Oral Presentations

O01

Bisphenols impairs liver metabolism and morphology in male C57BL/6 mice independent of a high-fat diet and induces hepatocyte toxicity in human huh-7 hepatoma cells

Vinicius Sepúlveda Fragoso¹, Emanuelle Barreto dos Reis², Thais de Souza Carvalho Laureano², Beatriz Alexandre-santos², Emma de Juan Barroso Fernández³, Manuel Vázquez-carrera³, Milena Barcza Stockler-pinto², Leandro Miranda-alves¹, Eliete Dalla Corte Frantz² and D'angelo Carlo Magliano²

¹Federal University of Rio de Janeiro; ²Fluminense Federal University; ³University of Barcelona

INTRODUCTION: Metabolic-associated fatty liver disease (MAFLD) is the most common liver disorder worldwide, strongly associated with the obesity epidemic. Bisphenols, a class of endocrine disrupting chemicals (EDC) used in the plastic industry, have been shown to present obesogenic activity. Bisphenol S (BPS) is the major substitute of bisphenol A - most used bisphenol in the last decades - and has been presented as a safer option, but recent studies have shown it might also act on the development of obesity. Therefore, we aim to compare the effects of different doses of BPS exposure in the liver of C57BL/6 mice fed a standard or a high-fat diet, as well as different concentrations of BPS in Huh-7 cells pre-treated or not with palmitate.

MATERIAL AND METHODS: (CEUA 1929240521) C57BL/6 mice (3-mo-old) were divided into 4 groups fed a standard-chow (SC) diet and 4 groups fed a high-fat (HF) diet: SC; SCB4 (standard chow animals exposed to 4 μg/kg/day of BPS); SCB25 (25 μg/kg/day of BPS); and SCB50 (50 μg/kg/day of BPS). HF; HFB4 (high-fat diet animals exposed to 4 μg/kg/day of BPS); HFB25 (25 μg/kg/day of BPS); and HFB50 (50 μg/kg/day of BPS). The protocol lasted for 12 weeks. BPS was added to the drinking water. Food, water and energy intake, glucose tolerance (through oral glucose tolerance test-OGTT) and body mass, as well as hepatic mass, cholesterol and triglycerides content, and histology were evaluated. Human Huh-7 hepatoma cells were exposed to BPS (10, 50, 100, 200, or 400 μM) with or without palmitate (50 μM) for 24 h. Data presented as mean±standard deviation and analyzed by one-way ANOVA with Holm-Sidak post-hoc test (p < 0,05).

RESULTS: In mice, SCB4 and SCB25 groups presented higher body mass at the end of the protocol compared to both SC and SCB50 groups. In HF-fed groups, HFB4 and HFB50 decreased final body mass in comparison to HF and HFB25 groups. The area under curve of OGTT was higher in SCB25 group in comparison to SC and lower in HFB4 and HFB50 when compared to HF group. Liver mass, hepatic cholesterol, and stereology-quantified percentage of steatosis were higher in all SC-fed interventions in relation to SC group, but only SCB25 group showed increased hepatic triglycerides and only SC50 group presented a higher amount of binucleated hepatocytes in comparison to SC group. In Huh-7 cells, cell viability was significantly decreased in cells treated with 100, 200 and 400 μM of BPS in comparison to DMSO, as well as in cells treated with 400 μM of BPS along with 50 μM of palmitate in comparison to those only treated with 50 μM palmitate. Hepatocytes treated with 400 μM BPS also presented higher triglycerides content in comparison to DMSO-treated cells.

CONCLUSION: BPS exposure showed, as expected for EDC, non-monotonic dose responses and impaired metabolism and hepatic outcomes in SC diet-fed mice but not necessarily in HF diet-fed mice. In Huh-7 cells, BPS was also prone to induce hepatocyte toxicity and fat accumulation.

O02

High-intensity interval training improves cardiomyocyte contractile function and intracellular calcium handling in obese rats

Matheus Corteletti dos Santos¹, Lucas Furtado Domingos², Jóctan Pimentel Cordeiro³, Ana Paula Lima Leopoldo³, André Soares Leopoldo³ and Daniel Sesana da Silva³

¹Postgraduate Program in Physiological Sciences, Health Sciences Center, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil; ²Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil; ³Postgraduate Program in Physical Education, Center of Physical Education and Sports, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil

INTRODUCTION: Obesity is a multifactorial and complex disease characterized by the excessive accumulation of body fat, which can lead to a reduction in quality of life and life expectancy, as well as causing various vascular and metabolic dysfunctions. Studies have indicated that obesity is associated with myocardial contractility dysfunction, and literature data have demonstrated that cardiac dysfunction resulting from obesity may be due to an imbalance in intracellular calcium (Ca2+) handling. Given the exponential growth of obesity worldwide, numerous treatment strategies are reported in the literature, including physical exercise. Within this context, physical exercise is an important non-pharmacological tool that is widely used, with continuous aerobic exercise being more frequently observed. In this sense, literature data also show that high-intensity interval training (HIIT) has demonstrated significant results in reducing body adiposity and reversing risk factors associated with obesity. However, no studies were found that investigated the effect of HIIT on intracellular calcium handling. The purpose was to investigate the effects of HIIT on cardiomyocyte contractile and intracellular Ca2 + handling in obese rats induced by a saturated high-fat diet.

MATERIAL AND METHODS: Wistar rats were initially randomized into a standard diet and a high-fat diet group. The experimental protocol consisted of 23 weeks, divided into the induction and maintenance of obesity (15 weeks) and high-intensity interval training treatment (8 weeks). Performance was assessed using the maximum oxygen consumption (VO2max) test. Cardiac, adipose, and skeletal histology, contractility, and intracellular calcium handling were determined.

RESULTS: High-intensity interval training reduces the area of visceral adipose tissue, increases cardiorespiratory condition analyzed by (VO2max)test, prevents the risk of insulin resistance, and increases the diameter of the fibers of the gastrocnemius muscle. Considering myocardial morphology and contractility, high-intensity interval training prevents left ventricle interstitial fibrosis, improves functional parameters of cardiac contractility, and enhances Ca2 + myofilament sensitivity, visualized by a reduction in systolic calcium/% shortening and maximum shortening rates.

CONCLUSION: HIIT promotes physiological cardiac remodeling with improvement in contractile cardiomyocytes and enhances Ca2 + sensitivity of myofilaments in obesity. This approach also improves cardiorespiratory and physical performance, as well as reducing the visceral area and preventing interstitial fibrosis. Funding and Acknowledgement: Espírito Santo Research and Innovation Support Foundation FAPES.

O03

Hypothalamic CXCR3 + immune cell recruitment protects mice from high-fat diet-induced metabolic dysfunction

Natalia Ferreira Mendes¹, Ariane Maria Zanesco², Cristhiane Ferreira Aguiar³, Gabriela Flávia Rodrigues Luiz⁴, Dayana Cabral da Silva², Jonathan Ferreira Campos², Pedro Manoel Mendes Moraes-vieira³, Niels Olsen Saraiva Camara⁵, Eliana Pereira de Araújo⁶ and Licio Augusto Velloso²

¹School of Medical Sciences, Department of Translational Medicine (Section of Pharmacology), University of Campinas (UNICAMP), Brazil; ²Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, University of Campinas (UNICAMP), Brazil; ³Laboratory of Immunometabolism Institute of Biology, University of Campinas (UNICAMP), Brazil; ⁴Federal University of Santa Catarina (UFSC), Brazil; ⁵Laboratory for Transplantation Immunobiology - Institute of Biomedical Sciences, University of Sao Paulo (USP), Brazil; ⁶Faculty of Nursing, University of Campinas (UNICAMP), Brazil

ABSTRACT: A high-fat diet (HFD) promptly induces hypothalamic inflammation, triggering metabolic dysfunction. Neurons and glial cells release proinflammatory signals, leading to the recruitment of peripheral immune cells to the hypothalamus. However, the specific chemokine pathways and the roles of the recruited cells in hypothalamic inflammation remain unclear. Here, we utilized CX3CR1GFP/+CCR2RFP/+ mice fed either a chow or an HFD to investigate the transcriptome of CX3CR1 + microglia and CCR2 + recruited cells. For RNA-sequencing, we sorted CX3CR1 + and CCR2 + cells from the hypothalami of chow- and HFD-fed mice. Illumina NovaSeq S2 PE150 was employed for sequencing. The experimental protocol was approved by the Committee on Ethics in Animal Use (CEUA 6210–1/2023) of the University of Campinas. Comparing chow- and HFD-fed mice, we observed 25 upregulated and 9 downregulated differentially expressed genes (DEGs) in CXCR3 + microglia of female mice. In contrast, males exhibited 261 upregulated and 151 downregulated DEGs in their CX3CR1 + transcriptome. Curiously, in CCR2 + recruited cells we identified 1,598 upregulated and 1,676 downregulated DEGs when comparing male and female mice, indicating significant sex dimorphism. We targeted CXCR3 and intervened by systemically blocking it, as it is widely expressed in CCR2 + cells. Using CCR2RFP/− HFD-fed mice treated with AMG487 (CXCR3 antagonist) (5 mg/kg) or vehicle via IP injections every 48 hours over 4 weeks, we found that AMG487 treatment reduced CCR2 + cell chemotaxis to the hypothalamus but increased adiposity and glucose intolerance. Our analysis revealed transcriptomic differences in hypothalamic CX3CR1 + microglia and CCR2 + immune cells between chow- and HFD-fed mice. Blocking CXCR3 + cells reduced CCR2 + cell recruitment in HFD-fed mice but accelerated metabolic dysfunction, emphasizing their anti-inflammatory and protective role in diet-induced hypothalamic inflammation.

O04

Female mice lacking liver adrenoceptor alpha-1b are more susceptible to obesity

Anisia Judith Da Costa E. Silva^1,2, Mathilde Mouchiroud², Alexandre Caron^2,1,3 and Joel Elmquist⁴

¹Université Laval, Quebec City, QC, Canada; ²Quebec Heart and Lung Institute, Quebec City, QC, Canada; ³Montreal Diabetes Research Center, Montreal, QC, Canada; ⁴University of Texas Southwestern Medical Center, Dallas, TX, USA

BACKGROUND: The prevalence of obesity does not cease to increase globally. Obesity is characterized by an excessive accumulation of adipose tissue which can result in several health problems. It is a complex and multifactorial pathology resulting from the interaction of environmental, neurobehavioral, genetic, biological, and metabolic factors. It is also the strongest risk factor for the development of type 2 diabetes (T2D), a condition characterized by insulin resistance and impaired glucose homeostasis. Autonomic dysfunctions including neuropathies have been also associated with the progress of metabolic diseases. In addition to classical hormonal control, the brain has several ways of influencing glucose metabolism, including the regulation of liver metabolism. In particular, norepinephrine rapidly mobilizes glucose from the liver by increasing hepatic glucose production. Therefore, understanding the mechanisms by which the sympathetic nervous system (SNS), through the release of norepinephrine, regulates liver metabolism offers important possibilities to better understand and treat alterations in glucose homeostasis observed in metabolic disorders.

METHODS: Confirming a previous anatomical profiling study of GPCR expression, we observed that the adrenoceptor alpha-1b (Adra1b) was the dominant subtype expressed in the liver. We found that Adra1b expression was increased in diet-induced of genetically obese mouse models. Using CRISPR-Cas9 technology, we developed a conditional mouse model for the Adra1b gene. These mice were bred with an Albumin-Cre mouse to generate mice lacking Adra1b specifically in hepatocytes.

RESULTS: We found that selective deletion of Adra1b in mouse liver induced metabolic deterioration in female mice fed a high-fat diet (HFD). These mice showed increased body weight, glucose intolerance, and insulin resistance. These mice also showed an alteration in gene expression related to lipid metabolism in adipose tissue. However, we did not observe any difference in male mice, highlighting the presence of sex-dependent mechanisms.

CONCLUSION: Our data suggest that ADRA1B is key in mediating the effects of the autonomic nervous system on hepatic metabolism, and seems to alter lipid storage and metabolism in female adipose tissue. Additional studies are needed to elucidate the mechanisms by which the ADRA1B receptor regulates liver metabolism, and especially why females are more likely to develop metabolic alterations in the absence of hepatic ADRA1B. A better understanding of the receptors and pathways involved in the sympathetic outflow of the liver will help develop a thoughtful perspective on how the autonomic control of peripheral organs is altered in metabolic diseases.

O05

Increasing glp1-ra efficacy by targeting non-coding rna: a combinatory approach to develop a more effective therapeutic paradigm

Riccardo Panella, Simone Tomasini, Anna Altieri and Sakari Kauppinen

Center for RNA Medicine

ABSTRACT: Obesity, affecting nearly 2 billion people globally, is a significant public health issue linked to type 2 diabetes, cardiovascular disease, MAFLD, and cancer. We've identified miR-22 as a key regulator in lipid homeostasis. Our anti sense oligonucleotide (ASO) therapy inhibits miR-22 (RES-010), protects against obesity in mice. Unlike GLP-1 RA, RES-010 works independently of food intake. Our hypothesis is that combining GLP-1 RA and miR-22 inhibition enhances positive effects. Data support a therapeutic paradigm: induction phase with GLP1-RA with RES-010, followed by RES-010 in monotherapy followed by drug-free periods. C57BL/6 mice on GAN or HFD were treated with vehicle, Semaglutide, miR-22 ASO (RES-010) or Semaglutide + RES-010. Weight, food intake, blood, and liver biochemistry were monitored for 24 weeks of treatment and for an additional 13 weeks of drug-free periods to assess sustained effects. Mice treated with Semaglutide experienced a rapid 20% initial body weight loss, followed by significant regain between weeks 12 and 24, mainly in still-obese mice. RES-010-treated mice initially showed no BW decrease, but metabolic rewiring induced weight loss between week 12 and 24 (additional 6% on average, up to 10%). Heavier mice lost more weight on RES-010. Withdrawal of RES-010 in monotherapy maintained metabolic benefits for over 7 weeks, stabilizing weight despite a high-fat diet. RES-010 also reduced plasma triglycerides and LDL cholesterol, which were sustained even after discontinuation. Combining GLP1-RA with RES-010 resulted in an initial BW drop, followed by stabilization due to miR-22 inhibition, preventing regain seen in GLP1-RA monotherapy. Single-mouse analysis showed ongoing weight loss in combo-arm overweight/obese mice between weeks 12 and 24, highlighting miR-22 inhibition's potential for fat mass loss. At the end of treatment, 50% in the combo arm lost at least 20% BW, compared to 11% in the semaglutide alone. After 24 weeks, 70% in the combo arm remained non-obese, with ongoing weight loss, while only 44% on GLP1-RA monotherapy were non-obese. The data support a novel therapeutic paradigm for obesity, combining GLP1-RA and miR-22 inhibition (RES-010). GLP1-RA induces immediate BW loss, while RES-010 causes gradual metabolic rewiring, impacting key pathways without affecting food intake or lean mass. RES-010 reduces lipid biosynthesis, increases mitochondrial biogenesis, and induces white adipose tissue brownization. Unlike GLP1-RA's immediate effect, RES-010's metabolic changes take time. Proposed therapeutic phases include an initial combination, followed by RES-010 monotherapy for persistent fat loss, and a drug-free period before restarting. Reducing GLP1-RA usage time efficiently addresses side effects and improves patient compliance. The combinatory treatment allows GLP1-RA discontinuation, leveraging RES-010's prolonged efficacy on excessive fat mass for substantial patient benefits and more efficient obesity therapy.

O06

The therapeutic potential of microrna-22 in MASH and obesity

Riccardo Panella, Simone Tomasini, Anna Altieri and Sakari Kauppinen

Center for RNA Medicine

ABSTRACT: MicroRNAs (miRNAs) are short endogenous non-coding RNAs that function as post-transcriptional regulators of gene expression of many biological processes and have been implicated in the pathogenesis of a wide range of human diseases, including cardiometabolic diseases. We identified microRNA-22 (miR-22) as a key regulator of lipid and metabolic homeostasis using miR-22 knockout and transgenic mice, respectively. Furthermore, miR-22 is upregulated in adipose tissue of obese human subjects and its levels correlate with the severity of fibrosis in MASH patients. The therapeutic potential of miR-22 inhibition in MAFLD and obesity was assessed in mouse models of NASH and obesity, non-human primates, and human liver organoids using a systemically delivered antimiR-22 oligonucleotide compound. Here, we report that pharmacological inhibition of miR-22 has a great protective effect towards hepatic lipid accumulation, inflammation, fibrosis and weight loss. miR-22 knockout and transgenic mice were used to demonstrate the role of miR-22 in metabolism. A data set from 127 MASH patients with different stages of fibrosis was used to confirm the role of miR-22 in humans. to prove the therapeutic effect of miR-22 inhibition we used diet induced obesity (DIO) mouse models, the biopsy-confirmed Gubra Amylin model, non-human primates fed with a fast-food diet and human derived liver organoids with NASH. We found that over-expression of miR-22 leads to an obese phenotype and liver steatosis, in mice fed with normal chow. miR-22 null mice fed with High Fat Diet (HFD) were unable to increase their body weight and their liver were protected from steatosis. We designed and tested an anti-sense oligonucleotide (ASO) based on LNA chemistry able to target mir-22 and inhibit its function and we tested it in DIO and GAN mice, as well as in in a 24 weeks long experiment with non-human primates and in a 3D model of human liver organoids. We detected a strong and consistent effect of our anti-miR-22 therapy on triglyceride levels, body weight and hepatic collagen deposition, demonstrating the efficacy of miR-22 inhibition in NALFD and obesity We demonstrate that miRNA-22 influences the expression of genes involved in lipid biogenesis, energy expenditure, hepatic inflammation and fibrosis. By modulating its levels with a new compound that we designed and tested, we have been able to simultaneously impact several different coordinated pathways that all contributes to the insight and the progression of complex, systemic, diseases like obesity and NASH. We tested our therapy in multiple mouse models, as well as in non-human primates and primary human organoids, providing extensive evidence that miR-22 role is conserved between species and that its pharmacological inhibition is an effective therapy to address diseases with high unmet medical need like NASH. Our data are paving the way for a new pharmacological approach, with an innovative approach based on targeting a non-coding RNA.

O07

Breastfeeding, brown adipose tissue and il10: impact on the thermogenesis of neonates

Bruna Bombassaro, Ana Luisa Gallo Ferraz, Marcela Reymond Simões, Guilherme Augusto da Silva Nogueira, Sergio Marba, Jamil Pedro de Siqueira Caldas, Licio Augusto Velloso and Eliana Pereira de Araújo

Unicamp

ABSTRACT: The brown adipose tissue (BAT) identification in human adults has stimulated the search for new strategies to treat metabolic conditions as obesity. However, prior studies explored the role of BAT during early life. In low birth weight and pre-term infants specially, hypothermia is a prevalent condition that can lead to life-threatening outcomes, such as infections, arrhythmia, and coagulation abnormalities. Maintaining body temperature stability is a great challenge neonates face after birth, as they are no longer protected by the mother's environment and additional to that, human babies are not able to promote shivering thermogenesis relying exclusive on brown adipose tissue to effectively maintain body temperature. Interleukin-10 (IL-10) is known for its role as an anti-inflammatory cytokine; however, a prior study from our group has shown it is also involved in the correct structure and function of BAT mitochondria. The lack of IL-10 in adult mice impairs thermogenesis and appropriate BAT structure. In this study, the absence of functional IL-10 in newborn KO mice was evaluated in the context of cold exposure. We show that in the first days of life, IL-10 KO mice are cold intolerant, but this phenotype can be reverted upon fostering in wildtype females. The oral supplementation of IL-10 also improved the IL-10 KO mice response to cold as well as in wildtype neonate mice, and was also capable of inducing increase in gut secretin transcript, a recently described BAT thermogenesis inducer. The intraperitoneal IL-10 administration did not prevent the temperature loss and didn't increase secretin transcript, showing a novel oral IL10 role on thermogenesis. In humans, IL-10 is present in both neonate serum at birth and in mother's milk and they show correlation. Thus, IL-10 rises as a potential milk factor promoting thermoregulation in neonate mice.

