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Background Dietary intake, physical activity and other lifestyle factors, behaviors known to change in college students, may affect long-term health outcomes. The mobile Ecological Momentary Assessment (mEMA) methods represent an innovative, detailed and valid approach to capture the complexity of food intake and behaviors and to overcome limitations of traditional dietary assessment methods. The main aim of the HEALTHY-UNICT study is to characterize heating habits, including Mediterranean Diet adherence, and others lifestyle factors, and their relationship with anthropometrics and emotions in a sample of college students of the University of Catania, using real-time mEMA methods and an innovative custom mEMA application. Methods Data will be collected using a mEMA tool administered via a web-based application. mEMA data collection will be carried out in two waves during the second semester of the academic year. During each wave, participants will receive prompts via the text messages to complete the surveys during four selected days, eight times per day. Results This abstract describes the protocol of the study. The HEALTHY-UNICT study aims to follow university students from a large university. A total of 100 students will be enrolled in the pilot phase. Expected results are the characterization of dietary behaviors, including Mediterranean diet adherence, food choices and others lifestyle factors, including smoking habits and physical activity and their relationship with anthropometrics and emotions in the sample of college students of the University of Catania. Conclusions The project idea should be relevant since results of the study could be useful to identify targets for the improvement of health and the promotion of healthy lifestyles in young adults. The HEALTHY-UNICT project will contribute to Sustainable Development Goals (SDGs) in the area of food and nutrition, to improve nutrition and lifestyle, through actions that combine tradition and innovation. Key messages The study will provide a better understanding of the food choices that college students make and insights for individual and population level prevention interventions. Findings of this study could be used to develop targeted interventions that encourage healthy food choices and healthy habit and ultimately reduce the risk of overweight and others adverse outcomes.

Background Achieving gender equality is one of the most important Sustainable Development Goals to guarantee health and wellbeing worldwide. Here, we aimed to assess gender-differences in risk factors and outcomes among patients admitted to Italian Intensive Care Units (ICUs). Methods Here, we included 12,534 patients from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 48 hours. Firstly, characteristics at ICU admission were compared between males and females using the Mann-Whitney U or the Chi-Squared tests. Next, we compared the probability of death between genders by applying a logistic regression analysis. Results were adjusted for covariates (i.e., age, patient's origin, trauma, non-surgical treatment for acute coronary disease, surgical intervention and presence of intubation) and reported as Odds ratio (OR) and 95% Confidence Interval (CI). Finally, the Kaplan-Meier analysis was applied to assess gender difference in survival. Results Compared with male patients, females were older, more likely to come from other wards or healthcare facilities and to undergo a surgical intervention (p-values Conclusions Our results pointed out gender-differences in patients' characteristics at ICU admission, which resulted into a higher risk of death and lower survival among females. In a Public Health point of view, these findings underline that is still important to sustain gender equality in ICUs and other hospital wards. Key messages There are several gender-differences in risk factors and outcomes among patients admitted to ICUs. Gender poses per se a higher risk for death in ICU, also considering other risk factors.

Background Unhealthy diet during pregnancy poses serious risks for both mothers and children, representing an important Public Health issue. Although Epigenetics offers a plausible explanation of the transgenerational pathway from mother to child, it is still necessary to understand if maternal epigenetic aging increases the risk for adverse outcomes in newborns. In this scenario, the “MAternal Diet, Risks and Epigenetic age during pregnancy: a Real-world Ecological momentary Assessment” (MADRE-REA) study aims to evaluate the relationship between maternal diet, epigenetic age and risk for adverse pregnancy outcomes in a mother-child cohort. Methods We will develop a smartphone-based ecological momentary assessment (EMA) of dietary, behavioral, physical, and sociopsychological information of 400 pregnant women recruited by the “Mamma & Bambino” cohort (Catania, Italy). Women will be asked to complete 6 waves of EMA during the 2nd and 3rd trimesters of pregnancy, and 3, 6, 9 and 12 months after delivery. Each wave consists of a 7-day assessment based on a signal-contingent approach, which prompts participants to record dietary consumption and other information. We will also examine maternal epigenetic age at recruitment and at delivery, using the DNAm PhenoAge. Results The novelty of the MADRE-REA study lies in the opportunity to apply a smartphone-based EMA to capture the complexity of dietary intake during and after pregnancy. Moreover, expected findings will help to understand if maternal behaviors and other exposures might affect epigenetic age, and hence if the eventual accelerated biological aging might be associated with health and disease in newborns. Conclusions This study could disentangle the relationship between maternal diet, epigenetic aging, and adverse outcomes, laying the foundation for future strategies to reduce the burden of disease in newborns throughout their life. The study is funded by the Italian Ministry of Health (Bando Ricerca Finalizzata 2019). Key messages The application of a smartphone-based tool could overcome limitations of traditional methods to assess dietary behaviors in the periconceptional period. Uncovering the relationship between maternal diet and epigenetic aging could provide the molecular basis for future strategies against adverse pregnancy outcomes.

