andLynn L Moore

Boston University School of Medicine, MA

Objective: To determine whether preschool fruit juice consumptionhas beneficial effects on later whole fruit intake and overall diet qualitythroughout childhood, we investigated the association between 100%fruit juice intake among 3- to 6-y-old children and whole fruit intakeat 14–18 y of age, as well as scores on the Healthy Eating Index (HEI)and the likelihood of meeting USDADietary Guidelines for fruit intakeduring adolescence.

Methods: We used data from children initially enrolled in theFramingham Children’s Study at 3–6 y of age who were subsequentlyfollowed for 10 y. Dietary data were collected repeatedly each year usingmultiple sets of 3-d diet records. Diet quality was estimated based on the

2015–2020 Dietary Guidelines for Americans and the associated HEI.Mixed linear regression and logistic regression models were used forstatistical analyses.

Results: Children who drank ≥1.0 cup of 100% fruit juice per day(vs. <0.5 cups/d) during preschool (3–6 y) consumed 0.9 cups/d moretotal fruit (P< 0.0001) and 0.5 cups/d more whole fruit (P< 0.0001) at14–18 y of age; HEI scores during adolescence for those with the highestpreschool juice intakes were almost 6 units higher than those with thelowest fruit juice intakes (P = 0.0044). Preschoolers consuming <0.5cups/d of fruit juice had sharply decliningwhole fruit intake throughoutchildhood compared with those preschoolers consuming ≥1.0 cups/d,who had stable intakes of whole fruit throughout childhood. Finally,those children who consumed ≥0.75 cups/d of fruit juice duringpreschool (vs.<0.75 cups/d) were 3.8 times as likely tomeet theDietaryGuidelines for whole fruit intake during early adolescence (P < 0.05).

Conclusions: In this study, consumption of 100% fruit juice duringpreschool was associated with beneficial effects on diet quality in laterchildhood. Further, children who consumed more fruit juice duringpreschool were more likely to consume whole fruit during adolescence.

Funding SourcesJuice Products Association.

Effect of Gestational Diabetes on Physical Development ofNeonates (P13-149)

Ling Wang,1 Weifeng Dou,1 Nana Li,2 Weixiang Wang,3 andYanhua Liu4

1Zhengzhou University, China; 2Zhengzhou Central Hospital ofHenan Province, China; 2Renmin Hospital of Henan Province, China;and 4First Affiliated Hospital of Zhengzhou University, China

Objective: The aim of this study was to explore the effects ofprepregnancy body mass index (BMI), gestational weight gain (GWG),and concentrations of the maternal blood lipids, vaspin, and visfatin onthe physical development of neonates of mothers who had experiencedgestational diabetes mellitus (GDM).

Methods: Prepregnant body weight and GWGwere recorded in thesubjects who delivered in a local hospital (96 GDM and 131 controlpregnancy women). Their blood samples were drawn for quantificationof lipid profiles, vaspin, and visfatin. A range of physical measurements(weight, height, head circumference, and chest circumference) of theneonates were recorded. The association of maternal prepregnant BMI,GWG, blood lipids, vaspin, and visfatin with the physical developmentof neonates was analyzed.

Results: The birth weight and circumferences of chest and head inthe GDM group were larger than that in the control group (Pmacroso-mia (OR: 2.307; 95%CI: 1.470, 3.622). Prepregnant overweight or obesewomen had a high risk of delivering a child with macrosomia (OR:1.956; 95% CI: 1.145, 3.342). The birth weight of neonates was lowerin the low GWG group than in the high GWG group (P > 0.05).

Conclusions: GDM and prepregnant overweight or obesity are riskfactors for macrosomia, but they have no effect on neonatal body lengthand head circumference. Maternal lipid profile, and serum vaspin andvisfatin have no effect on birth weight, length, or circumference of headin neonates exposed to GDM or not.

Funding SourcesScience and technology research project of Henan Province, China.


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Effects of Dietary Milk Oligosaccharides on the Gut MicrobiotaComposition in Neonatal Piglets (P13-150)

Mei Wang,1 Marcia Monaco,1 Jian Yan,2 Ryan Dilger,1 andSharon M Donovan1

1University of Illinois; and 2Nestlé Nutrition R&D

Objective: Milk is a source of glycans that shape the newborn’sgutmicrobiome. Bovinemilk-derived oligosaccharides (BMOs) containsome oligosaccharides structurally identical to the ones of humanmilk,but lack most that are specific for humans (HMOs). The aim of thisstudy was to assess the effects of BMOs, HMOs [2′-fucosyllactose (2′-FL) and lacto-N-neotetraose (LNnT)], and a combination of BMOs andHMOs on piglet gut microbiota composition.

