Body composition in Nepalese children using isotope dilution: the production of ethnic-specific calibration equations and an exploration of methodological issues.

Background. Body composition is important as a marker of both current and future health. Bioelectrical impedance (BIA) is a simple and accurate method for estimating body composition, but requires population-specific calibration equations. Objectives. (1) To generate population specific calibration equations to predict lean mass (LM) from BIA in Nepalese children aged 7-9 years. (2) To explore methodological changes that may extend the range and improve accuracy. Methods. BIA measurements were obtained from 102 Nepalese children (52 girls) using the Tanita BC-418. Isotope dilution with deuterium oxide was used to measure total body water and to estimate LM. Prediction equations for estimating LM from BIA data were developed using linear regression, and estimates were compared with those obtained from the Tanita system. We assessed the effects of flexing the arms of children to extend the range of coverage towards lower weights. We also estimated potential error if the number of children included in the study was reduced. Findings. Prediction equations were generated, incorporating height, impedance index, weight and sex as predictors (R (2) 93%). The Tanita system tended to under-estimate LM, with a mean error of 2.2%, but extending up to 25.8%. Flexing the arms to 90° increased the lower weight range, but produced a small error that was not significant when applied to children <16 kg (p 0.42). Reducing the number of children increased the error at the tails of the weight distribution. Conclusions. Population-specific isotope calibration of BIA for Nepalese children has high accuracy. Arm position is important and can be used to extend the range of low weight covered. Smaller samples reduce resource requirements, but leads to large errors at the tails of the weight distribution

Associations of stunting at 2 years with body composition and blood pressure at 8 years of age: longitudinal cohort analysis from lowland Nepal

BACKGROUND: Stunting remains a very common form of child malnutrition worldwide, particularly in South Asian populations. There is poor understanding of how it develops and how it is associated with subsequent phenotype. SUBJECTS/METHODS: We used data from a longitudinal cohort of children (n = 841) in lowland Nepal to investigate associations of stunting at 2 years with maternal traits and early growth patterns, and with body size and composition, kidney dimensions by ultrasound, lung function by spirometry and blood pressure (BP) at 8 years. RESULTS: Compared to non-stunted children, children stunted at 2 years came from poorer families and had shorter, lighter mothers. They tended to have higher birth order, were born smaller, and remained shorter, lighter and thinner at 8 years. They had lower leg length, lean and fat masses, smaller kidneys, and reduced lung function (all p < 0.0001). These differences persisted with smaller magnitude after adjusting for current height, maternal height and education, family assets and birth order. Stunting was not associated with BP. DISCUSSION: Stunting developed on an inter-generational timescale in this population and its risk increased with birth order. At 8 years, children stunted at 2 years had deficits in tissue masses and some aspects of physical function that were only partially attributable to their persisting short height and maternal phenotype. This suggests that the early stunting is associated with greater deficits in long-term outcomes than would be expected from the persistent short stature alone

Effectiveness of female community health volunteers in the detection and management of low-birth-weight in Nepal

Introduction: Low birth weight (LBW) is a major risk factor for neonatal death. However, most neonates in low-income countries are not weighed at birth. This results in many LBW infants being overlooked. Female community health volunteers (FCHVs) in Nepal are non-health professionals who are living in local communities and have already worked in a field of reproductive and child health under the government of Nepal for more than 20 years. The effectiveness of involving FCHVs to detect LBW infants and to initiate prompt action for their care was studied in rural areas of Nepal. Methods: FCHVs were tasked with weighing all neonates born in selected areas using color-coded spring scales. Supervisors repeated each weighing using electronic scales as the gold standard comparator. Data on the relative birth sizes of the infants, as assessed by their mothers, were also collected and compared with the measured weights. Each of the 205 FCHVs involved in the study was asked about the steps that she would take when she came across a LBW infant, and knowledge of zeroing a spring scale was also assessed through individual interviews. The effect of the background social characteristics of the FCHVs on their performance was examined by logistic regression. This study was nested within a community-based neonatal sepsis-management intervention surveillance system, which facilitated an assessment of the performance of the FCHVs in weighing neonates, coverage of FCHVs’ visits, and weighing of babies through maternal interviews. Results: A total of 462 babies were weighed, using both spring scales and electronic scales, within 72 hours of birth. The prevalence of LBW, as assessed by the gold standard method, was 28%. The sensitivity of detection of LBW by FCHVs was 89%, whereas the sensitivity of the mothers’ perception of size at birth was only 40%. Of the 205 FCHVs participating in the study, 70% of FCHVs understood what they should do when they identified LBW and very low birth weight (VLBW) infants. Ninety-six per cent could describe how to zero a scale and approximately 50% could do it correctly. Seventy-seven per cent of FCHVs weighed infants at least once during the study period, and 19 of them (12%) miscategorized infant weights. Differences were not detected between the background social characteristics of FCHVs who miscategorized infants and those who did not. On the basis of maternal reporting, 67% of FCHVs who visited infants had weighed them. Conclusions: FCHVs are able to correctly identify LBW and VLBW infants using spring scales and describe the correct steps to take after identification of these infants. Use of FCHVs as newborn care providers allows for utilization of their logistical, geographical, and cultural strengths, particularly a high level of access to neonates, that can complement the Nepalese healthcare system. Providing additional training to and increasing supervision of local FCHVs regarding birth weight measurement will increase the identification of high-risk neonates in resource-limited settings