Background Social disadvantage and unhealthy lifestyles may induce molecular changes associated with aging and age-related diseases. For instance, previous studies reported socioeconomic difference in DNA methylation, which in turn led to aberrant gene expression and genome instability. Socioeconomic status (SES) alone, however, does not completely explain this difference, and further studies are needed to unveil what factors contribute to it. Methods We conducted a cross-sectional study on 349 Italian women, aged 25-64 years, to assess SES differences in LINE-1 methylation level - a surrogate marker of global DNA methylation - and to examine the mediating effect of lifestyles (i.e. diet, smoking habits, physical activity, and weight status). Educational level was used as SES indicator. The adherence to Mediterranean diet (MD) was assessed by the Mediterranean Diet Score (MDS). Leukocyte LINE-1 methylation was assessed by pyrosequencing. Mediation analysis was conducted using the PROCESS macro for the SPSS software. Results We first observed that women with high educational level were more likely to be normal weight (p Conclusions To our knowledge, this is the first study demonstrating the mediation of diet in the relationship between SES and DNA methylation. Thus, our findings add even more value to the promotion of healthy dietary habits among social disadvantaged people. Key messages Social disadvantage is associated with epigenetic changes related to aging and age-related diseases. Adherence to the Mediterranean diet might mediate the association between socioeconomic status and DNA methylation.

Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy. We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions. Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates. Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs. *Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca Key messages Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.

Background Comparisons among European populations is useful to identify opportunities for planning nutrition strategies to reduce social inequalities in health. Our study aims to identify dietary patterns in adult women and to evaluate their association with educational level in Czech Republic and Italy, which display different health inequalities. Methods We performed a cross-sectional analysis of women (aged 25-64 years) with no history of severe diseases, who have been recruited in Brno (Czech Republic; n = 957) and in Catania (Italy; n = 841). Dietary patterns were derived by Food Frequency Questionnaire and Principal Component Analysis. We tested the association between educational level (low vs. high) and adherence to dietary patterns. Logistic regression models were used to assess Odds ratio (OR) and 95% confidence interval (CI), after adjusting for age, employment status, marital status, smoking status, parity, BMI, and menopause. Results In both cohorts, we identified the healthy and the unhealthy dietary patterns. We observed that women with high adherence to the healthy dietary pattern were less educated in Czech Republic, and more educated in Italy. After adjusting for covariates, low educational level was positively associated with adherence to the healthy dietary pattern among Czech women (OR = 2.033; 95%CI=1.301-3.176; p = 0.002), and negatively associated among Italian women (OR = 0.166; 95%CI=0.029-0.952; p = 0.044). No association was identified between educational level and the unhealthy dietary pattern. Conclusions In the Italian cohort, findings were consistent with the notion that healthy dietary choices are less common among low-educated groups. By contrast, in newly developed countries such as the Czech Republic, the “nutrition transition” from traditional staples to western foods might be more common in highly-educated groups, probably due to the advocacy of Western culture through mass media and commercial marketing. Key messages Low educational level has an opposite effect on healthy diet, exhibiting a positive association in Czech women, and a negative association in Italian women. From a broader perspective, the observed effect of education on diet quality helps explain social health inequalities in Central and Southern Europe.

Background In 2009, the Institute of Medicine (IoM) revised the guidelines on recommended gestational weight gain (GWG), taking into account pre-pregnancy body mass index (BMI) independent of age and ethnicity. However, more than half of mothers does not meet these guidelines with adverse outcomes for themselves and for newborns. Here, we used data of 232 women from the “Mamma & Bambino” cohort (Catania, Italy) to investigate the association between maternal dietary patterns, pre-pregnancy BMI and GWG. Methods Pregnant women were enrolled during the prenatal genetic counselling, at 4-20 gestational week. Dietary patterns were derived by food frequency questionnaire and principal component analysis. Self-reported pre-pregnancy BMI and GWG was calculated according World Health Organization and IoM guidelines, respectively. Results Adherence to the “western” dietary pattern - characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks - was associated with increased GWG (β = 1.217; SE = 0.487; p = 0.013), especially among obese women (β = 7.363; SE = 1.808; p = 0.005). In contrast, adherence to the “prudent” dietary pattern - characterized by high intake of potatoes, cooked vegetables, legumes, rice and soup - was associated with reduced pre-pregnancy BMI (β=-0.651; SE = 0.308; p-trend=0.035). Interestingly, the adherence to this pattern was positively associated with GWG among underweight (β = 4.127; SE = 1.722; p = 0.048), and negatively among overweight and obese (β=-4.209; SE = 1.635; p = 0.016 and β=-7.356; SE = 2.304; p = 0.031, respectively). Conclusions Our findings encourage further studies to evaluate potential preventive strategies against inadequate weight gain, including the promotion of healthy dietary habits even during the periconceptional period. Key messages Adherence to diet rich in red meat, fries, dipping sauces, salty snacks and alcoholic drinks increases GWG, especially among obese women. Adherence to diet rich in potatoes, vegetables, legumes, rice and soup was associated with lower pre-pregnancy BMI, increased GWG among underweight, and decreased GWG among overweight/obese women.