O08

Iprevent: increasing colonic propionate for the prevention of weight gain in younger adults, a 12-month randomised controlled trial

Jennifer Pugh¹, Katerina Petropoulou¹, Douglas Morrison² and Gary Frost¹

¹Imperial College London; ²SUERC, University of Glasgow

ABSTRACT: One in four UK adults is obese. Once individuals become obese, many fail to return to normal body weight. Presently, emphasis is placed on strategies for obesity treatment rather than proactive prevention. Circumventing weight gain in early adulthood is crucial for reducing obesity and preventing chronic diseases later in life. High daily fibre intake to enhance bacterial fermentation and the production of short-chain fatty acids (SCFAs) in the colon, is inversely associated with body weight. Few individuals reach the recommended intake of 30 g of fibre per day, thus forfeiting the beneficial effects of SCFA production. We developed a methodology to deliver the SCFA, propionate, to the colon via inulin-propionate ester (IPE). A 10 g dose of IPE releases propionate in the colon equivalent to the fermentation of 60 g of fibre. Our previous clinical studies in overweight, middle-aged adults demonstrated that IPE prevented weight gain and lowered abdominal adiposity over six months. This randomised, parallel-group, placebo-controlled, double-blind trial aimed to investigate the effect of increasing colonic propionate concentrations using IPE on preventing weight gain in young adults aged 20 to 40 years old (a population at high risk of weight gain). The secondary objectives were designed to investigate whether the increase in colonic propionate via IPE could beneficially affect body composition and cardiometabolic biomarkers. We recruited 270 (n = 135 per arm) young adults who were overweight and susceptible to further weight gain. Participants were randomised to consume either 10 g IPE or 10 g inulin control, daily for 12 months. At 12 months, body weight was 78.9 kg ± 11.8 (n = 114) and 81.4 kg ± 11.9 (n = 112) for inulin and IPE, respectively, resulting in a non-significant baseline-adjusted mean difference in weight gain of 1.02 (95% CI: −0.37 to 2.41) kg for IPE versus inulin control. Amongst secondary outcomes, the adjusted difference in means was statistically significant for fat-free mass; 1.07 kg (0.21 to 1.93), body water; 0.72 kg (0.1 to 1.33) and fasting glucose; 0.11 mmol/l (0.01 to 0.21), being higher for IPE compared to the inulin control. In conclusion, IPE did not differentially affect weight gain over 12 months, compared to the inulin control, in a cohort of young people at risk of obesity. Notably, neither group gained the estimated 2 kg body weight, suggesting that increasing quantities of fermentable carbohydrates in the colon prevents weight gain. These results suggest that younger adults may respond to IPE differently than middle-aged participants from previous studies. The augmented fat-free mass seen in the IPE arm indicates that propionate may have a distinct effect on body composition. Future research should explore the colonic environment, metabolism, and appetite differences between younger and older adults. Dietary recommendations emphasise the importance of fermentable carbohydrate consumption for body weight maintenance.

O09

The effects of phosphodiesterase 4 inhibitors on weight loss and energy homeostasis in mice with obesity induced by a high-fat-diet

Maria Amélia Aquino Montenengro de Andrade, Hellen Veida Paraguassu da Silva, José Antunes Rodrigues, Francisco Jose Albuquerque de Paula and Lucila Leico Kagohara Elias

FMRP - USP

INTRODUCTION: Obesity is a worldwide health problem with an increasing incidence of comorbidities, such as type 2 diabetes. Leptin (Lep) resistance arises from obesity-related inflammation, enhancing the appetite. The expression of phosphodiesterase 4 enzyme (PDE4) is increased in inflammatory conditions. Rolipram (Rol) acts to inhibit PDE4 reducing adiposity and peripheral inflammation. Notwithstanding, the effects of Rol on Lep sensitivity and energy balance are still unknown.

OBJECTIVE: To evaluate the effect of PDE4 inhibition on energy homeostasis and Lep resistance in mice with obesity induced by high-fat diet (HFD).

METHODOLOGY: Four-week-old male C57BL6 mice were fed a HFD (60%, Research Diets) or chow diet (C) for 10 weeks. In the 8th week, they received daily subcutaneous Rol injections (2 mg/kg) or vehicle (V) and food intake and body weight were daily measured. Energy expenditure (EE) was measured on the 8th day of treatment using a metabolic cage (Oxymax). After treatment, fasted mice for 6 h were subjected to glucose tolerance test (GTT (2 g/kg, ip). On the last day of treatment, 90 minutes after the Rol or V injection, Lep (5 mg/kg in 100ul, ip) or vehicle (saline) was injected, and weight and food intake were measured 14 and 24 h later. Also, after treatment, body composition (NMR) and brown adipose tissue (BAT) thermogenesis (FLIR) were assessed.

RESULTS: 6–12 mice were analyzed in each group (chow + V, CV; chow + Rol, CR; HFD + V, HV; HFD + Rol, HR). There was a significant difference in body weight between HR and HV: absolute weight (HR 35 + −4.18; HV 38.8 + −3.88 g; p 0.038) and weight variation (HR -2.26 + −0.99; HV -0.19 + −1.25 g; p 0.002), but no difference between CR and CV (27.98 + −2.25; 26.8 + − 2.22 g). Rol effectively reduced ingestion in both diets (CR 42.85 + −2.7; CV 48.13 + −4.51 g; p 0.03) (HR 24.75 + −2.44; HV 28.31 + − 2.81 g; p 0.01). In the HFD groups, compared to V, Rol increased VO2 (p 0.04) and energy expenditure (p 0.049) as well as the heat (p 0.03). There was no difference in VCO2 nor motor activity. Lep sensitivity was assessed in the HFD groups. As expected, there was no effect of leptin on body weight and food intake in the vehicle-treated group. However, remarkably, rolipram was able to revert this leptin resistance with a decrease of these parameters 14 h and 24 h after the Lep injection, compared to vehicle: food intake (14 h p 0.024; 24 h p 0.002) and body weight variation (14 h p 0.003; 24 h p 0.005). Fat mass was lower in the HR compared to HV group (p 0.03), with no difference in the lean mass. Rol was ineffective to improve FG/GTT in the HFD group. No difference in the BAT temperature was observed between groups.

CONCLUSION: Rolipram, a PDE4 inhibitor, effectively reduces the body weight of diet-induced obesity by reducing food intake, increasing basal energy expenditure and improving leptin sensitivity. PDE4 appears as a potential target to treat obesity.

O10

The role of mir-146a e mir-378 on c/ebp-Β, in obese insulin sensitivity improvement, induced by physical exercise

Fátima Lúcia Rodrigues Guimarães¹, Sadia Nanroz Khan², Min Shi², Xu Yan², Luydson Richardson Silva Vasconcelos³, Andrew J. Mcainch² and Bruno de Melo Carvalho¹

¹Instituto de Ciências Biológicas da Universidade de Pernambuco, Recife-PE, Brasil; ²Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia; ³Instituto Aggeu Magalhães da Fiocruz Pernambuco, Recife-PE, Brasil

BACKGROUND: Obesity is a multifactorial disease that triggers insulin resistance (IR), mainly by a chronic inflammatory profile. Impaired insulin sensitivity (IS) can lead to glycemic imbalance, worsening comorbidities, deteriorating quality of life, and increasing mortality risk. Obesity-induced IR undergoes epigenetic regulation on metabolic conditions guided by lifestyle. Increasing physical activity levels is crucial to avoid such metabolic diseases, once it prevents and treats obesity, possibly by modulating microRNA profile, that promotes anti-inflammatory responses and consequently improves IS.

OBJECTIVE AND METHODS: The main goal of this study was identify the role of some metabolic and inflammation involved microRNAs, miR-378 and miR-146a, on IS, after 6 hours of electrical pulse stimulation (EPS), a mimic acute exercise protocol used to human primary muscle cells derived from obese (OB) and obese/diabetes type 2 (ObD) individuals, collected to gene and microRNA expression analyzes, by real time polymerase chain reaction (RT-PCR), in order to compare inflammatory profile and insulin pathway stimulation between groups and correlate it with microRNA expressions.

RESULTS: EPS decreased miR-378 and increased in miR-146a expression in Ob and ObD cells analyzed together (OB&ObD), with greater effect in both microRNAs seen when obese were also diabetic. Further, ObD cells brought up higher inflammatory outline than OB cells, shown via greater tumor necrosis factor alpha (TNF-α) expression. In addition, being from ObD group, makes cells lose anti-inflammatory response induced by EPS, once there were no significant increase of interleukin-6 (IL-6) and nuclear factor kappa B subunit 1 (NFKB1) after EPS. Moreover, EPS downregulating insulin receptor substrate 1 (IRS-1) and phosphoinositide-3-kinase (PI3K) in ObD cells, and also affected both microRNA decreasing and increasing in miR-378 and miR-146a expressions respectively, in OB&ObD cells, along with a target of the miR-378, CCAAT enhancer binding protein beta (C/EBP-β), seeming to be less expressed in ObD and being related with anti-inflammatory responses. The microRNAs were also correlated to expression of IRS-1, PI3K, IL-6 and toll like receptor 4 (TLR4) in response to EPS from Ob&ObD cells, with greater proportion in ObD. But no correlation was found with NFKB1 or TNF-α. The IRS-1, PI3K, IL-6 expressions were also correlated to the components of an anti-inflammatory pathway (TLR4-PI3K-C/EBP-β) induced by EPS, and the microRNAs had strongly and inversely correlated to each other, with both with some relation with C/EBP-β, especially in ObD groups.

CONCLUSION: Therefore, it is suggested that ObD can have affected anti-inflammatory responses to exercise, miR-378 and miR-146a seem to be important in this response, and C/EBP-β could also be a key molecule that participate in it, which in turn, can indirectly help to regulate IS in ObD.

O11

Exploring the culinary skills and diet quality across different cardiometabolic phenotypes: insights from the menu project - culinary medicine and nutrition

Sâmella de Oliveira Ananias Gonçalves, Caroline Dario Capitani, Maria Eduarda Martelli, Vinicius Ferreira dos Santos, Isabela Solar, Bruno Geloneze and Ana Carolina Junqueira Vasques

UNICAMP

INTRODUCTION: The consumption of homemade food has been associated with a healthy dietary pattern, better adiposity profile, and cardiometabolic health. Among the limiting factors for the consumption of homemade food are low domestic culinary skills (DCS). There are no studies that have compared DCS among the normal weight metabolically healthy (NWMH) phenotype, metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO) phenotypes. The objective was to compare DCS and diet quality among adults with the MHNO, MHO, and MUO phenotypes and to investigate associations between DCS, diet quality, and cardiometabolic health indicators.

METHODS: A cross-sectional study with ongoing data collection, included 78 participants (aged 20–59 years), 61 women. The study was approved by the Research Ethics Committee (CAAE 39037120.0.0000.5404). Metabolically healthy was considered the absence of alterations in blood pressure and levels of glucose, HDL-cholesterol and triglycerides; and healthy weight was considered BMI < 25.0 kg/m² and obesity BMI ≥ 30.0 kg/m². Waist circumference, body composition (dual-energy X-ray densitometry), and plasma glycemic and lipid profiles were evaluated. DCS were assessed by the Primary Health Care Culinary Skills Scale and diet quality was assessed by the Diet Quality Scale, both validated for the Brazilian population. For both instruments, higher scores indicate better DCS or better diet quality. ANOVA test and Pearson correlation were performed using IBM SPSS 24.0 software; with p < 0.05.

RESULTS: The mean age was 33 ± 7 years, with 22 NWMH, 18 MHO, and 38 MUO. The mean DCS score was 65 ± 21; with 49% showing moderately high DCS, 28% moderately low, 15% high, and 8% low. Among the participants, 62% had a good diet quality, 31% very good, 6% poor, and 1% very poor. There was no difference (p = 0.08) in the distribution of the DCS score among the NWMH, MHO, and MUO phenotypes. The NWMH phenotype (281 ± 42) showed better diet quality (p = 0.01) compared to the MHO (238 ± 28) and MUO (241 ± 37) groups. Diet quality did not differ (p = 0.08) between individuals with low and very low DCS versus high and very high. DCS had a positive correlation with BMI (r = 0.23, p = 0.04), and diet quality inversely correlated with BMI (r = −0.37, p = 0.01), waist circumference (r = −0.25, p = 0.03), total body fat (r = −0.43, p = 0.01) and visceral (r = −0.39, p = 0.02), glycated hemoglobin (r = −0.26, p = 0.03), and HDL (r = 0.26, p = 0.02).

CONCLUSION: The results did not confirm the hypothesis that low DCS is positively associated with obesity with dysmetabolism and poor diet quality, which may be due to the fact that the sample is not yet complete. On the other hand, diet quality was better in the NWMH phenotype and was associated with adiposity and cardiometabolic health variables.

O12

The global diet quality score was associated with body adiposity indicators in participants of the nutritionists health study - NutriHS

Isabela Coral Gerólamo¹, Marina Maintinguer Norde¹, Sandra Roberta Gouveia Ferreira², Antônio Augusto Ferreira Carioca³, Bruno Geloneze⁴, Bianca de Almeida Pititto² and Ana Carolina Junqueira Vasques¹

¹Faculdade de Ciências Aplicadas - UNICAMP, Universidade Estadual de Campinas; ²Faculdade de Saúde Pública - USP, Universidade de São Paulo; ³Universidade de Fortaleza - UNIFOR; ⁴Faculdade de Ciências Médicas - UNICAMP, Universidade Estadual de Campinas

INTRODUCTION: Recently, the Global Diet Quality Score (GDQS) was developed and validated with the aim of being a simple yet robust dietary metric for simultaneous surveillance of dietary risk for nutritional deficiencies and the development of NCDs in different dietary scenarios and cultures. The objective was to assess the association of GDQS and its sub metrics, GDQS+ and GDQS-, with body adiposity indicators evaluated through anthropometry (BMI and waist circumference) and DXA technique (total body fat, gynoid, android, and visceral fat) in NutriHS participants.

METHODS: NutriHS is a cross-sectional, multicenter study conducted with nutrition undergraduates and nutritionists in three Brazilian cities: São Paulo, Campinas, and Fortaleza (CAAE UNICAMP: 79775817.4.1001.5404). Sociodemographic and dietary consumption information was collected through the e-NutriHS platform. GDQS was calculated from a quantitative food frequency questionnaire (QFA) containing 101 items. GDQS consists of 25 food groups, with 16 healthy food groups (GDQS+) and 9 unhealthy food groups (GDQS-), ranging from 0 to 49 points, where higher scores indicate better diet quality. Weight, height, and waist circumference were measured. Whole-body composition parameters were obtained using DXA body composition analysis. To examine the linear relationship between GDQS and its sub metrics with body adiposity parameters, a multiple linear regression model adjusted for classic confounding factors was used in the STATA software. The adopted significance level was 5%.

RESULTS: After excluding participants with incomplete QFA data and implausible energy consumption values, the final sample included 1,489 individuals (1,318 women and 171 men), with a mean age of 22 years (17 to 76 years). There was an association between GDQS and BMI (β (95% CI) = −0.08 (−0.12; −0.04)); body fat percentage (−0.27 [−0.47; −0.07]); gynoid fat (−0.27 [−0.46; −0.09]); android fat (−0.44 [−0.76; −0.12]); and visceral fat (−10.6 [−20.4; −0.70]), where higher GDQS values were associated with lower values of body adiposity indicators. The GDQS- sub metric was inversely associated with BMI, waist circumference, body fat, gynoid fat, and android fat (β (95% CI) = −0.25 (−0.35; −0.15); −1.06 (−1.50; −0.60); −0.80 (−1.20; −0.35); −0.75 (−1.18; −0.32); −1.12 (−1.90; −0.40), respectively). No associations were found between GDQS+ and body adiposity indicators.

CONCLUSION: Higher diet quality, represented by higher GDQS values, in nutritionists and nutrition students was indicative of lower total and central body adiposity. GDQS appears to be a good metric for monitoring dietary risk of NCDs related to body adiposity.

O13

Bat dysfunctionality and dysmetabolism in different degrees of adiposopathy

Maria Eduarda Martelli¹, Isabela Solar², Natalia Rossin Guidorizi³, Jessica Silveira Araújo⁴, Francisco José Albquerque de Paula³, Renan Magalhães Montenegro Júnior⁵, Ana Carolina Vasques¹, Licio Augusto Velloso¹ and Bruno Geloneze¹

¹Universidade Estadual de Campinas; ²Universidade Estadual Campinas; ³Universidade de São Paulo; ⁴Universidade Federal Ceará; ⁵Universidade Federal do Ceará

INTRODUCTION: Lipodystrophies, similar to obesity, is a disease with white adipose tissue (WAT) dysfunction, but with worse metabolic profile. The inherited lipodystrophies can be classified as generalized and partial, with the extent of adipose tissue loss being associated with the severity of the metabolic complications. Brown adipose tissue (BAT) has a different embryonic origin from WAT and the presence and functionality of BAT on lipodystrophies is unknown. The study aimed to compare BAT activity and metabolic health parameters between individuals with congenital generalized lipodystrophy (LGC), partial familial lipodystrophy (LPF), obesity (OB) and eutrophy (EU).

METHODS: A total of 137 individuals were evaluated: 7 with LGC, 14 LPF, 62 OB and 54 EU. Blood glucose, glycated hemoglobin (A1c), insulin, lipid profile, triglycerides (TG), AST, ALT and HOMA-IR were determined. Measurements of waist circumference (WC), hip circumference (HC), neck circumference (NC), and waist-to-hip ratio (WHR) were performed. Body composition was assessed be Dual -energy X-ray absorptiometry (DXA) and data presented as % of total fat (%TF), android gynoid ratio (A/G) and visceral fat (VF). The BAT was assessed through infrared thermography during a 2 hour cold exposure in a acclimatized room with controlled temperature set at 18°C. Thermographic images were taken every 15 minutes in the supraclavicular (Tscv, BAT location) and pectoral regions (control region). Data were presented in area under the curve of supraclavicular temperature (AUCtscv) and area under the curve of relative temperature (AUCtr).

RESULTS: LGC had higher values for glycemia, A1c, TG and lower values for HDL, LDL, % TF, A/G, VF, weight, BMI, WC, HC (p < 0.001 for all) compared to OB. LPF had higher concentrations for TG, AST, ALT and lower values for HDL, %TF, weight, BMI, WC and HP (p < 0.001 for all) than OB. Glycemia, A1c, insulin, HOMA-IR, TG, ALT and NC were higher and HDL, %TF, and HC were lower in the LGC compared to EU (p < 0.001 for all). LPF showed higher glycemia, A1c, insulin, HOMA-IR, TG, AST, ALT, A/G, VF, BMI, WC, NC, WHR and lower value for HDL than EU (p < 0.001 for all). A1c was higher, %TF and VF were lower in LGC compared to LPF (p < 0.001 for all). OB had higher values for glycemia, A1c, insulin, HOMA-IR, TG, total cholesterol total, LDL-c, %TF, VF, A/G, BMI, WC, HC, NC, WHR and lower value for HDL-c compared to EU (p < 0.001 for all). AUCTscv was lower in the two groups of lipodystrophies compared to OB and EU; LGC showed higher AUCTscv compared to LPF and OB had lower AUCtscv compared to EU (p < 0.001). When the data was correct by pectoral region, the AUCtr suggested lower BAT activity in two groups of lipodystrophies compared to OB and EU (p > 0.001).

CONCLUSION: Individuals with lipodystrophies showed worse metabolic profile and BAT activity compared to OB. BAT may contribute to the dysfunctional state of lipodystrophy. FAPESP: 2020/12112–1; 2013/07607–8.