Methods: Piglets, 2 d old (n = 44), were randomized to 4 diets:control (CON; Purina ProNurse), BMOs (CON + 6.5 g/L BMOs),HMOs (CON + 1.0 g/L 2′-FL + 0.5 g/L LNnT), or HMOs + BMOs(CON + 6.5 g/L BMOs + 1.0 g/L 2′-FL + 0.5 g/L LNnT). On postnatalday 34, ascending colon (AC) contents and feces were collected and thegut microbiota was assessed by 16S rRNA sequencing. The microbiotacomposition was analyzed by distance-based redundancy analysis (db-RDA), and the relative abundances of bacterial genera were comparedby 2-way ANOVA.

Results: BMOs and HMOs + BMOs affected the overall microbiotacomposition in feces (db-RDA, P = 0.008). Relative abundancesof Escherichia, Megasphaera, and Acidaminococcus were higher andOscillospira and Ruminococcus were lower (P < 0.05) in feces ofpiglets fed BMOs-containing diets. In AC, BMOs-containing diets(BMOs, HMOs + BMOs) lowered abundances of Dorea, Eubacterium,Peptococcus, Lactococcus, and Desulfovibrio compared with piglets thatconsumed a diet without BMOs. Diets with HMOs did not affect theoverall bacterial communities, but they did decrease the proportions ofCoprococcus in AC regardless of the presence of BMOs. In AC, Blautiawas higher (P < 0.05) in the HMOs group than in all the other groups.Fecal Bacteroides were highest in the HMOs+ BMOs group and lowestin the HMOs group.

Conclusions: Supplementation with 6.5 g/L BMOs alone or incombination with HMOs affected the overall fecal microbiota com-position in the piglet model, whereas 1.5 g/L HMOs alone increasedthe relative proportion of specific taxa like Blautia, the second mostabundant genus. Ongoing analyses are exploring possible associationswith phenotypes.


Effects of Dietary Oligofructose Alone or in Combination with2′-Fucosyllactose on theComposition ofGutMicrobiota inNeonatalPiglets (P13-151)

Mei Wang,1 Marcia Monaco,1 Jian Yan,2 Ryan Dilger,1 andSharon M Donovan1

1University of Illinois; and 2Nestlé Nutrition R&D

Objective: Human milk contains a complex mixture of oligosac-charides (HMOs). Prebiotics are known to modulate gut microbiotacomposition, whereas HMOs are hypothesized to exert more specific

effects. The aim of this study was to assess the impact of dietary 2′-fucosyllactose (2′-FL), a predominant HMO, in combination with pre-biotic oligofructose (OF) on neonatal pig gut microbiota composition.

Methods: Piglets, 2 d old (n = 33), were randomized to 3 diets:control (CON; 0 g/L OF + 0 g/L 2′-FL, Purina ProNurse), OF (CON +5 g/L OF), or OF + 2′-FL (CON + 5 g/L OF + 1. 0 g/L 2′-FL).On postnatal day 34, ascending colon (AC) contents and feces werecollected and the gut microbiota was assessed by 16S rRNA genesequencing and real-time polymerase chain reaction (PCR). Theoverall composition of the microbiota was analyzed by principalcoordinate analysis (PCoA) and distance-based redundancy analysis(db-RDA). The relative abundances of bacterial genera and real-timePCR data were compared by one-way ANOVA.

Results: The overall microbiota of the CON group differed fromthat of the OF and OF + 2′-FL groups in both AC and feces (PCoAand dbRDA, P < 0.05). In AC, the CON group had higher relativeabundances of Lactococcus and Streptococcus, but lower proportions ofBlautia, Acidominococcus, andMegasphaera, than the OF and OF + 2′-FL groups. In feces, the proportions of Bacteroides and Oscillospirawere higher, but Acidaminococcus and Megasphaera were lower, in theCON group than in the OF and OF + 2′-FL groups. OF and OF + 2′-FL piglets had similar overall microbial composition in both AC andfeces (P = 0.98 and P = 0.99, respectively). However, OF + 2′-FLpiglets harbored lower (P < 0.05) abundances of Anaerotruncus andButyricicoccus in feces than OF piglets. Real-time PCR showed thatOF and OF + 2′-FL led to higher numbers of Bifidobacterium andlower prevalence of Bacteroides fragilis in feces compared with CON.In AC, abundances of Bifidobacterium were lowest in the CON group,intermediate in the OF group and highest in the OF + 2′-FL group(P < 0.05).

