Nutritional composition of ultra-processed plant-based foods in the out-of-home environment: a multi-country survey with plant-based burgers

Ultra-processed plant-based foods, such as plant-based burgers, have gained in popularity. Particularly in the out-of-home (OOH) environment, evidence regarding their nutritional profile and environmental sustainability is still evolving. Plant-based burgers available at selected OOH sites were randomly sampled in Amsterdam, Copenhagen, Lisbon and London. Plant-based burgers (patty, bread and condiment) (n 41) were lab analysed for their energy, macronutrients, amino acids and minerals content per 100 g and serving and were compared with reference values. For the plant-based burgers, the median values per 100 g were 234 kcal, 20·8 g carbohydrates, 3·5 g dietary fibre and 12·0 g fat, including 0·08 g TFS and 2·2 g SFA. Protein content was 8·9 g/100 g, with low protein quality according to amino acid composition. Median Na content was 389 mg/100 g, equivalent to 1 g salt. Compared with references, the median serving provided 31% of energy intake based on a 2000 kcal per day and contributed to carbohydrates (17-28%), dietary fibre (42%), protein (40%), total fat (48%), SFA (26%) and Na (54%). One serving provided 15-23% of the reference values for Ca, K and Mg, while higher contributions were found for Zn, Mn, P and Fe (30-67%). The ultra-processed plant-based burgers provide protein, dietary fibre and essential minerals and contain relatively high levels of energy, Na and total fats. The amino acid composition indicated low protein quality. The multifaceted nutritional profile of plant-based burgers highlights the need for manufacturers to implement improvements to better support healthy dietary habits, including reducing energy, Na and total fats.

POS0273 THE ROLE OF FACIAL, OCCIPITAL, SUBCLAVIAN AND CAROTID ARTERIES ULTRASOUND IN THE DIAGNOSTIC ASSESSMENT OF GIANT CELL ARTERITIS

Background

Giant cell arteritis (GCA) is the most common form of primary systemic vasculitis in patients aged >50 years. It predominantly affects the cranial arteries; however, extra-cranial disease involving the aorta and its major branches can also be present. Currently, ultrasound of the temporal (TA) and axillary (AX) arteries is the first imaging modality recommended in patients with suspected predominantly cranial GCA. Nevertheless, other arteries such as facial (FA), occipital (OC), subclavian (SC), and common carotid (CC) arteries can also show vasculitic changes on ultrasound. However, there are still conflicting data to support the inclusion of these arteries in the routine ultrasound assessment of patients with suspected GCA.

Objectives

To assess the value of adding the evaluation of the FAs, OCs, SCs and CCs in the ultrasonographic diagnosis of patients with GCA.

Methods

Single-center observational retrospective study, using data from patients diagnosed with GCA registered at the Rheumatic Diseases Portuguese Registry (Reuma.pt). All patients underwent ultrasound of the TAs and AXs ± FAs, OCs, SCs or CCs at the time of diagnosis. The halo sign was considered a positive ultrasonographic finding for GCA. Only patients with the presence of halo sign in at least one of the arterial segments evaluated were included. Binary logistic regression modelling was performed to explore associations between the presence of halo sign in different arterial segments.

Results

We included 84 patients, 57 (67.9%) females, with a mean ± standard deviation age at diagnosis of 75.6 ± 8.8 years. Halo sign was found in the TAs of 66/84 (78.6%) patients, AXs of 40/84 (47.6%) patients, FAs of 37/74 (50.0%) patients, OCs of 15/61 (24.6%) patients, SCs of 30/49 (61.2%) patients and CCs of 13/60 (21.7%) patients. Of the 18/84 patients with GCA without the presence of TA halo, 17/18 (94.4%) showed halo in the AXs, 1/18 (5.6%) in the FAs, 3/18 (16.7%) in the OCs, 15/17 (88.2%) in the SCs and 6/16 (37.5%) in the CCs. Of the 44/84 patients with GCA without the presence of AX halo, 43/44 (97.7%) showed halo in the TAs, 24/39 (61.5%) in the FAs, 12/32 (37.5%) in the OCs, 4/18 (22.2%) in the SCs and 3/33 (9.1%) in the CCs. A total of 83/84 (98.8%) patients had halo sign on the ultrasound of either the TA or AX arteries. The patient with normal TA and AX ultrasound had the presence of halo sign in the SCs. Table 1 shows the proportion of patients with positive TA and AX ultrasounds according to the presence of halo in the FA, OC, SC or CC arteries. Patients with involvement of the cranial arteries were more likely to have a TA halo (FA: OR 30.6, 95%CI 3.8-247.3; OC: OR not applicable) and less likely to have an AX halo (FA: OR 0.37, 95%CI 0.14-0.95; OC: OR 0.19, 95%CI 0.05-0.77). As opposed to patients with involvement of the extra-cranial arteries in whom the halo sign was more frequently found in the AXs (SC: OR 18.2, 95%CI 4.2-78.9; CC: OR 5.9, 95%CI 1.4-24.4) but not in the TAs (SC: OR 0.12, 95%CI 0.02-0.60; CC: OR 0.32, 95%CI 0.09-1.15).