O14

The effect of neuromodulation with transcranial direct current stimulation on glycemic excursion in subjects with overweight and obesity: a double-blinded randomized clinical trial

Olavo da Silva Carvalho Porepp¹, Olavo da Silva Carvalho Porepp¹, Paula Portal Teixeira¹, Poliana Correia Espíndola¹, Laura Backes Kunzler¹, Bárbara Birck Martins¹, Marcelo Madrid Bittencourt¹, Gabriella Richter da Natividade¹, Bernardo Frison Spiazzi¹, Amanda Farias Osório¹, Carina de Araújo² and Fernando Gerchman¹

¹Universidade Federal do Rio Grande do Sul; ²Universidade La Salle

ABSTRACT: Obesity is a public health problem commonly associated with the consumption of energy-dense and high glycemic index (GI) foods. Brain dysfunction in obesity is characterized by a reduction in metabolism and dopaminergic activity in the prefrontal cortex area, resulting in lower impulse control, dysregulation of brain areas related to glycemic homeostasis, and an increase in hunger and food craving. The right dorsolateral prefrontal cortex (rDLPFC) is critically involved in executive functions such as the cognitive control of eating, avoidance of overeating and craving for food. We have previously demonstrated that the activation of the rDLPFC with transcranial direct current stimulation (tDCS), a non-invasive and safe method of neuromodulation, increased insulin sensitivity, lowered fasting plasma glucose and reduced cravings for sweet foods. Therefore, we aimed to evaluate the effect of tDCS on the quality and quantity of carbohydrates contained in the diet of twenty-eight adults with excessive weight, not previously diagnosed with diabetes, participating in a randomized, double-blind clinical trial comparing 4 weeks (20 sessions) of fixed-dose tDCS (2 mA, 20 minutes) over the rDLPFC in an active group or sham procedure in a control group, both associated with a hypocaloric diet planned for a 3% weight loss during this time period. Three-day dietary records (3dDR) were collected at three times (baseline, first fortnight, and final). Weight, height, oral glucose tolerance test, and HbA1c were measured, and the GI and glycemic load (GL) of the 3dDR were calculated in each meal. The average of the period was used to define the GL. The longitudinal effect of tDCS was assessed using Generalized Estimating Equations, with predictors including group, time, and group versus time interaction adjusted for confounders. Twenty-three individuals completed the study (active group: n = 10, body mass index = 31.8 ± 2.6 Kg/m²; control group: n = 13, body mass index = 31.3 ± 2.4 Kg/m²). No significant difference in macronutrient consumption and weight loss was observed between groups. However, both groups decreased total intake of carbohydrates, proteins, and fats and increased fiber intake (all p < 0.05). There was a significant reduction in GL in both groups (p < 0.05), but not between groups (p = 0.48) over time. While a reduction in mean GL was related with decreases in 2-hour plasma glucose (ΔG120: r = 0.761, p = 0.01) and HbA1c levels (ΔHbA1c: r = 0.732, p = 0.01) in the active group, these relationships were not observed in the control group (ΔG120: r = 0.105, p = 0.73; ΔHbA1c: r = 0.061, p = 0.84). Therefore, we were able to show an effect of neuromodulation of the rDLPFC by continuous 4 weeks fixed-dose tDCS on GL, a measurement of glycemic excursion, suggesting that neuromodulation has an effect on the glycemic response to a dietary intervention. Its impact may be tested in future clinical trials in subjects with prediabetes and diabetes.

O15

Association of metabolic health and metabolic unhealthy obesity with hyperglycemic clamp parameters in adolescents brams (brazilian metabolic syndrome study)

Vinicius Santos¹, Marina Maintinguer Norde², Maria Eduarda Martelli², Maria Eduarda Martelli², Ana Carolina Junqueira Vasques^1,2, Mariana Porto Zambon², Maria ângela Reis de Góes Monteiro Antonio², Ana Maria de Bernardi Rodrigues³, Cleiliani de Cássia da Silva² and Bruno Geloneze²

¹University; ²State University of Campinas; ³School of Life Sciences and Health, Nossa Senhora do Patrocínio University Center

INTRODUCTION: To stratify grater metabolic risk, such as insulin resistance and type 2 diabetes risk, in adults and adolescents, it has been suggested to stratify the obesity into two phenotypes: 1) Metabolic healthy obesity (absence of any alterations in blood pressure, triglycerides, fractions of cholesterol, and glycemia; MHO); and 2) Metabolic unhealthy obesity (presence of at least one alteration; MUO).

OBJECTIVE: The aim was to compare hyperglycemic clamp parameters gold-standard for quantifying insulin resistance and secretion between eutrophic, MHO, and MUO phenotypes.

METHODS: The Brazilian Metabolic Syndrome Study (BRAMS) in pediatrics is convenience sample multicenter cross-sectional with adolescents aging 10 to 19 years. From the 1,033 original sample, 80 adolescents, who had complete information for anthropometry, blood biomarkers, blood pressure, and lifestyle, underwent a 2-hour hyperglycemic clamp protocol. Individuals were classified into eutrophy, MHO and MUO metabolic phenotypes. To compare means of the hyperglycemic clamp parameters between metabolic phenotypes, Kruskal-Wallis test was used with Tukey HSD post-test.

RESULTS: 49% of the final sample were girls, and 35 (44%), 18 (23%), and 27 (34%) adolescents were classified in eutrophic, MHO, and MUO phenotypes, respectively. MHO group was not different from MUO in relation to their BMI-for-age (in percentiles), waist-to-hip ratio, and hyperglycemic clamp glucose infusion rate, and insulin sensitivity index (p > 0.05). Hyperglycemic clamp glucose infusion rate, insulin sensitivity index, and disposition index tend to be lower across phenotypes in a linear manner and after adjustment for age, sex, and puberal status (Figure 1).

CONCLUSION: The present study showed a greater insulin resistance in adolescents with the MUO phenotype, compared to those classified in MHO and eutrophic phenotypes, highlighted by the linear decrease of hyperglycemic clamp glucose infusion rate, insulin sensitivity index, and disposition index across metabolic phenotypes. The results presented here reinforce the utility of stratifying obesity diagnosis into phenotypes for a better metabolic risk assessment. Acknowledgements: To CNPq, for the grant n° 563,664/2010–0.

O16

The short-term effect of nutritional education groups added to usual care in outpatients with type 2 diabetes mellitus: a randomized clinical trial

Aline Busanello, Vanessa Machado Menezes, Olivia Garbin Koller and Jussara Carnevale de Almeida

UFRGS

INTRODUCTION: Lifestyle modification strategies are recommended for managing diabetes. Research suggests that adopting a person-centered approach and increasing contact with healthcare teams, whether in group or individual settings, may improve disease outcomes. Diabetes treatment emphasizes anti-hyperglycemic medications, healthy eating, regular physical activity, self-monitoring, diabetes education, mental health, and smoking cessation. This study aimed to evaluate the effects of adding group nutritional education to usual care in specialized nutrition outpatient services on glycemic control, adherence to individual nutritional counseling, and contact hours with the healthcare team among patients with type 2 diabetes (T2DM).

METHODS: We conducted a parallel-group, randomized controlled trial at a university hospital involving outpatients diagnosed with T2DM and poor glycemic control. Participants were randomly assigned in a 1:1 to one one of two treatment arms: (1) individual usual care only or (2) usual care supplemented with nutritional education groups. Baseline and four-month assessments were performed for all participants. Outcome measures included glycemic control, adherence to nutritional counseling, frequency of contact with the health team, and attendance at scheduled visits and group sessions.

RESULTS: Baseline characteristics of randomized patients were compared, and potential interactions between groups and time were examined. A total of 170 participants were included. Attendance at group meetings was 71.1%, while scheduled appointments in the control group were 77.7% (P < 0.001). Significant differences were observed between groups in contact with the healthcare team after the intervention: [5 (IQR = 4–7) versus 4 (IQR = 3–6), respectively; P < 0.001]. Patients in the intervention group showed a higher proportion of adherence to counseling for the Diabetes Plate method and inclusion of health snacks (P < 0.05). A slight reduction was noted in weight, waist circumference, HbA1c, and HDL cholesterol at four months compared to baseline (P < 0.05 for all comparisons). However, no statistically significant differences were found when evaluating the interaction between time and randomization.

CONCLUSION: Group nutritional education, when added to usual care, led to significant improvements in several key outcomes among patients with type 2 diabetes. These improvements included increased contact with healthcare teams, higher adherence to nutritional counseling, and positive trends in weight, waist circumference, HbA1c, and HDL cholesterol levels. While statistical significance was not achieved for all parameters, the observed trends suggest the potential benefits of integrating group nutritional education into diabetes management programs. Further research is warranted to explore the long-term effects and refine strategies to optimize patient outcomes in diabetes care.

O17

The species anaerotruncus colihominis correlates with adiposity, metabolic markers, food comsumption and mental health status in women with obesity, normal weight, constitutional thinness and anorexia nervosa

Paula Waki Lopes da Rosa¹, Ariana Ester Fernandes², Roberta Cristina Rueda Martins³, Ester Cerdeira Sabino³, Lucas Augusto Moyses Franco³, Gaspar Camilo³, Aritânia Sousa Santos⁴, Táki Athanássios Cordás⁵, Cintia Cercato¹, Maria Edna de Melo¹ and Marcio Correa Mancini¹

¹Faculdade de Medicina da USP; ²Faculdade de Saúde Pública da USP; ³Instituto de Medicina Tropical da Faculdade de Medicina da USP; ⁴Laboratório de Investigação Médica LIM - 18 da FMUSP; ⁵Instituto de Psiquiatria do HCFMUSP

INTRODUCTION: Obesity (OB) is a chronic disease with increasing prevalence all over the world. Anorexia nervosa (AN) is characterized by self-image dissatisfaction and fear of weight gain, leading to dietary restriction regardless of low body weight. OB and AN represent an economic burden to health systems. On the other hand, constitutional thinness (CT) is a normal physiological condition, characterized by a BMI below 18.5 kg/m2, with body weight stability, difficulty in gaining weight, and regular and physiological periods. There is increasing evidence that gut microbiota (GM) associates with metabolic and psychiatric disorders, and hope on the therapeutic use of probiotic to reverse pathologic conditions. The species Anaerotruncus colihominis is an acetate and butyrate producer and there is still few evidence of how it interferes in host health and disease, but most studies suggest a negative correlation of its abundance in OB, diabetes, and high fat consumption. The aim of our study was to analyze GM correlations with food consumption, clinical and psychological parameters in women with OB, AN, CT, and normal weight (NW). The inclusion of the CT group for comparisons is an important originality to differentiate a physiologic low body weight from a pathologic condition.

METHODS: A total of 77 volunteers aged between 18 and 40 years with OB (20), NW (19), CT (20) and AN (18) were submitted to anthropometric measurements, laboratory tests, stool sample collection, psychological questionnaires related to body image satisfaction, eating behavior (restriction or compulsion), anxiety and depression. Although all groups were asked to bring the 3 days food consumption records, we could not have enough and trustable data from the AN group, which had to be excluded from this analysis. DNA was extracted from stool samples and submitted to 16S rRNA gene analysis in Ion Torrent Personal Genome Machine System.

RESULTS: The species A. colihominis showed a positive correlation with use of antidepressants (p = 0.02), Beck Anxiety Test (BAI) score (p = 0.02), and adiponectin levels (p = 0.004). There was a negative correlation with BMI (p = 0.01), waist circumference/height ratio (p = 0.04), as well as leptin (p = 0.013), fat mass adjusted leptin (p = 0.02), uric acid (p = 0.04), glycated hemoglobin (p = 0.02), and vitamin D (p = 0.03) levels. The CT, NW and OB group food record analysis showed negative correlation with total calories (p = 0,013), protein (p = 0.014), total fat (p = 0.002), saturated fat (p = 0.01) and polyunsaturated fat (p = 0,013) ingestion.

CONCLUSION: Our study presents negative correlation of A. colihominis with adiposity parameters and food consumption, and positive correlation with use of antidepressants and anxiety scores in women with OB, AN, CT and AN. Further studies are needed for better understanding of how this species acts on host lipogenesis, metabolism, and mental health status.

O18

Energy intake estimation from eating sensor data with the automatic ingestion monitor v2 (aim-2)

Delwar Hossain¹, Graham Thomas², Megan A. Mccrory³, Janine Higgins⁴ and Edward Sazonov¹

¹The University of Alabama; ²The Miriam Hospital; ³Boston University; ⁴University of Colorado School of Medicine

BACKGROUND: The Automatic Ingestion Monitor (AIM-2) is a device that passively monitors food intake without requiring self-reporting of eating episodes. The device relies on optical and accelerometer sensors to differentiate between eating, talking, and various kinds of physical activity. Additionally, the AIM-2 contains a camera sensor that is triggered by automatic detection of eating, allowing it to capture images of food and beverages being consumed. The objective of this presentation is to introduce the AIM-2 and the preliminary results of developing energy intake models relying on data from the AIM-2 sensors.

METHODS: The model training dataset was collected at the University of Alabama, which consists of 30 healthy participants (aged 18 – 45 years with a BMI range of 16.5–45.4 kg/m2), who wore the device for two days and provided weighed food records of their consumed meals and snacks. The researcher calculated the consumed caloric energy from the weighed food record data which were used as ground truth to develop a regression model for the estimation of energy intake from the optical and accelerometer sensor signals. The validation study took place at the Miriam Hospital, Providence Rhode Island, and Boston University, Boston, Massachusetts. The Institutional Review Board at Miriam Hospital approved the studies, and all individuals gave written, informed consent prior to participation. Healthy, non-smoking participants (n = 40) aged 18–65 years with a BMI range of 27.1–44.2 kg/m2 who had no medical conditions that affected their ability to eat or chew food were recruited. The participants wore the AIM-2 during the waking hours for one week. Randomly selected three days (two weekdays, one weekend day) food images captured by AIM-2 were annotated by trained nutritionists at the University of Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Campus. The annotated data were used to validate the trained regression model for the estimation of energy intake from the optical and accelerometer sensor signals.

RESULTS: The trained sensor-based regression model to estimate energy intake achieved an R-squared value of 0.46. When blindly applied to the validation dataset, the sensor-based regression model estimated daily caloric energy consumption of 2,800 ± 2,420 kcal,. By addressing and removing the false food intake detection through sensor-assisted manual image review, the daily average caloric energy consumption estimation by the sensor model was reduced to 1900 ± 850 kcal.

CONCLUSION: The preliminary results of energy intake estimation from the optical and accelerometer sensor signals of AIM-2 support the feasibility of using the device in studies of energy intake. Further improvement of the models will focus on integrating information from the food images to remove false intake detection to reduce overprediction in energy intake models.

O19

Effects of mirabegron and quinolone on the activation of brown adipose tissue in humans (miraql-BAT study)

Marcelo Miranda de Oliveira de Lima, Bruno Geloneze, Licio Augusto Velloso, Celso Darío Ramos, Maria Eduarda Martelli and Marcelo Alves Mori

State University of Campinas

ABSTRACT: Brown adipose tissue (BAT) has regulatory functions on energy (thermogenesis), glucose and lipid homeostasis. Drugs such as beta-3 adrenergic agonists and quinolones are candidates for activating BAT for therapeutic purposes in humans

OBJECTIVE: To evaluate the effects of mirabegron (beta-3 adrenergic agonist), ciprofloxacin (quinolonone), or the combination of both, on the activation of BAT, glucose and lipid homeostasis. We present here the preliminary results of this ongoing study.

METHODS: Population: adult women up to 40 years-old, BMI 27–35 kg/m2 and insulin resistance (HOMA-IR > 2,7). Prospective, double-blind, randomized, crossover study, with 20 participants allocated to two interventions in random order: (1) mirabregron 100 mg/day plus placebo, 4 weeks (M intervention); (2) mirabregron 200 mg/day plus placebo for 2 weeks, followed by mirabregron 200 mg/day plus ciprofloxacin 1,000 mg/day for 2 weeks (MQ intervention). Ten of the participants were also randomized to participate in a third intervention: placebo for 2 weeks, followed by ciprofloxacin 1,000 mg/day plus placebo for 2 weeks (Q intervention). There was a washout period of 4 weeks between interventions. Primary outcome: increased BAT activity [positron emission tomography with fluorodeoxyglucose computed tomography (FDG-PET-CT) at room temperature (25°C). Secondary outcomes: changes in weight and circumference of the waist, hip and neck; changes in glucose, insulin, hemoglobina A1c, total cholesterol and fractions and triglycerides.

RESULTS: we have included 13 participants so far (median age 31 years, range 19–38 years; median BMI 32.9 kg/m2, range 29.3–35.0 kg/m2). The median HOMA-IR was 6.4 (range 3.7–8.6). There were no significant changes in anthropometric and metabolic parameters after interventions. BAT was not activated by ciprofoxacin alone in ten participants. BAT was activated in 4/7 participants after mirabegron (M) (median SUVmax = 13.3, range 7.0–23.6) and 2/4 after mirabegron plus ciprofloxacin (MQ) (median SUVmax = 16.7, range 4.8–22.7). Two participants completed both M and MQ interventions. One of them had BAT activation in none of the interventions. The other one had BAT activation after M and, to a greater extent, after MQ (SUVmax 12.1 and 22,7, respectively; baseline SUVmax 2.65).

CONCLUSION: This is the first study that demonstrates BAT activation after mirabegron intervention at room temperature in a tropical country. BAT is not activated by ciprofloxacin but may be activated by mirabegron, either alone or in combination with ciprofloxacin. The combination resulted in greater activation of BAT in one participant, but further results of this study will confirm whether this was an effect of treatment or not.

O20

Long-term effect of metabolic-bariatric surgery on mortality and macro and microvascular outcomes in adults with obesity, metabolic dysfunction-associated steatotic liver disease, and diabetes

Arunkumar Krishnan¹, Arunkumar Krishnan¹, Tinsay A. Woreta² and Saleh A. Alqahtani³

¹Atrium Health Levine Cancer; ²Johns Hopkins University School of Medicine; ³King Faisal Specialist Hospital & Research Center

BACKGROUND: Obesity and type 2 diabetes (T2D) are well-known risk factors for the development of metabolic dysfunction-associated steatotic liver disease (MASLD). Metabolic and bariatric surgery (MBS) is a weight-loss intervention that results in long-term improvements in patients with MASLD. We aimed to investigate the long-term effects of BS on macro and microvascular outcomes and all-cause mortality in patients with obesity, MASLD, and T2D compared to nonsurgical care.

METHODS: This large population-based, retrospective cohort study was conducted using the data from the global federated health research network and included adult patients (> 18 years) diagnosed with MASLD, T2D, and obesity. We performed a 1:1 propensity score matching (PSM) for demographics, body mass index (BMI), and comorbid conditions to similar controls as patients without a surgical history. MBS procedures included Roux-en-Y gastric bypass and sleeve gastrectomy. The primary outcomes were the incidence of macrovascular diseases defined as the composite indicator of the first occurrence of heart failure, major adverse cardiovascular events (MACE), or cerebrovascular disease. Microvascular diseases were defined as the composite indicator of the first occurrence of retinopathy, neuropathy, or nephropathy, or all-cause mortality after the index date were considered secondary outcomes. Sensitivity analysis assessed the robustness of the findings, while an additional sensitivity analysis of the 7-year results determined the consistency of the outcomes by increasing the exposure lag by two years and excluding the events/incidences prior. The hazard ratio (HR) was calculated to compare the association of the BS with the outcomes.

RESULTS: A total of 91,922 patients were identified. Among these, 2,898 patients had a history of BS, and 89,024 did not, with a median follow-up time of 5.1 years. After PSM, MBS and nonsurgical groups (2,449 each) were well matched. MBS patients had a higher mean BMI than the nonsurgical cohort. In the adjusted analysis (Table 1), the risks of MACE (HR, 0.37), heart failure (HR, 0.43), and composite cerebrovascular diseases (HR, 0.65) were significantly lower for MBS than nonsurgical patients. MBS was also associated with a lower incidence of the secondary outcomes of microvascular diseases and all-cause mortality. These outcomes were consistent at follow-up durations of 1, 3, 5, and 7 years. The results of the sensitivity analyses were consistent, and all statistically significant associations remained unchanged.

CONCLUSION: Compared with nonsurgical care, MBS was associated with a significantly lower risk of macro and microvascular outcomes and all-cause mortality in patients with MASLD, obesity, and T2D. Thus, MBS could be considered an option for this patient group, especially those who have not shown significant improvements with lifestyle interventions and other treatments.