Conclusions: A specific effect of 2′-FL to increase the proportion ofBifidobacterium was observed in AC, whereas it had a minor effect onoverall microbiota composition. Supplementation of OF or OF + 2′-FLto a CONdietmodulated the overall microbiota composition of AC andfeces of piglets.


Maternal Plasma Folate and Childhood Asthma in a ProspectiveBirth Cohort (P13-152)

YouWang,1 Xiumei Hong,2 Xiaobin Wang,2 and Hui-Ju Cai3

1Johns Hopkins University, MD; 2Johns Hopkins Bloomberg Schoolof Public Health, MD; and 3National Health Research Institutes

Objective: Previous studies on the relations between maternalfolate concentration during pregnancy and childhood asthma risk areinconclusive. It is possible that the folate-asthma relations may bemodified by other known risk factors of asthma, which were notexplored in the previous studies. The aim of this study was to examinethe associations of maternal plasma folate concentration with risk forchildhood asthma in a prospective cohort, and explore whether theserelations varied by maternal history of asthma and/or prematurity.

Methods: This study included 1932 children from the BostonBirth Cohort, who have been followed since birth. Childhood asthmawas defined based on physician diagnosis. Maternal plasma folateconcentration at delivery was measured by chemiluminescent


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immunoassay. Low maternal folate concentration was defined as<13.5 nmol/L (the WHO’s recommended cutoff point). Logistic re-gressionmodels were applied to examine associations betweenmaternalfolate and childhood asthma, adjusting for pertinent covariates.

Results:Themean age of the study children at the last follow-up was7.3 ± 3.7 y. About 486 children (25.2%) had asthma. About 10.4% ofmothers had low folate and 14.7% had a history of asthma. Maternalfolate concentration had no association with childhood asthma inthe total sample. When stratified by maternal history of asthma, anL-shaped association between maternal folate concentration and risk ofchild asthma was observed in children with maternal history of asthmabut not in those without. In children with maternal history of asthma,low maternal folate concentration was associated with a 2.3 times(95% CI: 1.05, 4.90) higher risk of childhood asthma. Maternal folateconcentration and maternal history of asthma significantly interacted

to affect the risk for childhood asthma (P = 0.027 for interaction), andthe highest risk was found in children having maternal asthma historyand low maternal folate concentration (OR: 6.36; 95% CI: 3.09, 13.10)compared with children without maternal history and having highmaternal folate concentration. Similar findings were observed amongchildren born at term.

Conclusions: Low maternal folate concentration was associatedwith an increased risk of childhood asthma only in children with amaternal history of asthma.

Funding SourcesThis work on the Boston Birth Cohort was supported in part by

the March of Dimes PERI under grants 20-FY02-56 and 21-FY07-605, and by the NIH under grants R21HD066471, R21HD085556,R01HD086013, and 2R01HD041702.


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FIGURE P13-152-1 Smoothing plot for the probability of having childhood asthma with maternal plasma folate levels at delivery in thetotal sample (Fig 1a), stratified by maternal asthma history in the total sample (Fig 1b) and in the term birth subset (Fig 1c).

FIGURE P13-152-2 Odd ratios of having childhood asthma in children stratified by maternal history of asthma and maternal folate levelsin the total sample (Fig 2a), and in the term birth subset (Fig 2b). The maternal asthma history and low maternal folate status of thesamples are indicated by 0 (No) and 1 (Yes). P-value < 0.001 in the joint analysis is indicated by ***.


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Nutrient Assessment in Children with Autism Spectrum Disor-der inFlorida andComparisonswithNationallyRepresentativeData(P13-153)

Acadia Webber, Heewon Gray, Chantell Robinson, and BiancaAnuforo

University of South Florida

Objective:Children with autism spectrum disorder (ASD) are morelikely to develop unhealthy eating patterns and become overweight orobese. The prevention of obesity in these children is a pressing publichealth issue, with implications for health status, independent living, andquality of life. The purpose of this preliminary study was to assess thedietary intakes of children with ASD in Florida communities to findpotential areas to target for intervention.

