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PR, IFPRI3; DCA; 2 Promoting Healthy Diets and Nutrition for all; ISI, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Unhealthy eating habits are common among adolescents in Vietnam, where transitioning food environments increasingly offer energy-dense micronutrient-poor foods. Successful behavior change approaches must be feasible and acceptable, promoting local foods that are available, accessible, and preferred. Yet, few studies have investigated the potential of food-based approaches for adolescents. We used linear programming to identify problem nutrients, local nutrient sources, and realistic food-based recommendations (FBRs) to improve nutrient intake among girls 16–22 years in Thai Nguyen, Vietnam. We then identified a reduced set of FBRs to prioritize the most critical micronutrient gaps. Calcium and iron targets could not be met in any realistic diet modeling scenario. The best set of FBRs included seven recommendations which could meet intake targets for 9 of 11 modeled micronutrients. The best reduced set of three FBRs targeting iron and calcium only—although more feasible for behavior change—was less effective at improving intake of these nutrients since fewer foods were recommended. Given the difficulty of meeting calcium and iron targets using local foods within acceptable dietary patterns, additional interventions, such as supplementation, staple food fortification, or increasing the availability of affordable calcium- and iron-rich foods, may be necessary to promote dietary adequacy for adolescent girls.

PR, IFPRI3; ISI; CRP4; Capacity Strengthening; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. Objective We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12–18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). Methods Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). Results Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). Conclusions FRANI AI–assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors an

PR, IFPRI3; ISI; DCA; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Adolescence is a sensitive transition time that affects rights, roles, and responsibilities in food choice, yet limited evidence exists on dietary intakes during this critical period. This study assessed the food consumption pattern and the adequacy of energy, macronutrient, and micronutrient intakes among female youth belonging to three occupational groups in Vietnam. Dietary intakes were measured for 1001 participants aged 16–22 years using INDDEX24's 24-h recall method. Multivariate regression analyses were conducted to examine differences in diet outcomes among the three occupational groups. Dietary diversity was similar across groups but workers, compared to high school and college students, consumed less baked/grain-based sweets and fast foods, and more soft drinks, other sweets, and processed meat. Two-thirds of the sample showed energy intake lower than the estimated energy requirement, while a substantial percentage had insufficient or excessive intake of carbohydrate and fat. The mean probability of adequacy of nutrient intakes was low (0.33) and not different across all three occupational groups except for folate, which favored workers. Our study provides novel evidence supporting the development and implementation of interventions to achieve national targets, with emphasis on female youths who undergo special transitions in education, occupation, and lifestyle.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Adolescent and young women face grave nutrition challenges, but limited evidence exists on solutions to improve their diets. Action-research was done over 3 years (2020–2022) in secondary cities of Colombia (Medellin) and Vietnam (Thai Nguyen) to identify nutrient deficits in adolescent and young women diets; elaborate food-based recommendations to improve their nutritional status using Optifood linear programming; and engage respondents in incorporating suggested recommendations to their diet using a Social Innovation Challenge approach. A total of 1001 respondents were interviewed in Vietnam, 793 in Colombia. The probability of nutrient inadequacy in both locations was highest for iron and calcium, followed by the risk of deficiency for several other vitamins and minerals. Social Innovation Challenge teams (11 in Vietnam, 9 in Colombia) were created and supported in developing solutions to improve diets and tackle those deficiencies. Awards and resources were transferred to the most promising solutions to enable their implementation. Pre/post measurements of the interventions’ impact using the Global Diet Quality Score as outcome metric showed significant improvement in the diets of Challenge participants. After introducing a series of companion articles that offer detailed results on those various steps, this paper draws strategic lessons from an action-research perspective.

PR, IFPRI3; DCA; ISI; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Background The long-term association between preconception maternal hemoglobin (Hb) concentrations and child health and development is unclear. Objectives We examined associations between maternal preconception Hb concentrations and anemia with 1) birth outcomes (weight, length, preterm, gestational age, small for gestational age); 2) child Hb at 3 mo, 6 mo, 12 mo, and 24 mo; and 3) motor and mental development at 12 mo and 24 mo (Bayley scales for infant development) and cognitive functioning at 6–7 y (Wechsler Intelligence Scale for Children). Methods We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam. Over 5000 women who were intending to conceive were recruited, and offspring were prospectively followed from birth (n = 1599) through 6–7 y (n = 1318). Multivariable linear and logistic regressions were used to assess the association between preconception Hb or anemia (Hb < 12g/dL) on child health and development outcomes, adjusted by supplementation group (tested for interactions) and confounding at maternal, child, and household levels. Results At preconception enrollment, 20% of the women were anemic. Maternal preconception Hb was positively associated with child Hb at 3 mo (0.06; 95% CI: 0.01, 0.12), 6 mo (0.08; 95% CI: 0.03, 0.13), 12 mo (0.10; 95% CI: 0.04, 0.15), and 24 mo (0.07; 95% CI: 0.02, 0.12). Likewise, maternal preconception Hb was associated with reduced risk of child anemia at 6 mo (0.89; 95% CI: 0.81, 0.98), 12 mo (0.81; 95% CI: 0.74, 0.89), and 24 mo (0.87; 95% CI: 0.79, 0.95). Maternal preconception anemia was negatively associated with cognition (−1.64; 95% CI: −3.09, −0.19) and language development (−1.61; 95% CI: −3.20, −0.03) at 24 mo. Preconception Hb was not associated with birth outcomes or cognitive outcomes at 6–7 y. Conclusions Maternal preconception Hb was associated with child Hb across the first 1000 d of life. However, preconception Hb was not a significant predictor of birth outcomes or cognitive out

