The path to evidence-based guidelines for food insecurity during pregnancy

Abstract Background Food insecurity has negative health implications during and after pregnancy, however, identifying and then assisting women who are food insecure is complex. Successful screening programs are often embedded in practice guidelines that include referral and treatment guidance. Screening for food insecurity is vital to address food insecurity, however, it is not present in Australia, nor are there any guidelines for healthcare settings. This presentation will describe the steps taken to gather evidence to inform the development of practice guidelines. Methods The creation of practice guidelines for screening and responding to the needs of food insecure pregnant women was informed by 1) qualitative interviews with food insecure pregnant women, and 2) qualitative interviews with clinicians about their experiences of assisting hungry and food insecure pregnant women, 3) quantitative research with a cross-section of pregnant women about their experiences managing their food supply, 4) a systematic review describing the existing interventions addressing food insecurity during pregnancy, and 5) a modified Delphi to gather the opinions of experts on the best ways to address food insecurity in pregnancy. Results This work highlight the potential effectiveness of a food insecurity screening tool in the antenatal setting, the readiness of clinicians to respond to this need, the breadth and depth of current interventions to address food insecurity, and the opinions of experts on how this issue needs to be addressed. The combined impact of these 5 studies is the identification of a number of responces to food insecurity and hunger during pregnancy. Conclusions Given the lack of screening, standard care, and treatment of food insecurity in a clinical setting in Australia, it is essentail that guidelines are created that standardise patient care and control costs through efficient use of health care resources. Key messages • Food insecurity during pregnancy has significant implications for both mother and baby. • Creating supportive evidence-based mechanisms to address food insecurity will lead to positive outcomes.

Type 2 diabetes (T2D) is one of the most common noncommunicable diseases worldwide, with an increasing prevalence and a considerable global health burden. Substantial evidence has linked consumption of trans fatty acids (TFAs) to an increased risk of cardiovascular disease. However, the effects of T2D remain unclear. We aimed to investigate the associations between different types of TFAs (total, ruminant, industrial and corresponding specific isomers) and risk of T2D in the NutriNet-Santé prospective cohort. Overall, 105,551 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2021) were included (mean age at baseline = 42.7y (SD = 14.6y), 79.2% women). Dietary intake data, including usual TFA intake, were collected using repeated 24-hour dietary records (n = 5.7 [SD = 3.1]). Associations between sex-specific quartiles of dietary intake of TFAs and type 2 diabetes risk were assessed using multivariable Cox proportional hazard models adjusted for known risk factors. A total of 969 incident type 2 diabetes cases occured during follow-up. Total TFAs was associated with higher T2D risk (HRfor quartile 4 versus 1 = 1.38; 95% CI = 1.11-1.73; Ptrend<0.001). This association, specifically observed for industrial TFAs (HR = 1.45; 95% CI = 1.15-1.83; Ptrend<0.001), was mainly driven by elaidic acid (HR = 1.37; 95% CI = 1.09-1.72; Ptrend<0.001) and linolelaidic acid (HR = 1.29; 95% CI = 1.04-1.58; Ptrend = 0.07). In contrast, ruminant trans fatty acids were not significantly associated with the risk of T2D. In this large prospective cohort, higher dietary intakes of total and industrial TFAs were associated with increased T2D risk. These findings support WHO's recommendation to eliminate industrially-produced TFAs from the food supply worldwide. As such, consumers should be advised to limit the consumption of food products containing partially hydrogenated oils (main vector of iTFAs) as this, specifically, may contribute to lower the substantial global burden of T2D. Key messages: Higher dietary intakes of total and industrial trans fatty acids were associated with increased type 2 diabetes risk. Our findings support WHO's recommendation to eliminate industrially-produced TFAs from the food supply worldwide.
Abstract citation ID: ckac129.695 The path to evidence-based guidelines for food insecurity during pregnancy

Background:
Food insecurity has negative health implications during and after pregnancy, however, identifying and then assisting women who are food insecure is complex. Successful screening programs are often embedded in practice guidelines that include referral and treatment guidance. Screening for food insecurity is vital to address food insecurity, however, it is not present in Australia, nor are there any guidelines for healthcare settings. This presentation will describe the steps taken to gather evidence to inform the development of practice guidelines.