Methods: A cross-sectional analysis of dietary intake of 33 childrenaged 2–17 y with ASD living in Florida was conducted. A 24-h recalltelephone call was performed with a parent of each child to estimateenergy, nutrient, and food item intake. Data were entered into ESHAFood Processor software, and energy, and macro- and micronutrientoutcomes were generated. Food intake was categorized based on USDArecommendations and was compared with nationally representativeNHANES data (2007–2010)matched by age range. Descriptive statistics(e.g., mean, frequency, and percentage) were used, using SPSS. One-sample t tests and chi-square tests were performed to compare meansand proportions, respectively.

Results: The mean age was 8.02 y, and 73.9% of the sample wasmale. The majority of children met or exceeded recommendationsfor energy intake, and mean energy and macronutrient intakes didnot differ from the matched NHANES data. Mean intakes of folate,choline, calcium, and potassium were significantly lower than those oftypically developing children (P < 0.05). The percentage of the samplebelow USDA MyPlate food group recommendations was 43.5% forfruit, 87.0% for vegetables, 56.5% for grains, and 82.6% for dairy. Fruitintake was significantly higher (mean 2.23 vs. 1.16 servings/d) and grainintake was lower (4.87 vs. 5.95 servings/d; 56.5% vs. 21.9% of samplebelow USDA recommendations) in children with ASD than in typicallydeveloping children (P < 0.05).

Conclusions: Findings from this preliminary study suggest thatchildren with ASD may be at higher risk for low intake of certainmicronutrients than typically developing children. The results suggestthat there is room for intervention to increase fruit, vegetables, grains,and dairy in children with ASD in Florida communities.

Funding SourcesUniversity of South Florida, New Researcher Grant.

Classifying Pregnancy Weight Gain Trajectories in AfricanAmerican and Dominican Women from Northern Manhattan andthe South Bronx (P13-154)

Elizabeth M Widen,1 Ciara Nugent,1 Michael J Daniels,2 RadekBukowski,3 and Andrew G Rundle4

1University of Texas at Austin; 2University of Florida; 3Dell MedicalSchool, University of Texas at Austin; and 4Columbia University, NY

Objective: Pregnancy weight gain trajectories are potentially mod-ifiable, and may reflect the uterine milieu and nutrient availabilityto support fetal growth; however, evaluating weight gain over timeis challenging to implement and interpret in practice. We soughtto describe pregnancy weight gain trajectories with semi-parametricmethods.

Methods: Data are from a prospective cohort (n = 492) ofAfrican American (45.9%) and Dominican (54.1%) women fromNorthern Manhattan and the South Bronx enrolled during the thirdtrimester from 1998 to 2006. Prepregnancy weight was self-reported,and pregnancy weight data was abstracted from participant medicalcharts. In women with >3 observations, we fit a latent-class trajectorymodel with splines and individual random slopes; prepregnancybody mass index was used to predict class membership. Rates foreach class by trimester were calculated by predicting weight gainfor each latent class, and fitting a linear regression on the sets oftrimester predictions.

Results:Before pregnancy, 50.6%of thewomenwere normalweight,22.8% overweight, 21.5% obese, and 5.1% underweight. Overall, 5distinct trajectory classes were identified. Almost half of the women(49.8%) were in the LowSteady group, with gains of 0.6 lb/wk in the firsttrimester, 1.4 lb/wk in the second trimester, and 1.1 lb/wk in the thirdtrimester. About a quarter of women (28.0%) were in the SteadyGaingroup, with steady weight gain across pregnancy (1.2 lb/wk in the firsttrimester, 0.9 lb/wk in the second trimester, and 0.7 lb/wk in the thirdtrimester). About 9.8% of women were in the LossSteadyHigh group,with loss of 0.3 lb/wk in the first trimester, but gains of 1.7 and 2.4 lb/wkin the second and third trimesters, respectively. The HighLowSteadygroup (10.0%) showed gains of 2.4 lb/wk in the first trimester, 0.6 lb/wkin the second trimester, and 0.9 lb/wk in the third trimester. Only afew women (2.4%) were in the HighStableSteady group, with a veryhigh initial gain and then a minimal gain in the second trimester, anda 0.8 lb/wk gain in the third trimester.