Table 1.

Differences in the presence of halo sign in the temporal and axillary arteries according to the arterial segment affected.

Arterial segment with haloTemporal arteries with haloAxillary arteries with haloFacial arteries (n=37)36/37 (97.3%)13/37 (35.1%)Occipital arteries (n=15)15/15 (100.0%)3/15 (20.0%)Subclavian arteries (n=30)15/30 (50.0%)26/30 (86.7%)Common carotid arteries (n=13)7/13 (53.8%)10/13 (76.9%)

Conclusion

Our results support the need to assess both TAs and AXs in patients with suspected GCA, resulting in a diagnostic sensitivity of 99%. Only by adding the evaluation of the SCs to the already recommended TAs and AXs increased the diagnostic sensitivity of ultrasound to 100%. All patients with a positive FA, OC or CC ultrasound for GCA also showed a halo sign in either the TAs or AXs. Hence, the additional assessment of these arteries did not improve the diagnostic yield of ultrasound and, therefore, should not be recommended in routine practice.

Disclosure of Interests

None declared

POS0640 EFFECTIVENESS AND SAFETY OF ORIGINAL AND BIOSIMILAR ETANERCEPT IN bDMARD-NAÏVE PATIENTS IN A REAL-WORLD COHORT OF PORTUGAL

Background:

The patent expiration of the original etanercept in Europe has facilitated the development of biosimilar products. Non-significant differences in efficacy and safety were noted in clinical trials which are not expected to influence clinical performance. Nonetheless, daily practice data should be gathered to support the claim for biosimilarity.

Objectives:

To compare the effectiveness and safety of original and biosimilar etanercept, in biological-Disease Modifying Antirheumatic Drug (bDMARD)-naïve patients.

Methods:

A retrospective multicenter non-interventional study, using data collected prospectively from Reuma.pt (The Rheumatic Diseases Portuguese Register) was done, including patients with: age ≥ 18 years old; diagnosis of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Spondyloarthritis (SpA) (axial or peripheral); active disease who initiated treatment with etanercept as first line of biological treatment after 2010. Kaplan-Meyer was used to calculate the persistence rate in treatment. Disease activity at baseline and follow-up data at 6, 12, 18 and 24 months of treatment was compared using the chi-square for categorical variables and t-student or Mann-Whitney tests for continuous variables. Reasons for discontinuing therapy were summarized using descriptive statistics. Statistical significance was assumed for 2-sided p-values >0.05.

Results:

We included 1694 patients (413 on biosimilar and 1280 on original etanercept) 864 with RA, 335 with PsA and 494 with SpA. The population’s baseline characteristics were not significantly different among both groups, except concomitant treatment in RA (higher use of conventional DMARDs in biosimilar group and higher use of NSAIDs in original group) and in SpA patients (higher use of corticosteroids in original group).

At baseline, a higher joint count was found in patients treated with original etanercept with a statistical difference for swollen (p=0.03) and tender (p=0.01) joints count (SJC and TJC, respectively) in RA and in TJC in SpA patients (p=0.02). In RA patients, CDAI and SDAI were higher in patients who started original (p=0.03; p=0.04, respectively). Pain measured by visual analogic scale was higher in SpA patients treated with biosimilar (p=0.03).

The 3-year PR was not significantly different between both treatment groups in RA, PsA and SpA (Figure1). In RA, PR in biosimilar was 72.6%, with a median time-on-drug (TOD) of 28.3 months; for original etanercept PR was 63.6%, with a median TOD of 27.4 months (p=0.566). In PsA patients, the PR for biosimilar was 70.6%, with a median TOD of 27.6 months, and in original drug 67.0%, with a median TOD of 28.1 months (p=0.743). In SpA patients, the PR were 78.4% for biosimilar (median TOD of 27.4 months) and 71.5% for original treatment (median TOD of 28.0 months (p=0.816)).