Methods:
The creation of practice guidelines for screening and responding to the needs of food insecure pregnant women was informed by 1) qualitative interviews with food insecure pregnant women, and 2) qualitative interviews with clinicians about their experiences of assisting hungry and food insecure pregnant women, 3) quantitative research with a cross-section of pregnant women about their experiences managing their food supply, 4) a systematic review describing the existing interventions addressing food insecurity during pregnancy, and 5) a modified Delphi to gather the opinions of experts on the best ways to address food insecurity in pregnancy.

Results:
This work highlight the potential effectiveness of a food insecurity screening tool in the antenatal setting, the readiness of clinicians to respond to this need, the breadth and depth of current interventions to address food insecurity, and the opinions of experts on how this issue needs to be addressed. The combined impact of these 5 studies is the identification of a number of responces to food insecurity and hunger during pregnancy.

Conclusions:
Given the lack of screening, standard care, and treatment of food insecurity in a clinical setting in Australia, it is essentail that guidelines are created that standardise patient care and control costs through efficient use of health care resources. Key messages: Food insecurity during pregnancy has significant implications for both mother and baby. Creating supportive evidence-based mechanisms to address food insecurity will lead to positive outcomes.

Abstract citation ID: ckac129.696
The bidirectional relationship between growth and appetite regulation in the first year of life Childhood obesity is a public health crisis. Even though appetite traits in infancy were associated with childhood adiposity, whether early weight gain can influence later appetite has not been researched. Our aim was to prospectively examine the bidirectional association between growth and appetite traits during the first year of life. We followed up 450 healthy term infants for 12 months (m). Appetite traits at 4 weeks (wk), 6m and 12m were assessed using the Baby and Child Eating Behaviour Questionnaires. Infant feeding, anthropometric, socioeconomic and demographic data were also collected. Infant weight-for-age z-scores (WFAZ) were calculated using the WHO 2006 growth reference. Growth was assessed as conditional WFAZ change (cWFAZc) by saving the residuals from linear regression models of WFAZ at each successive time point versus WFAZ at the earlier time point. Multivariable linear regression was used to analyse bidirectional associations between cWFAZc (0-4wk, 4wk-6m, 6-12m) and appetite traits Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE) at 4wk, 6m and 12m. All models were adjusted for relevant confounders. At 4wk, SR score was associated with lower (b:-0.16; 95% CI:-0.28,-0.03), and FR score with higher (b:0.10; 95% CI:0.01,0.19) cWFAZc from 4wk to 12m. SR score at 6m was inversely associated with cWFAZc from 6-12m (b:-0.09; 95% CI:-0.16,-0.01). Conversely, higher cWFAZc between 4wk-6m was associated with higher EF (b:0.10; 95% CI:0.01,0.19) and FR (b:0.16; 95% CI:0.04,0.29) scores at 12m. cWFAZc between 6m-12m was inversely associated with SR at 12m (b:-0.18; 95% CI:-0.35,-0.01). Our results suggest that the growth acceleration hypothesis, where faster growth in infancy leads to later obesity, may be mediated by an up-regulation of appetite traits at 12m. This highlights the public health importance of avoiding growth acceleration in infancy as a way to curb the childhood obesity epidemic.

Background:
Globally, anemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by anemia. We carried out this study to estimate anemia prevalence and evaluate structural determinants and hematological parameters association among children aged 6 to 59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique.

Methods:
From August 2021 to January 2022, we conducted a crosssectional study at the 'Maputo Central Hospital' where we collected data from 397 inpatients or outpatients who attended pediatric consultations. The cut-off values for anemia were: mild (10g/dLHb10.9g/dL), moderate (7g/dLHb9.9g/dL), severe (Hb < 7.0g/dL). We used SPSS 28.0 software to perform descriptive analyses and Chi-Square tests.