Conclusions:Our results suggest that semiparametric methods canoffer amore nuanced understanding of pregnancy weight trajectories tosupport clinical management of pregnancy weight gain and evidence-based guidelines.

Funding SourcesK99HD086304.


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FIGURE P13-154-1 Class specific predicted mean trajectories

Association between Breastmilk and Infant Total BloodMercuryand Related Heavy Metal Concentrations (P13-155)

Amaris Williams and Tom Brenna

Dell Medical School at the University of Texas

Objective: To optimize infant cognitive development, pregnant andlactating women are advised to consume seafood to support adequatebreastmilk docosahexaenoic acid (DHA), but are also cautioned againstmercury contamination. The upper reference limit is set to 9 ug/L bloodmercury. Our goal was to use NHANES data to investigate dietaryand demographic factors that are associated with total blood mercuryconcentrations in 1-y-old infants.

Methods: NHANES data (1999–2014) on blood mercury, lead,cadmium, and diet, including breastfeeding, were analyzed using R.Weightings provided for data collected in the mobile examinationcenters were used to adjust for the intentional oversampling of selectedgroups. Final means and confidence limits represent true populationparameters.

Results: Infants, 1 y old, reported to have consumed breast milkin the 24-h recall portion of the NHANES [n = 70, unweighted; 0.71µg Hg/L (95% CI: 0.47, 0.95)] have higher total blood mercury thaninfants that were not reported to have consumed any human milk[n = 1225, unweighted; 0.43 µg/L (95% CI: 0.41, 0.45), P = 0.029].

Infants who consumed seafood [n = 612, unweighted; 0.56 µg/L(95% CI: 0.48, 0.63)] had higher total blood mercury than those thatdid not [n = 672, unweighted; 0.34 µg/L (95% CI: 0.31, 0.38), P = 7 ×10–7].

Lead, but not cadmium, trends in a similar way to these findings forbreastmilk, but not for seafood consumption.

AfricanAmericans have the greatest blood lead, whereas the “Other”category, including all ethnicities excluding whites, African American,and Latino, had the highest blood mercury. Blood lead decreases withincreasing income across all groups.

Conclusions: Breastfeeding and seafood consumption were bothassociated with greater total blood mercury in infants, but are an orderof magnitude below the upper limit. Many studies agree that bothpractices are beneficial to infant health and neural development. Lac-tating women do not meet recommendations for seafood consumption.Despite the mercury content of seafood, increasing maternal seafoodconsumption to recommended levels is unlikely to increase infant bloodmercury or Pb to harmful levels.

Funding SourcesCornell University Department of Nutrition Sciences.

Associations betweenMaternal Consumption of Energy-YieldingNutrients and Oligosaccharides in Milk Produced by Healthy,BreastfeedingWomen (P13-156)

Janet E Williams,1 Caroline Nissan,2 Mara York,3 Sarah LBrooker,1 Lars Bode,2 MarkMcGuire,1 andMichelle KMcGuire3

1University of Idaho; 2University of California, San Diego; and3Washington State University

Objective: Recent studies indicate that both environment andgenetics play roles in structuring human milk oligosaccharide (HMO)composition, and maternal nutritional status might be important in


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this regard. The primary goal of this investigation was to examinerelations between maternal consumption of energy-yielding nutrientsand concentrations of HMOs. Based on previous work suggestingrelations between maternal body mass index or body weight andvarious HMOs, we hypothesized that chronic maternal energy intakewould be positively correlated with 2′-fucosyllactose (2′-FL) and lacto-N-fucopentaose (LNFP) III, and negatively correlated with lacto-N-neotetraose (LNnT) and disialyllacto-N-tetraose (DSLNT). The aim ofthis study was to test that hypothesis.

Methods: Chronic maternal dietary intake was estimated byaveraging values obtained from 24-h diet recalls collected from 12healthy breastfeeding women at 9 time points between day 2 and6 mo postpartum. Similarly, HMO concentrations (analyzed by HPLC)were averaged across the same time points. Spearman rank correlationsbetween dietary and HMO values were then calculated.