Figure 1.

Drug survival in biosimilar and original etanercept in Rheumatoid Arthritis, Psoriatic Arthritis and Spondyloarthritis

In RA patients, we did not find differences between the two treatment groups for the proportion of patients in remission or low disease activity by CDAI ≤10, SDAI≤11 or DAS28 <3.2 at 6, 12, 18 and 24 months of treatment. For PsA, no differences were found in the same timelines for DAPSA≤14, DAS28<3.2, BASDAI<4, ASDAS<2.1 or PsARC response. Also, in SpA patients, no differences were found in BASDAI<4, BASFI<4, ASDAS<2.1, ASDAS response and BASDAI response in all the timelines with the exception of BASDAI response at 18 months, which was achieved in fewer patients in biosimilar therapy (p=0.02).

Overall, 535 (31.6%) patients stopped etanercept (428 patients on original and 107 patients on biosimilar). Discontinuations due to inefficacy were the most frequent, but there were no significant differences between both groups as for adverse events. Discontinuations due to “other reasons” were higher for the original group, both in RA (p=0.01) and in SpA (p=0.04).

Conclusion:

Biosimilar and original used as first-line biological treatment showed similar effectiveness and safety in our long-term cohort of patients with RA, PsA, and SpA

Disclosure of Interests:

None declared

Integrated indicator to evaluate vehicle performance across: Safety, fuel efficiency and green domains

In general, car manufacturers face trade-offs between safety, efficiency and environmental performance when choosing between mass, length, engine power, and fuel efficiency. Moreover, the information available to the consumers makes difficult to assess all these components at once, especially when aiming to compare vehicles across different categories and/or to compare vehicles in the same category but across different model years. The main objective of this research was to develop an integrated tool able to assess vehicle's performance simultaneously for safety and environmental domains, leading to the research output of a Safety, Fuel Efficiency and Green Emissions (SEG) indicator able to evaluate and rank vehicle's performance across those three domains. For this purpose, crash data was gathered in Porto (Portugal) for the period 2006-2010 (N=1374). The crash database was analyzed and crash severity prediction models were developed using advanced logistic regression models. Following, the methodology for the SEG indicator was established combining the vehicle's safety and the environmental evaluation into an integrated analysis. The obtained results for the SEG indicator do not show any trade-off between vehicle's safety, fuel consumption and emissions. The best performance was achieved for newer gasoline passenger vehicles (<5year) with a smaller engine size (<1400cm(3)). According to the SEG indicator, a vehicle with these characteristics can be recommended for a safety-conscious profile user, as well as for a user more interested in fuel economy and/or in green performance. On the other hand, for larger engine size vehicles (>2000cm(3)) the combined score for safety user profile was in average more satisfactory than for vehicles in the smaller engine size group (<1400cm(3)), which suggests that in general, larger vehicles may offer extra protection. The achieved results demonstrate that the developed SEG integrated methodology can be a helpful tool for consumers to evaluate their vehicle selection through different domains (safety, fuel efficiency and green emissions). Furthermore, SEG indicator allows the comparison of vehicles across different categories and vehicle model years. Hence, this research is intended to support the decision-making process for transportation policy, safety and sustainable mobility, providing insights not only to policy makers, but also for general public guidance.

Can artificial neural networks be used to predict the origin of ozone episodes?

Tropospheric ozone is a secondary pollutant having a negative impact on health and environment. To control and minimize such impact the European Community established regulations to promote a clean air all over Europe. However, when an episode is related with natural mechanisms as Stratosphere-Troposphere Exchanges (STE), the benefits of an action plan to minimize precursor emissions are inefficient. Therefore, this work aims to develop a tool to identify the sources of ozone episodes in order to minimize misclassification and thus avoid the implementation of inappropriate air quality plans. For this purpose, an artificial neural network model - the Multilayer Perceptron - is used as a binary classifier of the source of an ozone episode. Long data series, between 2001 and 2010, considering the ozone precursors, (7)Be activity and meteorological conditions were used. With this model, 2-7% of a mean error was achieved, which is considered as a good generalization. Accuracy measures for imbalanced data are also discussed. The MCC values show a good performance of the model (0.65-0.92). Precision and F1-measure indicate that the model specifies a little better the rare class. Thus, the results demonstrate that such a tool can be used to help authorities in the management of ozone, namely when its thresholds are exceeded due natural causes, as the above mentioned STE. Therefore, the resources used to implement an action plan to minimize ozone precursors could be better managed avoiding the implementation of inappropriate measures.