O21

Molecular characterisation of obesity by measuring metabolomic changes after weight loss

Madeleine L. Smith¹, Lucy J. Goudswaard¹, David A. Hughes¹, Jane M. Blazeby¹, Chris A. Rogers¹, Eleanor Gidman¹, The By-band-sleeve Trial Management Group¹, Alex Mcconnachie², Paul Welsh², Roy Taylor³, Michaele J. Lean², Naveed Sattar³, Nicholas J. Timpson¹ and Laura J. Corbin¹

¹University of Bristol; ²University of Glasgow; ³Newcastle University

ABSTRACT: Clinical trials of weight loss interventions offer the opportunity to precisely characterise the molecular underpinnings of obesity, using technologies such as metabolomics. Metabolomics is the measurement of small molecules (metabolites) that are products of cellular metabolism. In a trial setting, metabolomic changes can be tracked alongside changing body mass index (BMI) and other clinical outcomes. By-Band-Sleeve (BBS) is a randomized clinical trial that recruited 1,351 participants to compare the efficacy of gastric band, gastric bypass and sleeve gastrectomy. Serum samples were collected at baseline (pre-surgery) and 36-months post-baseline. Mass spectrometry (MS) and proton nuclear magnetic resonance (NMR) spectroscopy metabolomics analyses were performed on over 1,400 serum samples. After pre-processing and quality control, 1,434 samples had data for 1,253 MS-measured metabolites and 1,410 samples had data for 250 NMR-measured metabolic traits. Of the 1,129 MS metabolites that were tested in a linear mixed model, the abundances of 379 (31%) metabolites were altered after bariatric surgery (Holm-corrected p < 0.05) of which 216 (57%) were decreased and 163 were increased post-surgery. Metabolonic lactone sulfate was the MS metabolite with the strongest association with the intervention. This metabolite which has previously been found to have positive associations with BMI and cardiometabolic risk, was decreased post-surgery. Of the 250 NMR traits, 136 (54%) were altered after bariatric surgery (Holm-corrected p < 0.05). Six of the seven NMR traits with the strongest associations with the intervention were in the Large HDL subclass, including an increase in cholesterol in large HDL. Levels of large HDL have previously been found to have inverse relationships with cardiovascular risk. Branched chain amino acids (BCAAs), measured by both MS and NMR, were shown to decrease after surgery which is consistent with previous studies showing elevated levels in obesity. We compared the results from BBS to those from a clinical trial of a non-surgical weight management programme (the Diabetes Remission Clinical Trial [DiRECT]) where the same MS metabolites had been measured pre- and post-intervention. We found that 72 metabolites were associated with BMI in both studies, including BCAAs, glutamate and metabolonic lactone sulfate. We repeated analyses in BBS in subgroups according to the type of bariatric surgery the participant received and found that 23 of the 72 metabolites retained consistent associations with BMI in all three subgroups, including metabolonic lactone sulfate, valine and glutamate. These 23 metabolites are associated with BMI regardless of intervention type and likely provide insight into the biological processes altered during weight change. In summary, we have characterised the metabolomic footprint of weight loss using metabolomics data from two large clinical trials, to identify a set of metabolites relevant to the biology of obesity

O22

Does obesity confer a differing risk on pregnancy outcomes in women with type 1 diabetes versus type 2 diabetes? Novel data from an Australian retrospective study (2010–2019) comparing pregnancy outcomes stratified by BMI category in women with PREGE

Xi May Zhen^1,2, Jencia Wong³, Amanda Gauld², Arianne Sweeting¹, Stephanie Noonan², Lynda Molyneux¹, Maria Constantino¹, Anna-jane Harding¹, Adam Mackie¹, Hend Chatila⁴, Margaret Mcgill⁴, Ted Wu² and Glynis Ross¹

¹Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; ²Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; ³Department of Endocrinology, Blacktown Hospital, Sydney, NSW, Australia; ⁴Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia

BACKGROUND: Type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and obesity are individually associated with increased risk of adverse pregnancy outcomes. However, it is unclear whether overweight and obesity confer a differing risk with regard to pregnancy outcomes in those with pregestational diabetes. We present novel data comparing pregnancy outcomes in people affected by T1DM vs T2DM stratified by BMI category.

METHODS: Eligible participants were women with pregestational diabetes (T1DM or T2DM) and singleton pregnancies that had presented for their initial antenatal diabetes clinic visit within a 10 year period (2010 to 2019) at a tertiary referral hospital in Sydney delivering specialist diabetes and maternity services. Pregnancy outcomes between the T1DM and T2DM cohorts stratified by BMI category were analysed for comparison. Summary of Results The dataset included 263 pregnant women (N = 124 for T1DM, N = 141for T2DM). In the T1DM cohort, 34.7% of women had a BMI in the overweight category, while 11.3% of women were affected by obesity (1.6% had Class II or III obesity). In the T2DM cohort, 27.7% had a BMI in the overweight category, while 66.1% of women were affected by obesity (39.3% had class II or III obesity). Across all 3 BMI categories, women with T1DM were more likely to have a 3rd trimester HbA1c > 6% compared to women with T2DM. The risks of excess GWG and pre-eclampsia were comparable between those with T1DM vs T2DM across all 3 BMI categories. Amongst women with normal weight, the risks of preterm birth, LGA infant, and NICU admission were significantly higher in women with T1DM compared to women with T2DM (p < 0.05 for all). However, amongst those affected by obesity, women with T1DM vs T2DM were comparable in terms of the risks of preterm birth (aOR 2.404, 95% CI 0.433 to 13.342), LGA infant (aOR 0.378, 95% CI 0.074 to 1.938), and NICU admission (aOR 0.169, 95% CI 0.018 to 1.608).

CONCLUSION: Women with T1DM had higher 3rd trimester HbA1c across all weight categories when compared to those with T2DM. Amongst normal weight women, outcomes were generally worse in women with T1DM when compared with those with T2DM. Obesity appears to have a stronger association with increased risks of preterm birth, LGA infant, and NICU admission in women with T2DM compared to T1DM.

O23

Service evaluation of a tier 3, integrated weight management pathway using saxenda (liraglutide) and its impact on reducing cardiovascular risk factors for people living with obesity

Dr Ranjana Babber¹, Dr Sophie Edwards¹, Paul Gately² and Dr A. B. Sirin-ayva¹

¹MoreLife, UK; ²Leeds Beckett University

ABSTRACT: Background NICE (TA664) has approved Liraglutide as an adjunct to reduced calorie diet and increased physical activity for managing weight in adults living with obesity, prediabetes and one of the other cardiovascular risk factors. Our two-year integrated weight management pathway includes a comprehensive medication pathway led by Consultant Endocrinologist, offers review and monitoring at regular intervals by multidisciplinary team including specialist dietitian, clinical psychologist. Although the safety and efficacy of medication is monitored through one-to-one remote clinics, all the patients are enrolled to a psychologically informed evidence based behavior change intervention delivered through group sessions to ensure peer-based learning, social support and reinforce strategies aimed at sustained engagement with healthy eating and active lifestyle. Methods The patients enrolled for our Greater Manchester Tier 3 adult weight management service (March 2022–July 2023) were screened for Saxenda as per eligibility criteria defined by NICE guidance. The results for biochemical parameters as HbA1c, lipid profile and blood pressure readings were requested from patients GP at the start as well as for annual review. Retrospective audit of data was carried out to examine and report the 12-month outcomes for improvement in cardiovascular risk factors. Results Out of total 85 patients, who started on Saxenda pathway, these 12 month outcomes are reported for a subgroup (n = 23), who attended their annual review with Consultant Endocrinologist. The demographic profile indicated that mean age of the group is 52y (SD 9.1), majority females (82.6%) and from British ethnic origin (81%), Black Caribbean (9.5%), Asian (4.8%) and other ethnic origin (4.8%). The review of outcomes at 12 month review on medication pathway indicated substantial downward shift in BMI from mean 47.2 kg/m2 (SD10.7) to mean 41.7 kg/m2 (SD10.6) and clinically significant shift from non-diabetic hyperglycemia to normoglycemic levels as suggested by change in mean HbA1c levels of 43.5 (SD1.4) mmol/mol to 38.5 (SD2.7) mmol/mol. The results for lipid profile indicate reduction in mean total cholesterol levels from 6 (SD1.7) mmol/l to 4.6 (SD 1.7) mmol/l and improvement in mean HDL cholesterol levels 1.1(SD 0.25) to 1.4 (SD 0.28). There had been substantial reduction in both systolic (SBP) and diastolic blood pressure (DBP) readings as 138.6(SD 12.1) to 124.2 (SD 9.5)mmHg and from 86.2 (SD 4.3) to 79 (SD 8.5)mmHg respectively. Conclusion Our integrated medication pathway for weight management has been successful in improving weight loss outcomes as well as in improving glycemic control, that needs to be translated into reducing huge economic burden of managing diabetes. Such improvement in cardiovascular health associated with improved weight outcomes is vital and behavior change intervention is key to sustaining these results in long term.

O24

The metabolically healthy obesity phenotype has more activation of brown adipose tissue than the metabolically unhealthy obesity phenotype

Isabela Solar, Maria Eduarda Martelli, Laura Ramos Gonçalves, Vinícius Ferreira Santos, Lício Augusto Velloso, Bruno Geloneze and Ana Carolina Junqueira Vasques

Universidade Estadual de Campinas (UNICAMP)

BACKGROUND: Obesity with no metabolic alteration represents a unique model for the study of the mechanisms related to the increase of body adiposity and the development of comorbidities. Given the potential importance of the interrelationships of brown adipose tissue (BAT) with the different metabolic phenotypes of obesity, the opportunity opens for a better understanding of obesity as a disease from this perspective. This study aimed to compare cold-induced BAT activation in women with the phenotypes metabolically healthy obesity (MHO), intermediate obesity (IO), metabolically unhealthy obesity (MUO) and metabolically healthy eutrophy (MH) and their association with cardiometabolic health parameters.

MATERIALS AND METHODS: Ongoing cross-sectional study, approved by the Ethics Committee (39037120.0.0000.5404), with 84 women (22 MHO, 22 IO, 6 MUO, 34 MH) aged between 20 and 40. The metabolically healthy participants had no changes in blood pressure, glucose and lipid profile. The IO had one metabolic alteration and metabolically unhealthy had at least two metabolic alterations in these metabolic parameters. The BMI of eutrophy was < 25.0 kg/m² and obesity > 30.0 kg/m². The BAT activation was assessed by the infrared thermography in the supraclavicular area after 2 hours of cold exposure (18°C). The area under the curve of temperature (AUCtemp) obtained during the cold exposure was considered. Waist circumference and body composition were assessed by DXA, as were glycemic (fasting glycemia and insulinemia and glycated hemoglobin (A1c)) and lipid profiles (LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides) and HOMA-IR. We performed multiple linear regression analysis with the number of cardiovascular risk factors (blood pressure, glucose and lipid profile) and age as independent variables, and AUCtemp as the dependent variable.

RESULTS: The MHO, IO and MUO phenotypes did not differ according to BMI and age (p > 0.05). AUCtemp was negatively correlated with BMI (r = −0.61), waist circumference (r = −0.59), fasting glycemia (r = −0.39), insulinemia (r = −0.46), A1c (r = −0.37), HOMA-IR (r = −0.50), triglycerides (r = −0.44), total cholesterol (r = −0.34), LDL-cholesterol (r = −0.28), % body fat (r = −0.63), android fat (r = −0.64), gynoid fat (r = −0.59), visceral fat (r = −0.65), systolic blood pressure (r = −0.28) and diastolic blood pressure (r = −0.32) [p < 0.001]. All the phenotypes differed of BAT activation, and the MUO group showing lower AUCtemp (3,965 ± 69) than the NW (4,129 ± 74), MHO (4,034 ± 82) and IO (4,060 ± 45) [p = 0.001]. Finally, a multiple linear regression analysis adjusted for age showed that higher AUCtemp was associated with less risk factors (β = −37.71 [−56.4; −19.0] p = 0.001). Conclusion: The results suggest that the MUO phenotype shows lower BAT activation compared to the MHO, IO and MH phenotypes, and that greater BAT activation capacity is associated with a better cardiometabolic health and lower presence of risk factors. FAPESP: 2021/02008–5.

O25

Prevalence and trends of the metabolically healthy obese phenotype in an arab population

Nasser Al-daghri¹, Kaiser Wani¹, Balvir Kumar², Nasser Al-daghri¹ and Shaun Sabico¹

¹King Saud University; ²Chandigarh University

ABSTRACT: The metabolically healthy obesity (MHO) phenotype represents a complex and distinctive phenomenon, the prevalence of which remains unknown in the Saudi Arabian adult population. The present study aims to fill that gap. A combined total of 10,220 Saudi adults from 2 independent cohorts [2008–2019, N = 7,896 (2,903 males and 4,993 females), and 2021–2023, N = 2,324 (830 males and 1,494 females)] aged 19–70 years old was screened, of whom 9,631 (3,428 males and 6,203 females) were included. Anthropometric data were measured, and fasting blood samples were collected to assess circulating glucose and lipids using routine methods. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. Screening for MHO was done twice, using the empiric definition proposed by Zembic and colleagues and the criteria set by the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATPIII). Over-all, 3,949 (41.0%) participants, classified as obese, were used to investigate the prevalence and trends of MHO; 37.3% (95% confidence interval, CI, 30.6%,44.8%) of whom were considered MHO using the empiric definition, and 37.3% (95% CI, 30.8%,44.8%) using NCEP-ATPIII. The overall age-adjusted prevalence of MHO in the Saudi adult population was 15.3% (95% CI, 12.3%–19.1%) and 15.4% (12.9%–18.3%) by the two definitions respectively. Females had a significantly higher age-adjusted prevalence of MHO than males (OR = 1.5 [95% CI, 1.1–2.0], p = 0.009). MHO prevalence substantially increased over time from 2008–2023 (p < 0.001) for both definitions. In summary, the study highlights for the first time the prevalence and trends of the MHO phenotype among Saudi Arabian adults, opening new doors for obesity research in this homogenous ethnic group

O26

GLP-1 receptor agonists and the risk of cholangiocarcinoma in individuals with type 2 diabetes with overweight/obesity: a large population-based nationalwide matched cohort study

Arunkumar Krishnan¹, Arunkumar Krishnan¹ and Saleh A. Alqahtani²

¹Atrium Health Levine Cancer; ²King Faisal Specialist Hospital & Research Center

BACKGROUND: Preclinical evidence raises concerns that incretin-based drugs may increase the risk of cholangiocarcinoma (CCA), yet epidemiologic studies are conflicting. Available observational studies have examined the potential effect of new users of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on the risk of CCA and have reported contradictory results owing to confounding biases. Given the significant morbidity and mortality associated with CCA and the steadily increasing number of prescriptions of GLP-1RAs worldwide, there is an urgent need to investigate the long-term risks of using GLP-1RAs.

METHODS: We aimed to determine whether an association exists between new users of GLP-1RAs and the incidence of CCA in overweight/obese patients with type 2 diabetes (T2D). Using the TriNeTx database, we conducted a population-based cohort study to analyze consecutive patients diagnosed with T2D with overweight/obesity between 2007 and 2021. Using a time-varying exposure definition, we categorized patients into one of the four categories: GLP-1RA, sodium-glucose transport protein-2 inhibitors (SGLT2i), second or third-line drugs, and metformin. We conducted three separate cohort studies to analyze the association between the risk of CCA. Cohort entry to the study was considered the date of this new prescription. Only patients who continued these drugs after six months of treatment initiation were included. The primary outcome was the incidence of CCA. We performed a 1:1 propensity score matching (PSM) to reduce confounding effects. We conducted a secondary and sensitivity analysis by increasing the duration of the drug usage and latency period to assess the robustness of the findings. Outcomes were estimated using a Cox proportional hazards model with hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS: In this cohort, we identified 598,767 patients receiving GLP-1RA, 2,711,170 patients who were new users of second or third-line drugs, 467,890 using SGLT2i, and 178,679 using metformin. At one year of follow-up, CCA occurrence was observed in 143 patients with the use of GLP-1RA and 298 patients with the use of second- or third-line treatment after PSM (HR, 0.43 (95% CI 0.32–0.71) (Table 1). Compared with SGLT2i, CCA occurrence significantly reduced hazards of CCA observed among the new users GLP-1RA (HR 0.67, 95% CI 0.56–0.87). CCA occurrence was observed in 134 new users of GLP-1RA compared to metformin users (HR 0.51, 95% CI 0.42–0.79). The secondary and sensitivity analysis results showed a similar magnitude to the one generated in the primary analysis.

CONCLUSIONS: In this large population-based cohort study using nationwide, the use of GLP-1RAs, compared with second- or third-line medications, SGLT2i, and metformin was not associated with a significantly increased risk of CCA in adults with T2D and overweight/obesity. These findings provide reassurance regarding the safety of these drugs and the long-term risk of CCA.

O27

Combination of topiramate and sibutramine for the treatment of obesity in real-world clinical practice

Cintia Cercato, Marcio C. Mancini, Gabriel Neimann da Cunha Freire, Eduardo Zanatta Kawahara, Ariana Ester Fernandes and Maria Edna de Melo

HCFMUSP

INTRODUCTION: Long-term treatment of obesity with lifestyle changes alone is unsustainable for most individuals. Anti-obesity medications are indicated for individuals with a body mass index (BMI) ≥ 30 kg/m² or a BMI of ≥27 kg/m² in the presence of one or more comorbidities. In Brazil, the prescription of a combination of topiramate and sibutramine for obesity management is common. However, there is a lack of information regarding its effectiveness and safety. The objective of this study was to evaluate the combination of topiramate and sibutramine for the treatment of obesity in real-world clinical practice.

METHODS: This retrospective study included individuals with obesity aged ≥18 years who were prescribed topiramate plus sibutramine for at least 6 months between 2012 and 2022 at a large tertiary healthcare system. Baseline and follow-up demographic characteristics (age, sex, weight, BMI, comorbidities of interest) and cardiometabolic biomarkers (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blod glucose, and triglyceride levels as well as blood pressure) were captured from medical records.

RESULTS: The full cohort consisted of 859 participants of which 247 (28.8%) received the combination therapy. The mean doses of sibutramine and topiramate were 11.3 ± 4.6 mg and 119.7 ± 54.8 mg, respectively. Most participants were female (86.2%) with mean age of 43.4 ± 12.7 years, 52% had hypertension, 31.8% had type 2 diabetes and 30% had dyslipidemia. The average baseline BMI and weight were 39.7 kg/m², and 100.1 kg, respectively. The average weight loss was 7.5% ± 12.4% at a mean follow-up duration of 24.3 ± 18.2 months. There was a significant change in body weight at 6, 12, and 24 months after initiation of treatment (95.1 ± 21.4 kg, p < 0.001; 94.4 ± 15.6 kg, p < 0.001; and 92.4 ± 19.3 kg, p < 0.001, respectively) as well as an improvement in cardiometabolic biomarkers. The most common adverse effects reported were paresthesia, somnolence, attention deficit and constipation, and the rate of treatment discontinuation due to adverse events was 7.7%.

CONCLUSIONS: In a real-world setting, a combination of topiramate and sibutramine was associated with clinically meaningful weight loss with improvement of cardiometabolic factors and satisfactory tolerability.

O28

Probiotic supplementation did not enhance the effects of continuous calorie restriction on body adiposity: a randomized, double-blind, placebo-controlled clinical trial

Camila Guazzelli Marques¹, Marcus Vinicius Lucio dos Santos Quaresma², Catarina Bortoloto França Ferracini², Filipa Bettencourt Alves Carrilho², Glaice Aparecida Lucin¹, Fernanda Patti Nakamoto², Leonardo Azevedo Mobília Alvares² and Ronaldo Vagner Thomatieli dos Santos¹

¹Department of Psychobiology, Federal University of São Paulo; ²Exercise and Quality of Life Laboratory, São Camilo University Center

INTRODUCTION: Continuous caloric restriction (CCR) is a well-established dietary intervention known for its effectiveness in reducing body mass and fat in people living with obesity. More recently, probiotics have been suggested as a potential weight loss strategy, particularly for their supposed positive role in the composition and activity of the gut microbiota (GM). However, the effects of probiotics on adiposity in humans are still inconsistent and limited, especially when combined with CCR.