Results: Our data did not support the hypothesized associationsbetween chronic energy intake and 2′-FL, LNFP III, and DSLNT (rs = –0.27, 0.46, 0.42; P = 0.39, 0.13, 0.17, respectively). Also, contrary to ourhypothesis, energy consumption was positively associated with LnNT(rs = 0.73; P = 0.007). Several other noteworthy associations weredetected, including positive relations between energy consumption andconcentrations of lacto-N-tetraose, LNFP II, and LS-tetrasaccharide b(rs = 0.70, 0.64, 0.75; P = 0.01, 0.02, 0.004, respectively). Additionally,LNFP II concentration was positively associated with intakes of protein(rs = 0.83; P = 0.0007), various fatty acids (e.g., oleic acid, linolenicacid, and arachidonic acid; rs = 0.69, 0.65, 0.69; P = 0.01, 0.02,0.02, respectively), and both mono- and polyunsaturated fatty acids(rs = 0.84, 0.72; P = 0.005, 0.008, respectively).

Conclusions: These results provide preliminary evidence thatmaternal dietary intakemay play a role inmodulatingHMO concentra-tions. Understanding themechanismswherebymaternal diet influencesHMO composition is important, as variation in the HMO profile hasbeen linked to infant health outcomes.

Funding SourcesSupported by the Bill &MelindaGates Foundation, National Science

Foundation grant IOS 1,344,288, and NIH grant P30 GM103324.

Dietary Patterns Affect the Fatty Acid Profile of Breast Milk inLactating Chinese Mothers (P13-157)

Lin Xie,1 Huimin Tian,1 Yixia Wu,1 Yiqi Lin,2 Xueyan Chen,1Miao Yu,1 Tong Lu,1 Yan Wang,1 and Wenhui Xu1

1School of Public Health, Jilin University, China; and 2Jilin Womenand Children Health Hospital, China

Objective: Fatty acids (FAs) contained in human milk play animportant role in meeting the nutritional demands and promoting thegrowth and development of breastfeeding infants. Breast milk FAs aresensitive to maternal dietary habits, and dietary patterns are better usedto explain the effect of diet on FAs. Few studies have examined theassociation between maternal dietary patterns and the FA componentsof breast milk in developing countries. In this study, we aimed todetermine whether dietary patterns could affect the FA profile of breastmilk in lactating Chinese mothers, with the overall goal of optimizingthe management of infant feeding.

Methods: A total of 274 lactating women, ranging from 22 d to6 mo postpartum, were included in this study, and samples of their

breast milk were collected together with completed questionnaires.Using principal component analysis, 4 dietary patterns were identifiedin a rotated componentmatrix. FA profiles were detected using capillarygas chromatography and presented as the percentage by weight of totalFAs.

Results: The different dietary patterns showed differences in thematernal intake of energy, carbohydrates, and proteins. In addition,there were significant differences in the total proportions of saturatedFAs, polyunsaturated FAs (PUFAs), and n–6 (ω-6) PUFAs in breastmilkamong the 4 patterns (P < 0.001, P = 0.025, P = 0.038).

Conclusions: The results demonstrate that maternal dietary pat-terns can affect macronutrient intake levels and milk FA profilesin lactating Chinese women. These results are of great significancefor understanding how maternal diet may improve both maternalmacronutrient intake and the FA nutritional status of breast milk.

Funding SourcesThis study is supported by The Health and Family Planning

Commission of Jilin Province, Grant No. 2016J077.Concentration of Lactoferrin in Human Milk in Different Chi-

nese Populations (P13-158)

Zhenyu Yang,1 Rulan Jiang,2 Qi Chen,3 Jie Wang,1 Yifan Duan,1Xuehong Pang,1 Shan Jiang,1 Ye Bi,1 Huanmei Zhang,1 XiaolinYuan,1 Lönnerdal Bo,2 Jianqiang Lai,1 and Shian Yin1

1National Institute for Nutrition and Health, China CDC;2University of California, Davis; and 3Hangzhou Tclab ClinicalLaboratory Co., Ltd

Objectives: Lactoferrin (Lf) is a multifunctional protein and thesecond most abundant protein in human milk. Maternal factors suchas ethnicity, diet, and stage of lactation may affect its concentration inhuman milk. The objectives of the present study were to examine thedynamic change in milk Lf concentrations throughout the course oflactation and explore factors associated with those concentrations invarious Chinese populations.