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Background: The long-term association between preconception maternal hemoglobin (Hb) concentrations and child health and development is unclear. Objective: We examined associations between maternal preconception Hb concentrations and anemia with: a) birth outcomes (weight, length, preterm, gestational age, small-for-gestational-age); b) child Hb at 3 mo, 6 mo, 12 mo, and 24 mo; c) motor and mental development at 12 mo and 24 mo (Bayley scales for infant development) and cognitive functioning at 6-7y (Wechsler Intelligence Scale for Children). Methods: We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam. Over 5000 women who were intending to conceive were recruited and offspring were prospectively followed from birth (n=1599) through 6-7y (n=1318). Multivariable linear and logistic regressions were used to assess the association between preconception Hb or anemia (Hb < 11g/dL) on child health and development outcomes, adjusted by supplementation group (tested for interactions) and confounding at maternal, child and household levels. Results: At preconception enrollment, 20% of the women were anemic. Maternal preconception Hb was positively associated with child Hb at 3 mo (0.06; 95% CI: 0.01,0.12), 6 mo (0.08; 95% CI: 0.03,0.13), 12 mo (0.10; 95% CI: 0.04-0.15) and 24 mo (0.07; 95% CI: 0.02,0.12). Likewise, maternal preconception Hb was associated with reduced risk of child anemia at 6mo (0.89; 95% CI: 0.81-0.98), 12 mo (0.81; 95% CI: 0.74-0.89) and 24 mo (0.87; 95% CI: 0.79-0.95). Maternal preconception anemia was negatively associated with cognition (-1.64; 95% CI: -3.09, -0.19) and language development (-1.61; 95% CI: -3.20, -0.03) at 24mo. Preconception Hb was not associated with birth outcomes or cognitive outcomes at 6-7y. Conclusion: Maternal preconception Hb was associated with child Hb across the first 1000 days of life. However, preconception Hb was not a significant predictor of birth outcomes or cognitive outcomes at 6-7y in

PR, 2 Promoting Healthy Diets and Nutrition for all; IFPRI3; ISI, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI); Food and Nutrition Policy, Background: Inequity in child development is found at early age, but limited evidence exists on whether these gaps change over time and what are the mediators. Objective: We aim to (1) quantify wealth related gaps in cognitive and socio-emotional development in early and middle childhood; (2) examine how these gaps were mitigated by maternal, child factors and home environment. Methods: We assessed the offspring of women who participated in a randomized controlled trial of preconception micronutrient supplementation in Vietnam (n = 1599). Child development was measured by the Bayley Scales of Infant Development-III (at 1-2y) and the Wechsler Intelligence Scale for Children®—IV (at 6-7y). We used multivariable regression to estimate the changes in wealth gaps for child development over time, adjusting for potential factors that potentially influence cognitive development. Results: We found significant wealth gaps in cognitive development during early childhood (gaps between top and bottom quintiles: 0.5 SD); these gaps increased substantially in middle childhood (0.9 SD). Wealth disparity in social emotion did not change over time (0.26–0.28 SD). Maternal factors, quality of home environment, and child nutritional status mitigated the wealth gap in cognitive development (7-42%) in early childhood. The contribution of these mitigating factors was smaller in middle childhood (2- 15%). Wealth gap in social emotion reduced by 13% and 43% among children with better nutritional status at 2y and higher quality of home environment at 6-7y, respectively. Conclusion: Interventions focusing on improving quality of home environment, maternal education, wellbeing, and child nutrition status may help reduce developmental deficits associated with poverty.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good; IFPRIOA, PHND, Background: There is a gap in data on dietary intake of adolescents in low- and middle-income countries. Traditional methods for dietary assessment are resource intensive and lack accuracy with regards to portion size estimation. Technology assisted dietary assessment tools have been proposed but few have been validated for feasibility of use in LMICs. Objectives: We assess the relative validity of FRANI (Food Recognition Assistance and Nudging Insights), a mobile Artificial Intelligence (AI) application for dietary assessment in adolescent females (n = 36) aged 12–18y in Vietnam, against weighed records (WR) standard, and compared FRANI performance to a multi-pass 24-hour recall (24HR).

PR, IFPRI3; POSHAN; 2 Promoting Healthy Diets and Nutrition for all; 5 Strengthening Institutions and Governance; DCA; ISI, PHND; SAR, Global success case analyses have identified factors supporting reductions in stunting across countries; less is known about successes at the subnational levels. We studied four states in India, assessing contributors to reductions in stunting between 2006 and 2016. Using public datasets, literature review, policy analyses and stakeholder interviews, we interpreted changes in the context of policies, programs and enabling environment. Primary contributors to stunting reduction were improvements in coverage of health and nutrition interventions (ranged between 11 to 23% among different states), household conditions (22–47%), and maternal factors (15–30%). Political and bureaucratic leadership engaged civil society and development partners facilitated change. Policy and program actions to address the multidimensional determinants of stunting reduction occur in sectors addressing poverty, food security, education, health services and nutrition programs. Therefore, for stunting reduction, focus should be on implementing multisectoral actions with equity, quality, and intensity with assured convergence on the same geographies and households.