OBJECTIVE: To verify the effect of CCR with probiotic supplementation on body adiposity in men with obesity. Methods: This is a randomized, double-blind, placebo-controlled clinical trial approved by the Ethics and Research Committee of UNIFESP (57484122.1.0000.5505). Inclusion criteria were sedentary men aged 25 to 44 years, with a BMI between 30 and 39.99 kg/m2, stable body mass, and without diseases or medications that affect GM. Randomization was performed in blocks of 4 participants, allocated in a 1:1 ratio to two groups: CCR with probiotics (CCRPro) and CCR with placebo (CCRPla). CCR was set at 30% of total energy expenditure (TEE). TEE was obtained by summing resting energy expenditure (measured through indirect calorimetry), physical activity energy expenditure (activity factor of 1.5), and the thermic effect of food (10%). The individualized diet comprised 50% carbohydrates, 30% fat, and 20% protein. Probiotic supplementation comprised 1x109 CFU of each strain (Lactobacillus acidophilus NCFM, Lactobacillus rhamnosus HN001, Lactobacillus paracasei LPC-37, and Bifidobacterium lactis HN019), while the placebo was maltodextrin. After the 12-week intervention, body adiposity was assessed by bioelectrical impedance. To evaluate the effects of time, groups, and interaction, a repeated-measures ANOVA plus Bonferroni post-hoc was applied. A significance level of p ≤ 0.05 was adopted to reject the null hypothesis.

RESULTS: 30 men were included in the study, with 15 in the CCRPro group (34.1 ± 4.48 years; 33.9 ± 2.41 kg/m2; 34.1 ± 5.08% body fat) and 15 in the CCRPla group (36.1 ± 3.75 years; 34.9 ± 2.40 kg/m2; 35.1 ± 3.0% body fat). After 12 weeks of CCR, total body mass decreased (F = 61.841; p < 0.001; η2G = 0.747), with no differences between groups (p = 0.658). Absolute fat mass (kg) decreased over time (F = 49.342; p < 0.001; η2G = 0.80) in both groups, without differences between groups (p = 0.803). Relative body fat (%) decreased after 12 weeks in both groups (F = 26.219; p < 0.001; η2G = 0.555), without differences between groups (p = 0.559). Still, visceral fat area (F = 25.999; p < 0.001; η2G = 0.565) decreased after 12 weeks in both groups, without differences between groups (p = 0.821). The average reduction in body fat was 4.74 and 5.66 kg in the CCRPla and CCRPro groups, respectively, indicating a difference of 16.25% (~ 920 g of body fat).

CONCLUSION: Probiotic supplementation did not exhibit an additive effect on the reduction of fat mass-related parameters after 12 weeks of CCR in men living with obesity.

O29

Relationships between blood DNA methylation, diet quality and metabolic health in a spanish population

Aline Rosignoli da Conceição¹, José Ignacio Riezu-boj², Marta Cuervo², J. Alfredo Martínez², Fermín I. Milagro² and Josefina Bressan¹

¹Department of Nutrition and Health, Federal University of Viçosa, Viçosa, MG, Brazil; ²Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain

INTRODUCTION: Epigenetic mechanisms have been proposed as a possible factor in understanding inter-individual differences in disease susceptibility, being DNA methylation (DNAm) the best well-characterized epigenetic marker. Since DNAm can be modulated through diet or specific nutrients this research aimed to determine the correlation between blood DNAm, diet quality, and metabolic health in a Spanish population. Also, we aimed to design a model that, based on DNAm, predicts the quality of diet. Materials and methods: Male and female individuals with normal weight (BMI < 24.9 kg/m2), overweight (BMI 25–29.9 kg/m2) or obesity (BMI 30–40 kg/m2) with an age range of 18–67 years old from the Obekit study were eligible for this study. Habitual dietary intake was evaluated with a validated semiquantitative food frequency questionnaire and diet quality was assessed using seven previously established scores: overall, healthy and unhealthy Plant-Based Diet Index (PDI, hPDI and uPDI, respectively), dietary diversity score (DDS), unprocessed/minimally processed foods (UMPF) and ultra-processed (UPF) consumption, and Mediterranean diet (MD) score. Basal DNAm was analyzed in white blood cells using the Infinium Methylation EPIC BeadChip kit.

RESULTS: Data from 337 participants aged 44.89 ± 10.39 years were evaluated in the present study, and 69.4% of them were female. We observed a negative correlation between hPDI and body weight, waist (WC) and hip circumference, fat mass, leptin/adiponectin and triglycerides/high-density lipoprotein cholesterol (HDL-c) ratio, and a positive correlation between UPF with body weight and WC. We found a total of 4 FDR-significant diet-associated CpGs: cg00167275 (located at GLUD1) correlated with alcohol, cg05218090 with folic acid, cg16682935 (located at PAPSS2) with selenium, and cg09821790 with the fish food group. We did not find a FDR statistical significance between these CpGs and the diet quality indices. A differentially methylated region (DMR) located at the zinc finger protein gene 57 (ZFP57) was positively correlated with BMI and WC. The mean of this ZFP57 DMR was bigger in individuals with obesity than in individuals without obesity. Regression prediction models of diet quality based on DNAm demonstrated the most predictive values were associated with UPF (57.7%) and hPDI (47.6%). Conclusion: The genes studied are involved in pathways underlying insulin metabolism, food responsiveness and emotional overeating. Our results suggest promising findings for developing precision dietary intervention approaches, for determining how diet quality may influence DNAm degree, and how DNAm can be used to predict diet quality.

CONFLICT OF INTERESTS: None.

O30

Correlation of the butyrate-producing bacterium fecalibacterium prausnitzii with a better metabolic profile in women

Ariana Ester Fernandes¹, Paula Waki Lopes da Rosa¹, Maria Edna de Melo¹, Roberta Cristina Ruedas Martins², Fernanda Galvão de Oliveira Santin³, Fernanda Galvão de Oliveira Santin³, Aline Maria da Silva Hourneaux Moura¹, Cintia Cercato¹ and Marcio C. Mancini¹

¹HCFMUSP; ²FMUSP; ³FFSPUSP

INTRODUCTION: Butyrate-producing bacteria have received attention for their important role in gut metabolism and homeostasis. Faecalibacterium prausnitzii is considered one of the most important butyrate-producing bacteria and bacterial indicators of a healthy gut, representing more than 5% of the total bacterial population. Recently, studies have associated a decreased abundance of F. prausnitzii with inflammatory bowel disease, obesity, and diabetes. This cross-sectional study aimed to explore the correlation of F. prausnitzii abundance in the human gut with anthropometric parameters, metabolic profiles, and food consumption in adult women.

METHODS: The study included women aged 18–40 years, categorized into obesity (n = 20), normal weight (n = 20), and constitutional leanness (n = 19). Participants were assessed for anthropometric and metabolic markers, including fasting glucose, insulin, triglycerides, HDL cholesterol (HDL-c), LDL cholesterol (LDL-c), uric acid, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), 25-hydroxyvitamin D [25(OH)D], adiponectin, leptin levels, and HOMA-IR. Food consumption was evaluated through 24-hour food recalls on three nonconsecutive days, categorized by the NOVA classification system (G1, unprocessed/minimally processed; G2, processed; G3, ultra-processed). F. prausnitzii were analyzed through next-generation sequencing of the 16S rRNA gene from fecal samples. The Spearman correlation coefficient examined the relationship between abundance of F. prausnitzii and other variables, with a significance level set at p < 0.05.

RESULTS: F. prausnitzii abundance was associated to lower uric acid (r = −0.441, p = 0.001), ALT (r = −0.30, p = 0.018), insulin levels (r = −0.387, p = 0.003), and HOMA-IR (r = −0.375, p = 0.005), along with higher adiponectin values (r = 0.417, p = 0.001). No significant association was found between F. prausnitzii abundance, and food consumption classified by NOVA.

CONCLUSION: Our findings suggest that abundance of F. prausnitzii is related to a favorable metabolic profile in women.

O31

Assessment of cardiometabolic comorbidities in adults with osteogenesis imperfecta

Vivian Roberta Ferreira Simões¹, Manuela Giuliani Marcondes Rocha-braz¹, Regina Matsunaga Martin¹, Marcio Correa Mancini¹ and Bruno Ferraz-de-souza²

¹University of Sao Paulo School of Medicine, Sao Paulo, Brazil; ²University of Notre Dame Australia, Fremantle, Australia

INTRODUCTION: Osteogenesis imperfecta (OI) is a heterogeneous bone fragility disorder. Extra-skeletal manifestations have been well documented in children with OI, but studies in adults lack. The objective was to evaluate the presence of metabolic and cardiac comorbidities in adults with OI.

METHODS: After informed consent, adult patients with OI attending a tertiary clinic were included in this prospective study. Disease severity score, mobility score and molecular diagnosis, if available, were registered. For that, a metabolic assessment was performed including collection of weight, height and BMI data, laboratory evaluation of glycemic and lipid profile. Cardiac assessment included arterial blood pressure measurement, 24-hour ambulatorial blood pressure monitoring, electrocardiogram and transthoracic echocardiogram. The software IBM SPSS v20 was used for statistical analysis.

RESULTS: A total of 94 adults (57 females, 37 males) with OI were assessed, with ages ranging from 21 to 76 years (half of the sample was aged between 20 and 29). Molecular diagnostics were available for 61 subjects, 79% of whom had collagen defects. Most subjects had moderate to severe OI (70%) and 48% required walking support/aid or did not walk. Overweight (including obesity) was present in 57%, the lower the mobility and independence, the higher the BMI (p = 0.069). Laboratory evaluation demonstrated that 38% had low HDL-cholesterol, 11% presented high triglycerides, 13% impaired fasting glucose, 9% glucose intolerance and 3% diabetes. Insulin resistance (indirectly evaluated through the calculation of the HOMA-IR > 2.71) was present in 33% of 66 subjects, and 15% of the cohort took antihypertensive medication, although a diagnosis of arterial hypertension was made through 24-hour ambulatory blood pressure monitoring in 26% of individuals. Regarding cardiovascular diseases, 79% had normal electrocardiogram and 43% had minimal or discrete valvular regurgitation on doppler echocardiography, without clinical impact.

CONCLUSION: Therefore, the high prevalence of overweight and obesity in this cohort of adults with OI observed suggests that constant weight monitoring is necessary during the follow up as well as adequate nutritional guidance to improve body composition. Moreover, the results of the electrocardiogram and doppler echocardiography may suggest an asymptomatic heart disease in adults with OI, that could be justified due to the relatively low average age of the cohort.

O32

Assessment of the performance of body adiposity indexes, relative fat mass and body roundness in the assessment of body adiposity and insulin resistance in adults

Mila Medina Aguiar Rangel¹, Isabela Solar¹, Najla Simão Kfouri Crouchan¹, Germano Borges de Oliveira Nascimento Freitas², Maria Eduarda Martelli¹, Vinícius Ferreira Santos¹, Bruno Geloneze¹ and Ana Carolina Junqueira Vasques¹

¹Universidade Estadual de Campinas (UNICAMP); ²Universidade de São Paulo (USP)

BACKGROUND: Body adiposity (BAI), relative fat mass (RFM), and body roundness (BRI) indexes were proposed to improve the accuracy in assessing body adiposity and cardiometabolic risk in populations. However, the performance of these indexes still requires investigation in the Brazilian population. This study aimed to evaluate whether BAI, RFM, and BRI differ from traditional anthropometric parameters in measuring body adiposity according to the dual-energy X-ray absorptiometry (DXA) scans and in identifying insulin resistance.

MATERIALS AND METHODS: Cross-sectional study with 276 participants of both gender, aged between 18 and 65 years and with a BMI ranging from 18.5 and 45 kg/m², approved by the Ethics Committee (CAAE: 39037120.0.0000.5404). Traditional anthropometric parameters considered were: body mass index (BMI), waist circumference (WC) and sagittal abdominal diameter (SAD). The calculation of the new indexes considered the following variables: IAC (hip circumference and height), RFM (height, WC and gender) and BRI (WC and height). The assessment of the percentage of total body fat and visceral adipose tissue were performed by DXA. The HOMA-IR index> 2.71 was considered as insulin resistance and the glycemic (glicated hemoglobin (A1c), fasting glycemia and insulinemia) and plasma lipid profiles (LDL-cholesterol, HDL-cholesterol, triglycerides and total cholesterol) were evaluated. Data were analyzed using MedCalc software version 22.016. To evaluate the performance of the new indexes in comparison to traditional parameters, ROC curves were constructed and the Z test was performed to compare the areas under the curves (AUC). Significant p was set at 5%.

RESULTS: The median (p25-p75) age and BMI were 29 (25–35) years and 27.5 (22.5–33.6) kg/m2, respectively, with 34 men and 243 women. All new indexes and traditional parameters of body adiposity showed a positive and significant correlation with markers of body adiposity, HOMA-IR index, fasting glycemia and insulinemia, A1c, total cholesterol, LDL-cholesterol and triglycerides (p < 0.001). In identifying high body fat percentage, BMI exhibited a higher AUC (0.95 ± 0.01) compared to all indexes and parameters tested (p < 0.05 for all). In regard to the accumulation of visceral adipose tissue, the BRI demonstrated an AUC (0.92 ± 0.02) similar to that of BMI, WC and SAD (p > 0.05 for all), yet no novel index outperformed the traditional parameters. For screening insulin resistance, WC exhibited a higher AUC (0.88 ± 0.02) compared to BMI and the three new indexes tested (p < 0.05 for all), not only differing from SAD. Furthermore, the new indexes were not superior to DAS and BMI in identifying insulin resistance.

CONCLUSION: The new indexes analyzed (BRI, BAI and RFM) did not demonstrate superior performance compared to traditional parameters (BMI, WC and SAD) in screening insulin resistance, as well as in diagnosing excess total and visceral body fat in the sample of adults assessed. FAPESP 23/07121–0.

O33

Adolescents with higher caloric intake at later hours are more likely to have an increased risk of excess weight: results from a population-based study

Maria Carliana Mota¹, Claudia Roberta de Castro Moreno², Ana Elisa Madalena Rinaldi³, Catarina Machado Azeredo³ and Cibele Aparecida Crispim³

¹Facmais - Faculdade Mais de Ituiutaba, Universidade Federal de Uberlândia (UFU-MG); ²Faculdade de Saúde Pública, Universidade de São Paulo (USP); ³Universidade Federal de Uberlândia (UFU-MG)

ABSTRACT: Chrononutrition, an emerging field of nutrition science, explores the relationship between circadian rhythms, nutrition, and metabolism, proposing that the timing of meals is as crucial as their content and quantity in determining the risk of overweight. Nevertheless, a more comprehensive understanding of the association between meal timing and body weight is required, particularly during early life stages, such as adolescence. This study aims to assess the association between a late eating pattern and the risk of excess weight among adolescents. The data analyzed in this cross-sectional study was obtained from the Brazilian Family Budgets Survey (Pesquisa de Orçamentos Familiares, POF), which was conducted between May 2008 and May 2009. This study included 7,377 adolescents [male (52%), aged between 14 and 19 years (60%), 20% were excess weight overweight or obesity]. The chrononutrition patterns analyzed included the times of the first and last meal, the percentage of calories consumed after 6 pm, 7 pm, 8 pm, 9 pm, or 10 pm, eating duration - defined as the time interval which reflects the length between the first and last caloric event each day; eating midpoint defined as ([time of the last meal - time of the first meal]/2) + time of the first meal; caloric midpoint time - represented the time at which 50% of an individual‘s daily calories were consumed; fasting window - determined through the calculation of the hours between the first and last feeding episodes of each day, subtracting this period from 24 hours; fasting window 7 pm-7 am - overnight fasting time interval. The independent variables were the chrononutrition patterns divided into tertiles, and the odds ratios of excess weight were predicted by comparing tertiles 2 and 3 with the lowest tertile (tertile 1; reference) for each chrononutrition parameter. Regarding eating duration, the third tertile group showed a significantly higher likelihood of being excess weight (OR = 1.2, 1.0–1.5; 95% CI, p = 0.04) compared to the reference group (tertile one). Concerning the fasting window from 7 pm to 7 am, the third tertile group showed a significantly lower likelihood of being excess weight (OR = 0.7, 0.6–0.9; 95% CI, p = 0.02) compared to the reference group (tertile one). In terms of the percentage of calories consumed after 8 pm, the third tertile group showed a significantly higher likelihood of being excess weight (OR = 1.3, 1.0–1.6; 95% CI, p = 0.03) compared to the reference group (tertile one). Given the importance of promoting healthy dietary habits during early stages of life, these results underscore the relevance of considering meal times as modifiable lifestyle factors that can be targeted to prevent excess weight

O34

Grazing after bariatric surgery: psychiatric comorbidity and weight outcomes

Maria Francisca Firmino Prado Mauro, Marcelo Papelbaum, Marco Antonio Alves Brasil, João Regis Ivar Carneiro, Ronir Raggio Luiz, João Hiluy and José Carlos Appolinario

UFRJ

BACKGROUND: Grazing, which is defined as the consumption of unplanned, small amounts of food without signals of hunger or satiety, is a potentially problematic eating pattern. This behavior is more frequent in the bariatric surgery (BS) population and is linked to less favorable weight outcomes, such as diminished weight loss and heightened weight regain. Additionally, evidence suggests that individuals who exhibit grazing may have a higher prevalence of general and eating-related psychopathology. Objective: This study assesses the prevalence of grazing and its relationship with psychiatric comorbidity and surgical outcomes in a post-BS population.

METHODS: In this cross-sectional study, 108 post-BS patients were sequentially included. Inclusion criteria were adults aged 18 years or older with more than 12 months postoperative. Exclusion criteria included corticosteroid use, untreated endocrinological comorbidities, and pregnancy. Grazing was assessed using the Picking and Nibbling question from the Eating Disorder Examination. Psychiatric comorbidities were evaluated using the Structured Clinical Interview for DSM-IV, with the eating disorders section based on DSM-V. A structured research protocol was developed to evaluate clinical/surgical outcomes such as total weight loss, excess weight loss, and weight regain from the maximum weight loss.

RESULTS: We found 64.81% (70) of participants with grazing. From psychiatric evaluation, grazing as positive associated with major depressive disorder (lifetime p = 0.005; current p = 0.0001), posttraumatic stress disorder (lifetime p = 0.01), generalized anxiety disorder (current p = 0.04), panic disorder (lifetime p = 0.02), body dysmorphic disorder (lifetime p = 0.04); and for eating-related mental disorders with binge-eating disorder (current p = 0.01). Clinically, grazing was associated with increased weight regain (p = 0.03), higher BMI (p = 0.01), longer postoperative time (p = 0.002), and physical inactivity (p = 0.008). However, the controlled analysis revealed that binge-eating disorder, with an odds ratio (OR) of 18.2, and longer postoperative time, with an OR of 0.14, maintained a statistically significant association with weight regain, as opposed to grazing.

CONCLUSION: Our study found a notably high prevalence of grazing behavior. Grazing participants exhibited a greater psychopathology, particularly in certain psychiatric diagnoses. Also, it was found that an extended postoperative time and sedentarism were associated with grazing. These findings emphasize the importance of addressing psychiatric comorbidities in patients who exhibit grazing following bariatric surgery. Keywords: weight regain; weight loss; psychopathology; physical activity; binge eating.

O35

Optimization of patient engagement in the phase 3 clinical trial program for survodutide in obesity through simulation

Domenica M. Rubino¹, Vicki Mooney², Viviënne van de Walle³, David Baanstra⁴, Wouter Daniëls⁴, Christopher Recaldin⁵ and Joe Nadglowski⁶

¹Washington Center for Weight Management and Research; ²European Coalition for People Living with Obesity; ³Pre-care Trial & Recruitment; ⁴Boehringer Ingelheim B.V.; ⁵Branding Science; ⁶Obesity Action Coalition

BACKGROUND: Unforeseen issues during the conduct of clinical trials can lead to suboptimal participant recruitment, retention, and outcomes. Proactive identification of potential issues before starting a trial can improve the experience of both participants and site staff. Clinical trial simulations (CTS) are a useful tool to optimize trial design by learning from individuals experience of trial materials, design, and procedures. Survodutide is a glucagon receptor/glucagon-like peptide-1 receptor dual agonist currently being investigated as a treatment for obesity. We provide a CTS description used for simulating three randomized, placebo-controlled, Phase 3 clinical trials from the survodutide clinical development program: SYNCHRONIZE-1 (NCT06066515), SYNCHRONIZE-2 (NCT06066528), and SYNCHRONIZE-CVOT (NCT06077864).