Methods: This was a part of a large cross-sectional study conductedin 11 provinces, autonomous regions, and municipalities (Beijing,Gansu,Guangdong,Guangxi,Heilongjiang, InnerMongolia, Shandong,Shanghai, Xinjiang, Yunnan, and Zhejiang) across China between 2011and 2013. Lactating women (n = 6481) within 0–330 d postpartumwere recruited in the original study. A subsample of 824 women wasrandomly selected and milk Lf concentrations were determined byultrahigh-performance liquid chromatography /MS.

Results: The median Lf concentration in milk from women deliver-ing at term was 3.16, 1.73, and 0.90 g/L for colostrum, transitional milk,and mature milk, respectively. Lf concentrations differed significantlybetween periods of lactation (colostrumvs. transitionalmilk, colostrumvs. mature milk, transitional milk vs. mature milk, all P < 0.001).Maternal body mass index, age, mode of delivery, parturition, proteinintake, and serum albumin concentration were not correlated to milkLf concentration. However, milk Lf concentration may vary amongdifferent geographical regions (Guangdong vs. Heilongjiang: 1.91 vs.1.44 g/L, P = 0.037; Guangdong vs. Gansu: 1.91 vs. 1.43 g/L P = 0.041)and ethnicities (Dai vs. Tibetan: 1.8 vs. 0.99 g/L, P = 0.007; Han vs.Tibetan: 1.62 vs. 0.99 g/L, P = 0.002) in China.

Conclusions: The concentration of Lf in human milk changesdynamically throughout lactation. Few maternal characteristics affect


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the milk Lf concentration, but milk Lf concentration may vary acrossdifferent regions and ethnicities in China.

Funding SourcesThis study was partially funded by the National High Technology

Research and Development Program of China (863 Program) (No.2010AA023004).

Diet Quality during Pregnancy and Fetal Growth: A MultiracialPregnancy Cohort Study (P13-159)

Yeyi Zhu, Monique Hedderson, Sneha Sridhar, Juanran Feng, FeiXu, and Assiamira Ferrara

Kaiser Permanente Northern California Division of Research

Objective: Emerging evidence suggests that nutritional perturba-tions during pregnancymay impact fetal growth and disease risk in laterlife, although with inconsistent data on individual foods or nutrients.Data on overall dietary quality during pregnancy in relation to fetalgrowth are limited.We aimed to investigate the prospective associationsof Healthy Eating Index-2010 (HEI-2010) scores during pregnancy,based on adherence to the USDA Dietary Guidelines for Americans,with birthweight z score and risk of small for gestational age (SGA) andlarge for gestational age (LGA).

Methods: In a prospective cohort of 2107 singleton pregnanciesin the Pregnancy Environment and Lifestyle Study, maternal dietaryintake during the past 3 mo was assessed by a food frequency ques-tionnaire during early pregnancy (gestational weeks 10–13). Offspring

birthweight and gestational age at delivery were obtained frommedicalrecords. Size for gestational age was categorized according to gestationalage, sex, and racial or ethnic specific birthweight distribution in theunderlying population. Linear regression and Poisson regression withrobust standard errors were used, adjusting for major risk factors.

Results:Total HEI-2010 score ranged from37.5 to 94.2 (mean± SD:71.2 ± 10.0). After adjusting for covariates, HEI-2010 score wassignificantly and inversely associated with birthweight z score (βcomparing the highest vs. lowest quartile: –0.14; 95% CI: –0.25, –0.02).Consistently, HEI-2010 score comparing the highest vs. lowest quartilewas associated with a 45% decreased risk of LGA [adjusted relativerisk (aRR): 0.55; 95% CI: 0.32, 0.95; P-for-trend = 0.036]. Thecorresponding aRR was 0.67 (95% CI: 0.46, 0.99) comparing good vs.poor diet quality defined by the cutoff of the 75th percentile (≥78.6vs. <78.6). No significant associations were observed for HEI-2010 inrelation to SGA risk.

Conclusions:Better diet quality and adherence to dietary guidelinesduring pregnancymay reduce the risk of LGA.Our findingsmay informpotential upstream prevention strategies to mitigate risk of fetal growthextremities.

Funding SourcesThis work was supported by grant R01ES019196 from the National

Institute of Environmental Health Sciences. YZ is also supported by3K12HD052163-18S1. MH and AF are supported by contract awardUG3OD023289 from the NIH Environmental Influences on ChildHealth Outcomes (ECHO) Program.


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Maternal, Perinatal, and Pediatric Nutrition

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