Effect of antenatal multiple micronutrient supplementation on anthropometry and blood pressure in mid-childhood in Nepal: follow-up of a double-blind randomised controlled trial

Background: In a randomized controlled trial in southern Nepal, we found that children born to mothers who had taken multiple micronutrient supplements during pregnancy had mean birthweight 77 g greater than a control group allocated to iron and folic acid supplements. They were a mean 204 g heavier at 2·5 years of age and their systolic blood pressure was a mean 2·5 mmHg lower. We followed the same children up in mid-childhood, hypothesizing that these differences would be sustained. Methods: We identified children from the original trial and measured anthropometry, body composition using bioelectrical impedance (with population-specific isotope calibration), blood pressure, and renal dimensions by ultrasound. We documented socieconomic status, household food security, and air pollution.Results: We assessed 841 children (422 control, 419 intervention) at mean age 8·5 years. Unadjusted differences (intervention minus control) were 0·05 z-scores (95% CI -0·09, 0·19) in weight-for-age, 0·02 z-scores (-0·10, 0·15) in height-for-age, and 0·04 z-scores (-0·09, 0·18) in body-mass-index-for-age. There was no difference in blood pressure. Adjusted differences were similar for all outcomes. Discussion: Differences in phenotype between children born to mothers who received antenatal multiple micronutrient or iron and folate supplements were not apparent at 8·5 years. Our findings did not extend to physiological differences or potential longer-term effects

Cross-sectional study of asthma and rhinitis symptoms in the context of exposure to air pollution in Nepal

Asthma is common in children worldwide, although its prevalence varies substantially by location. The prevalence of wheeze over a 12-month period ranged from 2.1% to 32.2% in the older age group (13–14 years) and 4.1% to 32.1% in the younger age group (6–7 years) [1]. There is a positive association between current symptoms of asthma in younger and older children with gross national income [2], and it is generally slightly less common in girls than boys in the younger group [1–3]. Exposure to air pollution is associated with asthma exacerbations. Odds ratios for wheeze in the past year and the use of solely an open fire for cooking were 2.17 (95% CI 1.64–2.87) for children aged 6–7 years and 1.35 (95% CI 1.11–1.64) for children aged 13–14 years [4]. Nepalese children are exposed to high levels of indoor air pollution from the burning of biomass fuels [5]. This study aimed to estimate their prevalence of asthma, and to investigate the association of air pollution and risk of wheeze and rhinitis symptoms using personal exposure estimates of air pollution

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

First Total Synthesis of Trehalose-Containing Branched Oligosaccharide OSE-1 of Mycobacterium gordonae (Strain 990)

The first total synthesis of the branched oligosaccharide OSE-1 of Mycobacterium gordonae (strain 990) is reported. An intramolecular aglycon delivery approach was used for constructing the desymmetrized 1,1-,-linked trehalose moiety. A [3+2] glycosylation of the trisaccharide donor and trehalose acceptor furnished the right hand side pentasaccharide. Regioselective O3 glycosylation of L-rhamnosyl 2,3-diol allowed expedient synthesis of the left hand side tetrasaccharide. The nonasaccharide was assembled in a highly convergent fashion through a [4+5] glycosylation

First total synthesis of trehalose containing tetrasaccharides from Mycobacterium smegmatis

Total synthesis of three important trehalose containing tetra-saccharides isolated from Mycobacterium smegmatis is reported for the first time, using regioselective opening of benzylidene acetals and stereoselective glycosylations as key steps. The 1,2-cis stereoselectivity in the glycosylation reactions was achieved using anchimeric assistance from a remote participating group, steric effects and solvent participation. The synthetic strategy can also be utilized for the assembly of structurally related oligosaccharides from M. tuberculosis