METHODS: A 3-phase approach using CTS to proactively improve clinical trial implementation was designed. The first phase, focusing on participant engagement, is reported here. For the CTS, participants matched inclusion criteria for the Phase 3 trials. Site staff had a mix of specialties, interest in obesity, ≥2 years clinical trial experience, and had engaged in ≥1 therapeutic obesity clinical trials. Participants and site staff were recruited from the US, Germany, Poland, Brazil, China, Japan, and Australia to understand potential cultural differences in response to trial design and materials. Participants and site staff were interviewed after experiencing various materials proposed for the studies questionnaires, guides, reading materials, images, animation, and testing of investigational product (IP) packaging. Additionally, interviews about trial design and procedures, visit duration and type, perceived safety, and well-being were conducted. Interviews were reviewed and analyzed by the authors.

RESULTS: Interviews identified aspects of trial materials and procedures for improvement. Different modalities for trial materials such as animated videos and print were desired. Wording was adjusted to minimize stigma of obesity and account for cultural differences to minimize bias. To reduce burden of trial, questionnaire lengths were limited to 20 minutes, diary entries were simplified, and visits were made flexible by reducing frequency and duration time, and by increasing visit windows. Packaging was redesigned to be more easily opened. Small refrigerators for IP storage were provided to participants. Pre-filled syringes were acceptable by participants as long as clinical support was available, with practice materials for teaching and an option to come in for injection. Marketing images were redesigned based on feedback with distinct cultural differences. Clinical care and support from site staff was important to research participants.

CONCLUSION: Use of CTS prior to conducting a trial provides insight to optimize participant engagement.

O36

Metabolic profile and its risks in a non-diabetic population undergoing kidney transplant

Débora Dias de Lucena, Juliana Figueredo Pedregosa Miguel, Sara Peres de Aguiar, Lucca Sokabe, José Omar Medina Pestana, José Roberto de Sá and Érika Beviláqua Rangel

UNIFESP

BACKGROUND: Metabolic risk factors are prevalent in kidney transplant recipients and may be associated with an increased risk of post-kidney transplant diabetes (PTDM) and metabolic syndrome (MS). These conditions contribute to increased mortality despite a functioning graft and diminished long-term graft survival in renal failure. Methods: We assessed 152 patients, aged over 45, without diabetes mellitus, who underwent kidney transplant between May 2022 and December 2023. Our analysis focused on the metabolic profile and associated risks during the initial 6 months post-transplant. Univariate logistic regression was conducted, considering P < 0.05 as significant.

RESULTS: In our study population, 56.6% were male, 45.4% were white, and 82.9% received organs from deceased donors. Hypertension was the underlying disease in 42.7% of cases, and 47.3% had a family history of diabetes. At transplant, 71 individuals had a BMI ≥ 25 kg/m² (40.7% men, 55.54% women), 64 (42.1%) exceeded the cardiovascular risk limit for waist circumference [WC] (88 cm for women, 102 cm for men), representing 24.4% of men and 65.1% of women. Additionally, 41 (24.4% men, 31.7% women) had Tg/HDL ≥ 3.5, and 25 met the criteria for MS (8.1% men, 27.2% women). At 3 months post-transplant, 26 individuals developed pre-diabetes (16.2% men, 18.1% women), and 12 developed PTDM (7% men, 9% women). By 6 months, 22 had pre-diabetes (10.6% men, 19.7% women), 9 developed PTDM (4.6% men, 7.6% women), 11 exceeded the WC limit (3.5% men, 19.7% women), and 8 met the criteria for MS, all of whom were women (12.15%). Regarding the development of PTDM at 3 months, the following risk factors were identified at transplant: BMI ≥ 25 kg/m² (OR = 5.46; p = 0.016) and WC (OR = 1.10; p = 0.011). At 6 months, the risk factors related to PTDM were BMI ≥ 25 kg/m² (OR = 12.2; p = 0.024), WC (OR = 1.19; p = 0.009), and HbA1c (OR = 6.24, p = 0.038). For MS at 6 months, the identified risk factors at transplant were BMI ≥ 25 kg/m² (OR = 18.08, p = 0.01), WC (OR = 1.14; p = 0.022), and Tg/HDL ≥ 3.5 (OR = 10.6; p = 0.037).

CONCLUSIONS: Kidney transplant recipients experience significant metabolic changes influencing the development of PTDM and MS, heightening cardiovascular risk. Women exhibit more metabolic changes than men. Therefore, evaluating the metabolic profile at transplant is crucial for identifying risks and planning clinical interventions to reduce cardiovascular risk and mortality in this population.

O37

The antiviral immune defense may be adversely influenced by weight loss through a calorie restriction program in obese women

Abdolreza Norouzy¹, Mahsa Mehrdad², Mohammad Safarian¹, Hossein-ali Nikbakht³, Maryam Gholamalizadeh⁴ and Mahmoud Mahmoudi¹

¹Mashhad University of Medical Sciences; ²Kurdistan University of Medical Sciences; ³Babol University of Medical Sciences; ⁴Shahid Beheshti University of Medical Science

BACKGROUND: Obesity and weight loss are reported to be associated with immune function. This study aimed to investigate the changes in counts of lymphocytes involved in microbial defense during weight loss in obese women. Methods: This clinical trial involved 29 women with a body mass index (BMI) ≥ 30 kg/m2. The intervention group was prescribed a low-calorie diet (600 kcal lower than caloric requirement per day) plus Orlistat (120 mg three times daily). The control group received ad libitum diet. Anthropometric indices, obesity-related traits, and blood pressure were assessed every three weeks. Metabolic indices and plasma count of lymphocyte subpopulations (CD3, CD4, CD8, CD19, and CD16/56, as well as the ratio of CD4:CD8) were measured at baseline and after the intervention (after 10% weight loss).

RESULTS: After the weight loss, natural killer cells (CD16/56) decreased in the intervention group (P = 0.014) even after adapting for all confounders. No significant changes were observed in other immune markers compared to the control group.

CONCLUSIONS: Caloric restriction-induced weight loss might independently weaken the antiviral immune defense. Further clinical trials are warranted to better clarify the association between weight loss, calorie restriction, and immunity.

O38

Association of the cost with the environmental impact of the current as well as healthy and sustainable diets in Brazil

Thaís Cristina Marquezine Caldeira¹, Ana Paula Bortoletto Martins², Giovanna Calixto Andrade², Sally Mackay³, Stefanie Vandevijvere⁴ and Rafael Moreira Claro¹

¹Universidade Federal de Minas Gerais; ²Universidade de São Paulo; ³University of Auckland; ⁴Sciensano

BACKGROUND: Current food systems, emphasizing intensive agriculture, livestock farming, and high production of industrialized foods, contribute to global climate crises. The increase in ultra-processed food (UPF) and red meat consumption, along with a decrease in the consumption of healthy foods, worsens this impact. While healthier and more sustainable diets can benefit human health and the planet, cost implications remain unclear. This study analyzes the association between cost and environmental impact of the current Brazilian diet, as well as comparing those with healthy and sustainable diets.

METHODS: A modeling study used data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database. Comparative cost analysis for adhering to a healthy and sustainable diet (based on the Brazilian Dietary Guidelines [BDG] diet and the EAT-Lancet diet) versus the current Brazilian diet was performed. Using an INFORMAS standardized protocol, the DIETCOST program generated multiple diets for each scenario. Average nutritional quality, cost, and environmental impact (carbon footprint (CF) and water footprint (WF)) were estimated. Simple linear regressions compare costs and environmental impact disparities among diets, using standardized sustainability parameters.

RESULTS: Significant differences in costs per 1,000 kcal were observed, with the BDG diet being less expensive (R$ 4.9; 95%IC:4.8;4.9 [USD$ 1.5]) than the current diet (R$ 5.6; 95%IC: 5.6;5.7 [USD$ 1.8]) and the EAT-Lancet diet (R$ 6.1; 95%IC: 6.0;6.1 (USD$ 1.9). Environmental impact per 1,000 kcal was nearly double in the current diet (CF:3.1 kg (95%IC:3.0;3.1); WF:2.7 thousand liters (95%IC:2.7;2.7)) compared to the BDG (CF:1.4 kg (95%IC:1.4;1.4); WF:1.5 thousand liters (95%IC:1.5;1.6)) and EAT -Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF: 1.4 thousand liters (95%IC:1.4;1.4)). Lower costs correlated with reduced environmental impacts, especially for BDG and EAT-Lancet. The association between environmental impact and the adjusted cost reinforced the link between increased environmental impact and cost. A one standard deviation increase in standardized CF corresponded to a R$0.48 increase in the cost of the current diet, similar for standardized WF (R$0.56). There was a similar relationship between the environmental impact and the cost of the BDG (standardized CF: R$0.20; standardized WF: R$0.33) and EAT-Lancet (standardized CF: R$0.04; standardized WF: R$0.18), but with a less pronounced effect.

CONCLUSION: Lower cost in each diet was associated with lower environmental impact, particularly for BDG and EAT-Lancet diets. This study emphasizes the need for policies encouraging sustainable food transitions and highlights the interconnection between food choices, cost, and sustainability.

O39

Nutritional status, food consumption, and environments of children in cities engaged in obesity prevention in São Paulo, Brazil

Nicole Almeida Conde Vidal, Gabriela Kimie de Azevedo Kimura, Mariana Julião Guilarducci, Ana Paula Bortoletto Martins, Camila Aparecida Borges and Patricia Constante Jaime

Universidade de São Paulo

INTRODUCTION: childhood obesity has negative repercussions on the growth and development of children, also serving as a risk factor for non-communicable chronic diseases in adulthood. In the Brazilian context, the Proteja strategy integrates care actions in primary health, supports existing health programs, and promotes healthy environments in small municipalities, representing 80% of Brazilian cities. The objective of this study was to analyze the nutritional conditions and the food environment of municipalities that have adopted Proteja in the state of São Paulo.

METHODS: an ecological study was conducted using data from the National Food and Nutritional Surveillance System, obtaining indicators of nutritional status and dietary consumption of fruits, vegetables, and ultra-processed foods in children aged 0 to 10 years. The characterization of schools and food and nutrition programs was obtained from the 2022 School Census. The community food environment was analyzed based on the existence of healthy food outlets using data from the Interministerial Chamber of Food and Nutritional Security. Statistical analyses were performed using Stata 15.0.

RESULTS: the Proteja strategy was adopted by 30 municipalities in the state of São Paulo, where high prevalences of childhood obesity (13.2%) and low consumption of fruits (69.3%) and vegetables (59.4%) were found, contrasting with the high presence of ultra-processed foods in children‘s diets (88.2%). Of the 193 schools in the municipalities, the majority were publicly administered (89.6%), adhered to the National School Feeding Program (88.6%), and had school cafeterias (90.7%). However, only 49.7% of schools claimed to have a nutritionist linked to school feeding, which may hinder nutrition education activities in these spaces. The analysis of the community food environment based on formal trade data showed a higher proportion of mixed businesses such as supermarkets and bakeries (53.6%), followed by ultra-processed food outlets (34.8%). Spaces for acquiring healthy foods had the lowest proportion (11.6%), identifying the absence of farmers‘markets in 24 out of the 30 municipalities, where 4 of them also lacked specialized outlets for fresh foods.

CONCLUSION: the nutritional conditions found in children, coupled with a precarious food environment, may reflect cities that do not promote healthy eating. Therefore, schools become potential environments for promoting healthy habits, emphasizing the importance of strategies that access this space and include community environments on the health agenda.

O40

The gut microbiome strongly mediates the impact of lifestyle combined variables on cardiometabolic phenotypes

Solia Adriouch¹, Eugéni Belda¹, Tiphaine Le Roy², Metacardis Consortium, Jean-daniel Zucker¹ and Karine Clément²

¹Sorbonne Université, Inserm, Nutrition and Obesities: Systemic Approaches, NutriOmics, Research Unit, Paris, France; ²IRD, Unité de Modélisation Mathématique et Informatique des Systèmes Complexes, UMMISCO, Sorbonne Université, Bondy, France

ABSTRACT: Background Decreased metagenomic richness, an indicator of microbiome health, and changes in microbiome composition are frequently observed in obesity and nutrition-related chronic diseases. Links between lifestyle and these microbial modifications are to be clarified knowing that individual lifestyle factors often moderately impact the gut microbiome and host biology in large-scale microbiome studies. Here, this study explores, whether and how individual lifestyle factors and their combined influence significantly impact the gut microbiome and determines the mediating role of the gut microbiome in the links between lifestyle and phenomes. Methods Analyzing 1,643 individuals from the MetaCardis European study, we performed an association study between lifestyle factors and metagenomics richness. Based on the most significant associations with microbiome richness, we created a non-exhaustive composite lifestyle score (QASD score) incorporating diet quality and diversity, physical activity and smoking to evaluate the global and combined impact of lifestyle on host's profiles and examine causal inference. Results Diet quality and diversity, physical activity, and non-smoking variables were positively associated with gut microbiome richness. The deduced QASD score demonstrated higher effect size on gut microbiome richness and higher explanatory power for microbiome composition variation compared to individual lifestyle variables. The QASD score was, also, positively associated with butyrate-producing bacteria, and serum metabolites, such as Hippurate, all of which are linked to metabolic health. Conversely, it was inversely associated with Clostridium bolteae and Ruminococcus gnavus, as well as serum branched-chain amino acids and dipeptides markers of poor metabolic health. Causal inference analyses identified 135 cases where the microbiome mediated more than 20% of the QASD score effects on the host metabolome. Microbiome gene richness also emerged as a strong mediator in the QASD scores impact on markers of host glucose metabolism (accounting for 27.3% of the effect on HOMA-IR), despite bidirectional associations between the microbiome and clinical phenotypes. Conclusion This study emphasizes the importance of combining lifestyle factors to understand their collective contribution to gut microbiome. We also demonstrate the mediating effects of the gut microbiome on the impact of lifestyle on host metabolic phenotypes and metabolomic profiles. This observation paves the way to discover actionable mediators for therapeutic nutritional strategies.

O41

The global diet quality score, compared to other healthy diet metrics, and type 2 diabetes risk - ELSA-Brasil cohort study

Marina Maintinguer Norde¹, Leandro Cacau², Megan Deitchler³, Sabri Bromage⁴, Ana Carolina Junqueira Vasques⁵, Dirce Maria Lobo Marchioni², Aline Martins de Carvalho², Isabela M. Benseñor⁶, Paulo A. Lotufo⁶, Lício A. Velloso⁷, Edward Giovannucci⁸ and Bruno Geloneze⁷

¹Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil; ²Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil; ³Intake-Center for Dietary Assessment, FHI 360,Washington, DC, USA; ⁴Institute of Nutrition, Mahidol University, Phuttamonton, Thailand; ⁵School of Applied Sciences, State University of Campinas, Limeira, SP, Brazil; ⁶Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo, SP, Brazil; ⁷Obesity and Comorbidities Research Center, State University of Campinas, Campinas, SP, Brazil; ⁸Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA

INTRODUCTION: Diet is the most important behavioral risk-factor for type 2 diabetes (T2DM). Monitoring dietary quality across countries and over time is crucial to track vulnerable areas, delineate appropriate strategies and assess effectiveness of government and civil society initiatives to promote healthy diets. The Global Diet Quality Score (GDQS), the Nova score, the Global Dietary Recommendations (GDR) score, and Minimum Diet Diversity for Women (MDD-W) were listed by the United Nations as promising tools to surveillance healthy diets across nations. We aimed to investigate performances of the GDQS, compared to that of the Nova score, the GDR score, MDD-W, and the Alternative Healthy Eating Index (AHEI), a food and nutrient-based diet metric, to track diet-related T2DM risk. Materials and methods: Participants of the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil) for whom diet, health, sociodemographic and lifestyle information were available were included in the study. All five-diet metrics were calculated using dietary data assessed by a validated 114-items food-frequency questionnaire applied at baseline (2008–2010). Diabetes relative risk at the third wave (2017–2019) of the study was estimated using a Generalized Linear Model with Poisson distribution and robust variance, adjusted for confounders. Performance comparison between diet metrics were tested using Wald's test.

RESULTS: In the final sample of 12,254 individuals, there were 1,515 incident cases of diabetes after an 8.2y mean follow-up period. All healthy diet metrics had higher scores in higher educational status, and in higher income categories (p < 0.001 for all). A lower risk for diabetes was observed in higher scores of the GDQS, GDR score, and AHEI, with no statistically significant difference in the magnitude of the association between diet metrics. With 1-SD increase in GDQS, GDR score, and AHEI, a 5%, 6%, and 7% decrease in diabetes risk was observed during the follow-up period, respectively, after adjustment for potential confounders. No reduction in T2DM risk was observed for Nova score and MDD-W variation.

CONCLUSION: Considering that AHEI, the GDR score, and GDQS had similar performances in monitoring diet-related risk of type 2 diabetes, the choice between them would ultimately be based on the operationalization of diet quality monitoring. Food-based metrics, such as the GDR score and the GDQS, are preferable, because they do not depend on food composition data. Given some particularities of GDQS and the GDR score scoring process, the GDQS has an additional advantage if the diet monitoring is to be done with secondary data from ongoing surveys.

ACKNOWLEDGEMENT: FAPESP grant n.2022/08172–4 and 2013/07607–8.

O42

Marketing and commercialization of products for infants and early childhood in the city of Maceió, Alagoas, Brazil

Emanuelle Cristina Lins Bastos, Nicole Almeida Conde Vidal, Luan Santos Aragão, Gabriel Marx Assunção Costa and Jonas Augusto Cardoso da Silveira

Universidade Federal de Alagoas

INTRODUCTION: breastfeeding (BF) is recommended for infant feeding; however, recent national surveys indicate a stagnation of BF indicators below the goals set by the WHO/UNICEF, especially in the Northeast region of Brazil. BF for a short duration is associated with childhood overweight. Therefore, promoting BF through healthcare and food environments is essential for obesity prevention. In Brazil, the “Brazilian Norm for the Marketing of Food for Infants, First Childhood, and Related Products” (NBCAL) is a set of legal acts that regulate commercial practices of products targeted at children aged 0 to 3 years, acting as substitutes or discouraging BF. The objective of this research was to assess NBCAL violations in areas frequented by children in Maceió/AL.

METHODS: a cross-sectional study conducted from April/22 to March/23 audited all food retail stores (FRS) selling products regulated by NBCAL within a 400 m radius buffer zone around childcare centers and healthcare units in Maceió/AL. Data on the type of commerce, retail network affiliation, products sold, and NBCAL violation presence and qualification were collected using mobile devices through a structured form on the KoboToolbox platform.

RESULTS: 1.176 FRS were identified, of which 103 (8.8%) had NBCAL violations. Violations were concentrated in pharmacies (65%, n = 67) and supermarkets (26.2%, n = 27). Within these two types of establishments (n = 601), 41.6% of FRS affiliated with retail chains (n = 161) had NBCAL violations. Among non-affiliated establishments (n = 440), only 6.1% had violations. The probability of identifying a violation in retail chains was 6.8 times (4.5–10.2 95% CI) higher than in non-franchised FRS. The most frequent violations by product group occurred in general milk (29.6%), follow-up formulas for early childhood (27%), infant formulas for infants (21.8%), nipples, pacifiers, bottles, and nipple protectors (13.3%), with lower frequency in transition foods (8.1%). When examining commercial promotion strategies related to violations, the most used was special exposure.

CONCLUSION: the retail food environment in Maceió/AL was not free of NBCAL violations, with pharmacy and supermarket chains representing the main threats to BF, necessitating attention from sanitary surveillance teams. Considering the responsibilities of distributors and the food industry outlined in NBCAL, this work describes the perpetuation of abusive commercial practices that negatively impact the human right to adequate infant feeding and nutrition.

O43

Picking the right nutrient profiling model for front-of-pack nutritional labeling: a randomized experiment in an online store setting with brazilian consumers

Ana Clara Duran¹, Camila Aparecida Borges¹, Neha Khandpur², Carmen Elise Prestemon³, Maxime Gregory Paul Bercholz³, Fernanda Olivato³ and Lindsey Smith Taillie⁴

¹Núcleo de Estudos e Pesquisas em Alimentação, Universidade Estadual de Campinas; Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, USP; ²Division of Human Nutrition and Health, Wageningen University; ³Global Food Research Program, Carolina Population Center, University of North Carolina at Chapel Hill; ⁴Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill

PURPOSE: Nutrient profiling models (NPM) play a crucial role in determining the eligibility for products to display a front-of-package nutrition label (FOPNL). We conducted a randomized experiment in an online grocery store to assess how different NPMs influence sugar, sodium, and saturated fat purchases among Brazilian adults. Additionally, we examined differences in the proportion of selected ultra-processed food (UPF) items and their likelihood to notice the FOPNL.

METHODS: We recruited 3,074 Brazilian adults to partake in a shopping task within a naturalistic online grocery store, between January to March 2023. Participants were randomly assigned to one of three conditions: 1 - control (products without FOPNL, n = 1,025), 2 participants exposed to foods and beverages with FOPNL displayed as a magnifying glass defined by the NPM developed by the Brazilian National Health Surveillance Agency (Anvisa) (n = 1,032); and 3 - participants exposed to foods and beverages with FOPNL displayed as a magnifying glass defined by the NPM established by the Pan American Health Organization (PAHO) (n = 1,017). The Anvisa NPM nutrient thresholds were determined using Anvisa own estimates. PAHO NPM thresholds for the same nutrients are based on the World Health Organization recommendations and only apply to processed and ultra-processed foods. The proportion of products displaying the FOPNL differed between arms, as per the underlying NPM. We used linear regression models to assess sugar, sodium, and saturated fat consumption and the proportion of selected ultra-processed food (UPF) items. We ran logit regressions to determine differences in the odds of participants noticing FOPNL.

RESULTS: Most participants reported having a college degree, identifying as white, serving as parents or caregivers, being married or cohabiting, undertaking all household grocery shopping, perceiving the online store as akin to a typical one, and finding the selected products during the experiment resembling their usual grocery choices. Mean sugar purchases significantly decreased in Group 2 (Anvisa NPM; −26.3; p = 0.003) and Group 3 (PAHO NPM; −22.3; p = 0.013) compared to the control group. No significant differences were observed between Groups 2 and 3. We did not observe differences for saturated fat or sodium. Participants exposed to the PAHO NPM arm exhibited a lower proportion of UPF items in their shopping basket compared to both the control group (PAHO vs. Control; p < 0.000) and the Anvisa NPM group (PAHO vs. Anvisa; p = 0.002). Participants showed similar odds of noticing FOPNL in Groups 2 and 3.

CONCLUSIONS: The presence of FOPNL defined by either NPM lowered average sugar purchases compared to the control group. PAHO NPM exposure resulted in a smaller proportion of UPF purchases compared to both the control group and the Anvisa NPM arm. Our findings highlight the key role that a robust NPM play in nutritional labeling policies.

O44

Incident cases and deaths attributable to overweight and obesity in Brazil until 2044

Eduardo Augusto Fernandes Nilson, Leandro Fórneas Machado Rezende, Fundação Oswaldo Cruz and Joyce Moreira Camargo

UNIFESP

BACKGROUND: Adult overweight and obesity in Brazil are increasing rapidly over time. The prevalence of obesity almost doubled increased from 2006 to 2019, reaching 20.3% of the adult population. Until 2030, projected prevalences are estimated to be 68.1% for overweight and 29.6% for obesity, and women, black and other minority ethnicities are estimated to have higher obesity prevalence by 2030. This also represents relevant epidemiological and economic burdens to the country, considering obesity and its comorbidities. Methods: We developed a multistate life table to estimate the impacts of overweight and obesity on 11 diseases associated to high Body Mass Index (BMI) in Brazil until 2044 considering that current trends are maintained (business-as-usual scenario). The model estimates the attributable deaths and incident cases of cardiovascular diseases, diabetes, chronic kidney disease, cirrhosis, and cancers based on demographic and epidemiological data from national surveys and from the Global Burden of Disease Study.

RESULTS: According to the business-as-usual policy scenario, the prevalence of overweight and obesity among Brazilian adults will increase from 57% in 2023 to 75% in 2024. Consequently, it was estimated that 10.9 million new cases and 1.2 million deaths attributable to overweight and obesity over the next 20 years. While the distribution of incident cases among men and women does not differ significantly, 64% of the attributable deaths during this period were among men. Diabetes represented over 51% of the incident cases and cardiovascular diseases attributable to overweight represented approximately 57% of the deaths until 2044.

CONCLUSION: The epidemiologic burden of overweight and obesity in Brazil will increase significantly, therefore bold policies need to be implemented in the country, including the treatment of existing cases and the prevention of overweight and obesity in all age-groups.

O45

Cost and affordability of current, healthy and sustainable diets in Argentina

Florencia Cámara, Leila Guarnieri, Victoria Tiscornia and Luciana Beatriz Castronuovo

FIC Argentina

BACKGROUND: Consuming healthy diets is a priority to reduce the prevalence of Non Communicable Diseases (NCD), particularly obesity, diabetes, and cardiovascular disease. Moreover, the adoption of healthy and sustainable diets could be key to safeguarding natural resources and reducing diet-related mortality. The EAT Lancet Commission has developed a universal framework for the adoption of healthy and sustainable diets, which can be adapted at the local level. Cost and affordability are some of the main barriers to population diet quality improvement.

OBJECTIVE: The aim of this study is to estimate the cost and affordability of healthy and sustainable diets in comparison to less healthy and sustainable diets in Argentina, following the optimal approach methodology proposed by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS). Methods: Model diets were developed considering a typical household structure, the INFORMAS framework, local dietary guidelines and Eat Lancet recommendations: Current Diet (CD), Healthy Diet (HD), Current Isocaloric Diet (CID), three versions of the Sustainable Diet (two flexitarian diets and a vegan diet: FD1, FD2 and VD) were modeled by nutrition experts. 123 food and beverages products were included in the diets and average prices of each product were estimated using Precios Claros website data (april/may 2020). The average costs of each diet were calculated by 10,000 replications of a Monte Carlo Simulation and affordability was estimated as the percentage of a monthly salary that is needed to buy the diet for a typical household.

RESULTS: The HD average cost (548.8 USD) is approximately 5% more expensive than the CD (523.7 USD) and 10% more expensive than the CID(497.6 USD). The CD and the FD1 have similar average cost (523.7 USD), and the FD2 (less animal protein included that de FD1) is the cheapest diet (496.4 USD). There are also differences in the affordability of the diets: 54.7% of the average family income is needed to buy a HD while 49.4% is needed to buy a FD1. The variability of the cost of diets is higher for current diets, mainly due to the greater variability in their composition, while the VD has the lowest variability in the cost.

CONCLUSION: Being aware of the cost and affordability of current, healthy and sustainable diets is an extremely important tool for the design of effective public policies to reduce obesity and NCDs in Argentina and to promote a sustainable environment. Furthermore, this work suggests that Argentina‘s dietary guidelines should be updated to align with international recommendations on sustainable diets. According to the results of our study, these diets are less expensive than healthy ones, providing an opportunity to promote diets that are both healthy and environmentally sustainable.

O46

The global diet quality score correlation with key-nutrients intake and other healthy diet metrics in Brazil a nation-wide representative study

Marina Maintinguer Norde¹, Sabri Bromage², Dirce Maria Lobo Marchioni³, Ana Carolina Junqueira Vasques⁴, Megan Deitchler⁵, Joanne Arsenaut⁵, Aline Martins de Carvalho³, Lício A. Velloso¹, Walter Willett⁶, Edward Giovannucci⁶ and Bruno Geloneze⁷

¹Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil; ²Institute of Nutrition, Mahidol University, Phuttamonton, Thailand; ³Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil; ⁴School of Applied Sciences, University of Campinas, Limeira, SP, Brazil; ⁵Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA; ⁶Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; ⁷Obesity and Comorbidities Research Center, UNICAMP, Campinas

INTRODUCTION: The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective of the present study was to investigate the correlation of the GDQS with key-nutrient intake and other healthy diet metrics in a national-representative sample of the Brazilian population.

MATERIAL AND METHODS: Nationally representative data from 44,744 men and non-pregnant and non-lactating women aging ≥10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-hour recalls (24HR). The GDQS was calculated along with other healthy diet metrics: a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women - MDD-W), an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods UPF, and one indicator of planetary health diet (planetary health diet index PHDI). Spearmans coefficient was used to investigate correlation between the GDQS and key-nutrients intake (protein, total fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12), MDD-W, UPF, IQD-R, and PHDI.

RESULTS: The mean GDQS for Brazilians was 14.5 (0–49 possible range), and only 1% of the population had a low-risk diet (GDQS≥23). The GDQS mean was higher in women, elder individuals and in higher-income households. Positive correlations were found between the GDQS and key-nutrients intake: protein (rho = 0.17), MUFA (rho = 0.09), PUFA (rho = 0.13), dietary fiber (rho = 0.34), vitamin A (rho = 0.11), folate (rho = 0.22), calcium (rho = 0.17), iron (rho = 0.10), and zinc (rho = 0.07). No correlation was found for vitamin B12 and an inverse correlation was found for SFA (rho = −0.02). An inverse correlation was found between the GDQS and UPF (rho = −0.21) and positive correlations were found between the GDQS and MDD-W (rho = 0.27), and the PHDI (rho = 0.22). Conclusion: the GDQS is a good indicator of key-nutrients intake, and correlates well with other healthy diet metrics such as UPF, MDD-W, and the PHDI in a nationally representative Brazilian sample. Other studies investigating the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks, are warranted.

ACKNOWLEDGEMENT: FAPESP grant n. 2022/08172–4 and 2013/07607–8.

O47

Association between obesity and the intersection of depression, gender, and race in Brazilian adults

Thaís Cristina Marquezine Caldeira¹, Daniela Silva Canella², Rafael Moreira Claro¹, Luiza Eunice Sá da Silva³ and Taciana Maia de Sousa²

¹Universidade Federal de Minas Gerais; ²Universidade do Estado do Rio de Janeiro; ³Ministério da Saúde do Brasil

BACKGROUND: The association between depression and obesity is well-established, with evidence indicating that physical impairment and emotional eating can mediate the development of obesity in individuals with depression. Racial and gender inequities related to both depression and obesity are notable, especially in low- and middle-income countries. Thus, this cross-sectional study aimed to investigate the association of obesity and the intersection between depression, gender, and race in Brazil.

METHODS: Data from Brazilian adults (≥18 years) collected by the 2019 National Health Survey were analyzed. Depression was investigated using the Patient Health Questionnaire-9 (PHQ9) (cutoff ≥10). Body Mass Index (BMI) was calculated using measured weight and height and classified according to the presence of obesity (BMI ≥ 30 kg/m²). Gender and race/skin color were used separately and combined into social profiles: white man; white woman; black/mixed-race man; black/mixed-race woman. Odds Ratios (OR) were estimated using Logistic regression models adjusted by age, education, per capita income, and presence of partner/spouse. Obesity was used as the outcome, while depression alone and the intersections of depression with gender and race/skin color were explanatory variables. Individuals without depression were the reference category in all models. Analyses were performed with Stata version 16.1, using the survey module for complex samples and significance level of 5%.

RESULTS: 87,497 adults were investigated. Depression was identified in 10.8%. Prevalence of obesity was 21.3%, higher among women (23.1%) than men (19.2%), with no significant differences for race/skin color. Obesity was more frequent in individuals with depression (26.8%) than those without depression (20.6%). Depression was associated with a higher chance of presenting obesity in the total population (OR:1.37; p < 0.001). Compared to individuals without depression, women with depression had a 55% higher chance to present obesity (OR:1.55; p < 0.001), with no significance for men with depression. Black/mixed-race individuals with depression (OR:1.37; p < 0.001) and white individuals with depression (OR:1.38; p < 0.001) had similar higher chances to present obesity. Considering the intersection between gender and race/skin color, compared to individuals without depression, black/mixed-race women with depression presented 59% higher chance of obesity (OR:1.59; p < 0.001), followed by white women with depression (OR:1.50; p < 0.001), with no significance for white or black/mixed-race men with depression.

CONCLUSION: Depression was associated with a higher chance of obesity and was affected by social profiles, being especially greater in black/mixed-race women. Our results highlight the gender and racial inequities related to obesity and depression in Brazil, emphasizing the need for public health policies intentionally targeted to most vulnerable groups.

O48

Assessing food availability and healthier options in an urban chinese university: a case study using the chinese nutrition environment measurement survey for stores (C-NEMS-S)

Xingbo Li¹, Haiyue Wang², Hendra Manafe², Andrea Braakhuis¹, Zengning Li² and Rajshri Roy³

¹The University of Auckland; ²The First Hospital of Hebei Medical University; ³The University of Sydney

ABSTRACT: Research shows that young adult students (18–24 years) in Western universities are frequently exposed to an environment that promotes unhealthy dietary behaviours. Little research has been done on the link between the university food environment, the nutritional value of food on offer, and the subsequent dietary behaviours of Chinese students. Using a validated tool, the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S), we assessed the availability, quality and price of foods in a large, urban Chinese university in Shijiazhuang City, China. A total of 52 on-campus canteen outlets were audited. The methodology involved on-site visits, pilot testing of the audit tool, and adjustments to the C-NEMS-S criteria, ensuring relevance to the specific university food environment. General food outlets (n = 43) and self-served food outlets (n = 7) were further categorized into eight subtypes. Beverage outlets (n = 2) were categorized separately. C-NEMS-S scores were significantly different across food outlet types (P = 0.0024), especially between noodle and rice outlets (P = 0.0415). Food availability scores for starchy tubers (P < 0.001), dry beans (P < 0.001), vegetables (P = 0.0225), and fruits (P < 0.001) were significantly different across food outlet subtypes. Healthier options were limited across all food and beverage outlets and only appeared in grains (n = 2) and meat and poultry (n = 2) categories. The findings were synthesized to provide a comprehensive overview of a Chinese university‘s food environment, including the lack of availability of certain food types such as fish and seafood, influenced by food safety concerns in China. Future research should focus on expanding the scope of studies in diverse university settings in China, refining audit tools, and exploring the relationship between university food environments, student purchase patterns, and dietary behaviours

O49

A trial of adult obesity prevention procedure in primary medical institutes

Chao-chun Wu¹, Shu-li Chia¹, Chia-hui Lee¹, Chen-su Lin¹, Yi-hua Chin¹, Yu-tien Chou¹ and Wen-yuan Lin²

¹Health Promotion Administration, Ministry of Health and Welfare, Taiwan; ²Taiwan Medical Association for the Study of Obesity

BACKGROUND: Prevalence of overweight and obesity is increasing in Taiwan year by year. In 2020, 50.3% of the adults in Taiwan were overweight or obese (BMI≧24). Health Promotion Administration (HPA) conducted online courses and educational programs for medical staff in 2022 to enrich their health literacy related to obesity prevention while developing an Adult Obesity Prevention Procedure for primary medical institutes. Later in 2023, HPA launched a trial in ten primary medical institutes.

METHODS: This procedure considered BMI, comorbidity, and risk factors of cardiovascular disease and intervened in different ways as diet-control, exercise, life style modification, psychological intervention and weight loss drugs based on obesity severity. The major indicator of intervention result was body weight and miner indicators were waistline, fasting plasma glucose, blood pressure, and triglycerides. 195 cases including 87 men and 107 women were enrolled in this trial from 10 primary medical institutes around northern, central, southern and eastern Taiwan. The average age was 45.5 ± 13.8 years old.

RESULTS: Indicators before intervention were body weight 80.1 ± 18.2 kg, BMI 29.4 ± 5.3 kg/m2, and waistline 91.0 ± 12.8 cm. Statistic by Paired Sample T-Test, after intervention, the body weight loss was 4.2 kg (95%CI:3.7–4.7), the average BMI decreased 1.5 kg/m2 (95%CI:1.3–1.7), and the waistline dropped 5.0 cm (p < 0.001). Metabolic factors, including blood pressure, fasting plasma glucose, glycated hemoglobin (HbA1c), and triglycerides, decreased significantly after the intervention and liver function was improved significantly. Besides, the data was stratified analyzed by age, gender, weight loss drugs and chronic disease, all of the results showed significant difference.

CONCLUSION: This trial optimized the Adult Obesity Prevention Procedure and ensured its applicability in primary medical institutes. These results can be used as reference to Metabolic Syndrome Prevention Project under National Health Insurance in Taiwan. Furthermore, medical institutions were able to follow the procedure promoting obesity intervention. This work was funded by the Health Promotion Administration, Ministry of Health and Welfare.

O50

Perceptions, attitudes, behaviors, and barriers to effective obesity care: an exploratory survey-based study among people with obesity and healthcare professionals in Indonesia

Sidartawan Soegondo^1,2, Gaga Irawan Nugraha³, Farid Kurniawan^1,4, Ana Asmara Jannati^1,5, Novo Nordisk^1,5 and Dicky L. Tahapary^1,5

¹Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia; ²Indonesia Diabetes Institute, Jakarta, Indonesia; ³Indonesian Society for the Study of Obesity; Department of Biomedical Science, Faculty of Medicine, Padjajaran University, West Java, Indonesia; ⁴Indonesian Society for the Study of Obesity; Metabolic; ⁵Diabetes Connection & Care, EKA Hospital, Banten, Indonesia

BACKGROUND: Obesity has increasingly become a major health issue in Indonesia. ACTION (Awareness Care and Treatment In Obesity Management) APAC aimed at identifying perceptions, attitudes, behaviors, and potential barriers to effective obesity care among People with Obesity (PwO) and Healthcare Professionals (HCPs) from 9 countries in South-East Asia. Here, we report findings from Indonesia.

METHODS: This cross-sectional survey-based study collected data using an online survey from April 2022 to May 2022. The survey was available in English and Indonesian, included PwO aged ≥18 years, residing in Indonesia, and having a current BMI of ≥25 kg/m2. PwO were excluded if pregnant or participating in intense fitness or body-building programs. HCPs were included based on relevant specialty, 50% of time spent in patients medical management, ≥2 years of clinical practice, and managing ≥100 patients in the past month, with at least ≥10 PwO.

RESULTS: A total of 1,000 PwO (44% urban; 39% suburban) and 200 HCPs were recruited. Half of PwO (51%) fell into the obesity class 1 category (BMI 25 to 29.9 kg/m2). HCPs had an average of 12.3 years of clinical practice from specialties that included general practice (25%), internal medicine (16%), cardiology (15%), endocrinology (10%), and others (34%). Most PwO (67%) perceived themselves as overweight or normal weight instead of obese, with only 28% committed to taking action to lose weight. Nevertheless, 70% PwO and 91% of HCPs acknowledged the significant health impact of obesity. PwO were primarily motivated to lose weight by a desire to be more fit/in better shape (56%) and to feel better physically with more energy (52%). Unhealthy eating habits (75% of PwO; 78% of HCPs) and lack of exercise (79% of PwO; 82% of HCPs) were identified as barriers to weight loss. While 80% of HCPs felt motivated to help PwO lose weight, only 30% of PwO had discussed weight with an HCP in the past five years. The primary reasons cited by PwO for avoiding weight discussion were financial concerns (45%) and the belief that it was their responsibility to manage their weight (43%). HCPs initiated only 53% of weight conversations, and reasons for not initiating weight discussion included the perception that patients were not interested (49%), not motivated (55%), not able to lose weight (51%), or did not have weight-related comorbidities (48%).

CONCLUSION: This study highlights disparities in perception, attitudes towards obesity, and barriers to weight discussion among PwO and HCPs in Indonesia. Although both groups recognize the impact of obesity on overall health, weight discussions between HCPs and PwO remain limited. Further training for HCPs and providing accessible education resources for PwO are essential to tackle the barriers and promote effective obesity management in Indonesia. Keywords: barriers, obesity, weight discussion, Indonesia, people with obesity, healthcare professional.

O51

Emotional appeals in soda ads: impact on children's choices and policy implications

Fernanda Mediano¹, Francesca Dillman Carpentier², María Fernanda Parra³, Mercedes Mora-plazas³ and Luis Fernando Gómez⁴

¹Pontificia Universidad Católica de, Chile; ²University of North Carolina at Chapel Hill; ³Pontificia Universidad Javeriana; ⁴Universidad Nacional de, Colombia

BACKGROUND: Marketing of unhealthy foods has negative effects on childrens food preferences and diets. Therefore, countries are recommended to implement restrictions to the power and exposure to unhealthy food marketing. Regulations to food marketing power typically ban child-directed strategies. However, children are highly exposed to general audience marketing that uses universal-emotional appeals, such as happiness and friendship, which are attractive across ages. This study assesses the differential effect of child-directed and general audience appeals used in sugar-sweetened soda (SSS) ads on childrens attitudes and beverage choices. Methods: Children 11 and 12 years old from Colombia participated in a web-based randomized between-subjects experiment (N = 322). They were exposed to one of three SSS advertisements: child-directed emotional ad, general audience emotional ad or product-focused rational ad. We assessed attitudes toward the ad and product (0 to 4), and then, the number of times children selected a soda (0–8) or bottled water (0–5) over another beverages. RESULTS: We found that children's exposure to universal-emotional appeals indirectly increased preferences for sodas (R2 = .47, F[4,319] = 22.39, p < .001) and decreased preferences for bottled water (R2 = .40, F[4,411] = 15.08, p < .001) by first enhancing attitudes toward the ad, then product (serial mediation). Both ads with emotional appeals indirectly increased soda preferences (Boot-B = .41, Boot-SE = .13, 95%CI: .18, .68), and decreased water preferences (Boot-B = −.35, Boot-SE = .11, 95%CI: −.59, −.15), compared to the product-focused ad. Conclusion: Child-directed appeals did not have a stronger effect than general audience ads. Emotional appeals drove the effects of SSS ads on childrens choices, increasing soda preferences and decreasing water preferences. These results suggest regulations banning child-directed marketing only would not fully protect children. The findings also support the call for more comprehensive mandatory regulations to protect children from unhealthy food marketing.

O52

Childhood overweight and its association with socioeconomic and environmental determinants in Brazilian municipalities

Nicole Almeida Conde Vidal¹, Jonas Augusto Cardoso da Silveira² and Risia Cristina Egito de Menezes¹

¹Universidade Federal de Alagoas; ²Universidade Federal do Paraná

INTRODUCTION: childhood overweight (OW) is an escalating health issue for children, as well as a risk factor for non-communicable chronic diseases in adulthood. During development, children begin their lives at home, where access to food is mediated by caregivers. As they transition to community life, new influences come into play, shaping their behaviors and dietary habits. The objective of this study was to analyze the prevalence of childhood overweight in Brazil based on micro, meso, and macroenvironmental determinants.

METHODS: an ecological study was conducted using data of 2019 obtained from the Food and Nutritional Surveillance Information System for the age groups of 0–2 years (infants), 2–5 years (preschoolers), and 5–10 years children (school-age) from 5,570 municipalities. Childhood overweight was defined based on the body mass index-for-age (Z score > 2SD) and classified by the criteria of WHO-UNICEF. Negative binomial regression models with mixed effects were estimated for each age group to analyze the association between childhood overweight and socioenvironmental factors (obesity prevalence in women [domestic environment], density of unhealthy stores [community environment], and the Sustainable Cities Development Index [SCDI macroenvironment]).

RESULTS: in Brazil, the prevalence of childhood overweight in infants, preschoolers, and school-age children was considered moderate (8.3%), high (13.7%), and high (13.2%), respectively. This posed a severe public health problem (high or very high prevalence) in 1581 (28.4%), 4,177 (75.0%), and 4,270 (76.7%) municipalities, respectively, according to the life cycle stages. In the Northeast region, the highest prevalence of childhood overweight was found among infants (10%) and preschoolers (15.3%), which also had the second-lowest SCDI (42.2 points) and the lowest density of unhealthy stores (4.24 stores/10 thousand inhabitants). Among school-age children, the highest prevalence of childhood overweight was observed in the South (15.9%), a region that had the highest prevalence of obesity in women (36.7%) and the second-highest density of unhealthy stores (14.34 stores/10 thousand inhabitants). In age-specific regression models, a higher SCDI of the municipality was associated with a lower probability of childhood overweight in infants (RR 0.99 [0.986 0.993 95% CI]) and preschoolers (RR 0.99 [0.989 0.994 95% CI]). Regarding school-age children, the prevalence of obesity in women (RR 1.0071 [1.0056 1.0086 95% CI]) and the density of unhealthy stores (RR 1.0038 [1.0023 1.0053 95% CI]) were associated with an increased childhood overweight rate.

CONCLUSION: given the magnitude and extent, the prevalence of childhood overweight in children up to 10 years in Brazil is a severe public health problem and should be addressed as a top priority in public agendas. Strategies to address this condition should consider the determinants that operate at each stage of the life cycle.

O53

Effectiveness of canadian front-of-pack labelling regulations and Canada’s food guide recommendations in identifying ultra-processed foods

Mary R. Labbe, Jennifer Lee, Christine Mulligan, Nadia Flexner, Mavra Ahmed, Hayun Jeong and Laura Vergeer

University of Toronto

BACKGROUND: There is a growing body of evidence linking the consumption of ultra-processed food products (UPPs) with high intakes of nutrients-of-concern along with increased risk for chronic diseases. As a result, many governments (Urugay, Ecuador, Peru, Israel, Malaysia, Chile and Mexico), have followed the example of Brazil and are recommending limiting the intake of UPPs by incorporating the NOVA food classification criteria into their national dietary guidelines. Recent updates to Canada's food guide (CFG, 2019) and Canada's Dietary Guidelines include recommendations to limit the intake of highly processed foods that are high in nutrients-of-concern (i.e., sodium, sugars and saturated fats), although the methodology used to distinguish these highly processed foods rests primarily on the 2022 Front-of-Pack Labelling (FOPL) regulations that will identify foods that meet/exceed thresholds for these nutrients. The objective of this study was to examine the effectiveness of Canadian FOPL and CFG in identifying UPPs.

METHODS: Using Food Label Information and Price (FLIP) 2017, a branded food composition database (n = 17,008), pre-packaged foods and beverages were categorized according to the NOVA classification system, FOPL regulations, and CFG nutrient profile model. The proportion of foods classified under these three food classification systems was compared.

RESULTS: 73% (12,396/17,008) of packaged foods in FLIP 2017 were UPP; of these 65.6% (n = 8,129) would display a high in front-of-pack nutrition symbol (43.2% for one nutrient-of-concern, 21.4% for two, and 1.0% for 3). Similarly, 65.3% (n = 8,097) UPPs would be identified as a poor or very poor choice according to CFG, while 13.4% (n = 1,667) and 2.4% (n = 292) UPPs would be identified as a good, or excellent choice, respectively. Interestingly, 38.3% (n = 816/2,130) of Processed foods, (3.0% (n = 14/472) of Cooking Ingredients, and 8.0% (n = 160/2,010) of Minimally or Unprocessed foods would display a high in front-of-pack nutrition symbol, according to Canadian FOPL regulations. Among Processed foods (NOVA-3) (n = 2,130), 38.2% (n = 814) would be identified as a poor or very poor choice according to CFG, while 41.4% (n = 882) and 4.7% (n = 100) would be identified as a good, or excellent choice, respectively.

CONCLUSIONS: Our findings highlight that many UPPs will be identified with a high in front-of-pack nutrition symbol when FOPL regulations are implemented in 2026. However, some UPPs are identified as a good or excellent choice according to CFG and some non UPPs would display a nutrition symbol for having high levels of nutrient-of-concern. The vague definition of highly processed food in Canada may contribute to the misalignment between the NOVA food classification system and Canadian regulations, underscoring the need for additional guidance on how to interpret and define processing levels to determine the healthfulness of foods in Canada.

O54

Changes in the healthfulness of food and beverage purchases from 2006 to 2020 in formal, mixed, and informal outlets in Mexico

Ana Paula Domínguez Barreto¹, Irene Farah², Nancy López-olmedo³, Carolina Perez-ferrer³, Yenisei Ramírez-toscano³, Brent A. Langellier⁴, M. Arantxa Colchero³, Juan A. Rivera³, Tonatiuh Barrientos-gutiérrez³ and Dalia Stern⁵

¹Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico; ²Department of City and Regional Planning, University of California at Berkeley, Berkeley, CA, USA; ³Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico; ⁴Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; ⁵CONAHCyTCenter for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico

BACKGROUND: Despite the increased penetration of formal outlets such as supermarkets and chain convenience stores in the global south, a wide variety of food retailers outside the formal sector prevail. Recent studies have tried to better understand the retail food environment in Mexico and its relationship with health; however, little is known about the quality of food purchases at different food retailers. To better inform retail food environment policies in the global south, it is necessary to further understand the healthfulness of food and beverages purchased by type of food outlet over time.

METHODS: Using repeated cross-sectional data from the National Income and Expenditure Survey (ENIGH) in Mexico (2006 to 2020), we categorized food outlets as formal (supermarkets, chain convenience stores), informal (street markets, street vendors, acquaintances), fiscally mixed (public markets, small neighborhood stores, specialty stores), and others. We used the NOVA classification criteria as a reference measure of the healthfulness of food purchases. We estimated the proportion of total purchases in each food outlet and the percentage of the types of foods purchased by outlet for the overall sample and stratified by education level and urbanicity.

RESULTS: In 2006, the food outlets with the largest proportions of ultra-processed foods purchases were chain convenience stores (49%), small neighborhood stores (37%) and supermarkets (35%). In contrast, the outlets with the highest proportions of minimally processed food purchases were street markets (83%), public markets (81%), and specialty stores (75%). Over time, households improved the proportion of expenditure in minimally processed foods in supermarkets and small neighborhood stores (49 to 56% and 46 to 48%, respectively). Conversely, the proportion of expenditures in minimally processed foods decreased from 70 to 63% in street vendors. Households without formal education and residing in rural localities increased their minimally processed food purchases in supermarkets and specialty stores, but decreased in street vendors, acquaintances and public markets. Households with higher education and residing in more urbanized areas increased their purchases of minimally processed foods in supermarkets and small neighborhood stores, and decreased in street vendors. Households in metropolitan cities also decreased purchases of minimally processed foods in chain convenience stores and specialty stores.

CONCLUSIONS: Over time, purchases from informal outlets were healthier compared to purchases from the formal and mixed sectors, but no outlet sold only healthy or unhealthy foods. To ensure access to healthy foods, food policies should consider where the largest proportion of food purchases is being made, where the healthiest purchases are, and why some purchases from certain food outlets are becoming healthier, while in others they are becoming less healthy.

O55

Time trends of hypertension and diabetes among adults living with obesity in Brazil, 2006 to 2023

Bruna Castro Barbosa de Matos¹, Jacqueline Wahrhaftig¹, Leandro F. M. Rezende¹, Bianca de Almeida-pittito¹, Rafael Claro² and Gerson Ferrari³

¹Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil; ²Nutrition Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; ³Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile

BACKGROUND: The global prevalence of obesity has reached epidemic proportions with an alarming impact on morbimortality worldwide. Obesity is widely recognized as a major risk factor for non-communicable diseases (NCDs),such as cardiovascular disease (CVD)and diabetes mellitus (DM),which are among the leading causes of death globally. In 2023,the prevalence of DM and hypertension in Brazilian adults was9.1% and 26.3%,respectively. Still,the national prevalence of these morbidities among people living with obesity by sociodemographic characteristics has not been described yet. In this study, we aimed to identify time trends in hypertension and diabetes among Brazilian adults living with obesity by sex, age group,and educational attainment. Methods:We retrieved data from 141,547adults living with obesity between 2006 and 2023, using the Surveillance System of Risk and Protective Factors from Chronic Diseases by Telephone Survey (Vigitel),which is a unique telephone-based survey in Brazil. Information on sex,age group(18–24,25-34,35-44,55–64, and ≥65 years of age),educational attainment (none to7,8 to 11,and ≥12 years of study)were obtained from the sociodemographic questionnaire. We also calculated the prevalence of diabetes,hypertension, and both conditions combined (obtained by self-reported medical diagnosis)by sociodemographic characteristics and the year of the survey. Prais-Winsten linear regression models using linear splines were performed to identify temporal variations and trends.

RESULTS: We observed a decreased prevalence of hypertension (from 44.5% in 2006 to 41.7% in 2023),an increased prevalence of diabetes(12.8% to 15.1%),and a constant prevalence of both conditions combined (10.2 to 11.2%).We observed a differential time trend in the prevalence of all four hypertension and diabetes in people living with obesity by sex and age group. In men with obesity, the prevalence of all medical conditions increased in the period,whereas in women with obesity, the prevalence of hypertension decreased, and diabetes and both conditions combined remained constant. By age group,we observed a decreased prevalence of hypertension among age groups between 35–44 years and 45–54 years. Prevalence of all the indicators,except hypertension,increased among participants with 0–8 and 9–11 years of education. Among participants with 12 or more years of education,the prevalence of hypertension slightly decreased, whereas diabetes and both conditions combined remained constant over time.

CONCLUSION: Among adults with obesity,the prevalence of hypertension, diabetes, and both conditions combined were higher in women, older participants, and adults with 0–8 years of education. We observed distinct time trends in hypertension and diabetes by sociodemographic characteristics. Considering these nuances,our results suggest the need for differentiated approaches to interventions and health policies. Keywords:Time trends;hypertension;diabetes;obesity and social determinants of health.

O56

Improvements in the global diet quality score is associated with lower body weight gain, waist circumference, and the metabolic syndrome risk - ELSA-Brasil cohort study

Marina Maintinguer Norde¹, Megan Deitchler², Sabri Bromage³, Leandro Cacau⁴, Edward Giovannucci⁵, Ana Carolina Junqueira Vasques⁶, Dirce Maria Lobo Marchioni⁴, Aline Martins de Carvalho⁴, Isabela M. Benseñor⁷, Paulo A. Lotufo⁷, Lício A. Velloso¹ and Bruno Geloneze¹

¹Obesity and Comorbidities Research Center, State University of Campinas, Campinas, SP, Brazil; ²Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA; ³Institute of Nutrition, Mahidol University, Phuttamonton, Thailand; ⁴Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil; ⁵Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; ⁶School of Applied Sciences, State University of Campinas, Limeira, SP, Brazil; ⁷Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo, SP, Brazil

INTRODUCTION: Metabolic syndrome (MetS), characterized by insulin resistance, abdominal obesity, and some metabolic disorders including hyperglycemia, dyslipidemia, and hypertension, is a pathological condition that increases the risk for chronic non-communicable diseases (NCDs), the main causes of death worldwide. Dietary quality can affect MetS risk indirectly, by its effect on abdominal obesity, or directly affecting metabolic disorders. The Global Diet Quality Score (GDQS) is a promising tool to track dietary quality and diet-related risk for under- and overnutrition. We aimed at investigating the association between changes in GDQS and body weight, waist cirfumference, and MetS risk over time.

MATERIALS AND METHODS: Participants of the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil) for whom diet, health, sociodemographic and lifestyle information were available were included in the study. The GDQS was calculated using dietary data assessed by a validated 114-items food-frequency questionnaire applied at baseline (2008–2010) and at the third wave (2017–2019) of the study, and GDQS change was calculated by subtraction. Differences in the increase rate of body weight, waist circumference and MetS parameters over time between GDQS change extreme quartiles were tested using mixed effect linear models adjusted for classical confounders including a GDQS change quartile*time interaction term in the model. Changes in MetS prevalence over time was assessed using a generalized estimating equation model with binomial distribution and logit link function adjusted for confounders.

RESULTS: In the final sample of 11,327 individuals, those in the lowest quartile for GDQS change presented a 3 point decrease, or more, in GDQS after an 8.2y mean follow-up period and those in the highest quartile presented an increase of 3 points or more. In comparison to those individuals in the first quartile, those that increased at least 3 points in GDQS had lower increase in body weight (β(95%CI) = −0.14 (−0.18; −0.11)), body mass index ((β(95%CI) = −0.06 (−0.07; −0.04)), waist circumference ((β(95%CI) = −0.17 (−0.20; −0.13)), systolic and diastolic blood pressure ((β(95%CI) = −0.21 (−0.30; −0.12) and −0.15 (−0.20; −0.09), respectively), triglycerides ((β(95%CI) = −0.91 (−1.53; −0.29)), and insulin resistance (p < 0.001), as well as 6% lower risk of MetS over time (p < 0.001). Individuals in the highest quartile for GDQS change had higher increase in HDL-cholesterol ((β(95%CI) = 0.09 (0.03; 0.15)) over time.

CONCLUSION: Improvements in dietary quality, measured using the GDQS, are associated with better metabolic heath parameters over time, reinforcing the importance of dietary quality surveillance longitudinally and across different scenarios, and showing that the GDQS is a good tool to track diet-related metabolic disease risk.

ACKNOWLEDGEMENT: FAPESP grant n°2022/08172–4 and 2013/07607–8.

O57

Global alliance for children's healthy diets: Latin American and the Caribbean chapter. State of the evidence

Lilia Pedraza¹, Tania Aburto¹, Carolina Batis¹, Simón Barquera¹, Gustavo Cediel², Maria Elisa Zapata³, María Laura da Costa Louzada⁴, María Andrea Santos¹, Gabriela García¹, Mauro Brero⁵, Fabio Gomes⁶, Alejandro Calvillo⁷, Fiorella Espinosa⁵, Andrea Graciano⁸, Camila Corvalán⁹, Patricia Jaime¹⁰, Gabriela Rivas-mariño¹¹ and Olga Corzo¹²

¹National Institute of Public Health, México; ²School of Nutrition and Dietetics, University of Antioquia; ³Center of Studies in Child Nutrition Dr. Alejandro O'Donnell (CESNI); ⁴Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo; ⁵United Nations International Children‘s Emergency Fund; ⁶Pan American Health Organization; ⁷El POder del Consumidor, México; ⁸University of Buenos Aires; ⁹Latin American and Caribbean Nutrition and Health Community of Practice; ¹⁰Department of Nutrition, School of Public Health, University of São Paulo; ¹¹Regional Office of the Food and Agriculture Organization of the United Nations, FAO for Latin America and the Caribbean; ¹²Red PaPaz, Colombia

BACKGROUND: In October 2023, the Global Alliance for Children's Healthy Diets: Latin American and the Caribbean Chapter was launched as an effort to protect children's right to healthy food environments and nutrition. This movement, spearheaded by academia and civil society, and backed by UNICEF and WHO/PAHO is based on existing evidence of high intake of unhealthy food, particularly ultra-processed products (UPP) by children and adolescents in the region. The aim of this work is to summarize a systematic review about the problem, new analyses showing increasing trends in UPP intake in the last 25 years and disseminate the Global Alliance work in the region.

METHODS AND RESULTS: A systematic review shows that the availability and intake of UPP is associated with higher prevalence of overweight and obesity in children and adolescents and with negative markers of cardiovascular health from an early age. It also showed that in LAC, minimally or non-processed foods and beverages contribute with as little as 24% of the energy intake of children and adolescents, while UPP contribute with as much as 44% of the energy. The consumption of unhealthy UPP has increased substantially among younger population, partly due to their highly palatable and addictive ingredients, aggressive advertising and promotion aimed at young people and their parents, and to their high and widespread availability. Analyses using 24-hour recall survey data from Mexico, Colombia, Argentina, and Brazil, shows that sweetened cereals (i.e. breakfast cereals and cookies) and sugar-sweetened beverages such as flavored-milks and soda were the top food and beverage categories contributing to preschoolers, children, and adolescents UPP intake. Moreover, trend analyses showed that UPP contribution to energy intake has significantly increased between 5–14% in preschoolers, between 1–10% in school-age children, and between 1–8% in adolescent women in these countries. These increases were steeper in the lowest SES in Mexico and the middle SES in Colombia and showed a slight decrease in the high SES in Brazil.

CONCLUSIONS: Given the stated evidence, the members of the Global Alliance propose 10 recommendations to encourage governments in the LAC region to protect the right of children and adolescents to healthy food environments, free of unhealthy foods. These recommendations are detailed in the Cuenca Consensus and range from dietary guidelines as a basis for the development of programs and policies, adoption of the International Code of Marketing of Breast-Milk Substitutes, regulations to restrict access to unhealthy products and promote consumption of natural foods, food and nutritional education, guaranteeing access to water, strengthening capacities of the first level of care associated with nutritional issues, among others. Global Alliance for Children's Healthy Diets operates upon reflecting that, if governments and current society do not protect the rights of our children, who will?