Development of prediction equations for body composition in Indian children using bioelectrical impedance analysis

We aimed to develop a BIA equation to predict fat free mass (FFM) using deuterium oxide (2H2O) dilution as the reference method for children. Seventy seven children (36 boys and 41 girls), aged 6 to 24 month participated in the study. The best fit FFM prediction equation included weight, sex and length2/resistance (adjusted R2=0.83 and root mean square error of 0.49 kg). Applying ‘leave-one-out’ method the mean of the differences of FFM in kg and % body weight were nearly zero with 95% confidence intervals of ±0.108 kg between those derived by 2H2O dilution and by the validated equation. PRESS statistic residual was 473g (»0). The best fit equation for FFMkg was: FFMkg=0.72+0.30× (weight) +0.16× (sex) +0.52× (Length2/resistance) (Length in cm, weight in kg, resistance in W, sex: boys=1, girls=0) The derived predictive equation has good precision and is useful for community based studies on body composition in South Asian children

Development of prediction equations for body composition in Indian children using bioelectrical impedance analysis

We aimed to develop a BIA equation to predict fat free mass (FFM) using deuterium oxide (2H2O) dilution as the reference method for children. Seventy seven children (36 boys and 41 girls), aged 6 to 24 month participated in the study. The best fit FFM prediction equation included weight, sex and length2/resistance (adjusted R2=0.83 and root mean square error of 0.49 kg). Applying ‘leave-one-out’ method the mean of the differences of FFM in kg and % body weight were nearly zero with 95% confidence intervals of ±0.108 kg between those derived by 2H2O dilution and by the validated equation. PRESS statistic residual was 473g (»0). The best fit equation for FFMkg was: FFMkg=0.72+0.30× (weight) +0.16× (sex) +0.52× (Length2/resistance) (Length in cm, weight in kg, resistance in W, sex: boys=1, girls=0) The derived predictive equation has good precision and is useful for community based studies on body composition in South Asian children

Prediction Equations for Body-fat Percentage in Indian Infants and Young Children Using Skinfold Thickness and Mid-arm Circumference

The objective of the study was to develop prediction equations for fat-mass percentage in infants in India based on skinfold thickness, mid-arm circumference, and age. Skinfold thicknesses and mid-arm circumference of 46 apparently-healthy infants (27 girls and 19 boys), aged 6–24 months, from among the urban poor attending a well baby clinic of a hospital in Kolkata were measured. Their body-fat percentage was measured using the D2O dilution technique as the reference method. Equations for body-fat percentage were developed using a stepwise forward regression model using skinfold thicknesses, mid-arm circumference, and age as independent variables, and the body-fat percentage was derived by D2O dilution as the dependent variable. The new prediction equations are: body-fat percentage=-69.26+5.76×B-0.33×T2+5.40×M+0.01×A2 for girls and body-fat percentage=-8.75+3.73×B+2.57×S for boys, where B=biceps skinfold thickness, T=triceps skinfold thickness, and S=suprailiac skinfold thickness all in mm, M=mid-arm circumference in cm, and A=age in month. Using the D2O dilution technique, the means (SD) of the calculated body-fat percentage were 17.11 (7.25) for girls and 16.93 (6.62) for boys and, using the new prediction equations, these were 17.11 (6.25) for girls and 16.93 (6.02) for boys. The mean of the differences of paired values in body-fat percentage was zero. The mean (SD) of the differences of paired values for body-fat percentage derived by the D2O technique and the new equations, applied on an independent sample of 23 infants (11 girls and 12 boys) were -0.93 (6.56) for girls and 1.14 (2.43) for boys; the 95% confidence limits of the differences of paired values for body-fat percentage were -2.03 to +3.89 for girls and -0.26 to +2.54 for boys. Given that the trajectories of growth during infancy and childhood are a major risk factor for a group of diseases in adulthood, including coronary heart disease and diabetes, these predictive equations should be useful in field studies

Prediction equations for body-fat percentage in Indian infants and young children using skinfold thickness and mid-arm circumference

The objective of the study was to develop prediction equations for fat-mass percentage in infants in In-dia based on skinfold thickness, mid-arm circumference, and age. Skinfold thicknesses and mid-arm cir-cumference of 46 apparently-healthy infants (27 girls and 19 boys), aged 6-24 months, from among the urban poor attending a well baby clinic of a hospital in Kolkata were measured. Their body-fat percent-age was measured using the D 2 O dilution technique as the reference method. Equations for body-fat per-centage were developed using a stepwise forward regression model using skinfold thicknesses, mid-arm circumference, and age as independent variables, and the body-fat percentage was derived by D 2 O dilu-tion as the dependent variable. The new prediction equations are: body-fat percentage=-69.26+5.76\u3a7B-0.33\u3a7T 2 +5.40\u3a7M+0.01\u3a7A 2 for girls and body-fat percentage=-8.75+3.73\u3a7B+2.57\u3a7S for boys, where B=biceps skinfold thickness, T=triceps skinfold thickness, and S=suprailiac skinfold thickness all in mm, M=mid-arm circumference in cm, and A=age in month. Using the D 2 O dilution technique, the means (SD) of the cal-culated body-fat percentage were 17.11 (7.25) for girls and 16.93 (6.62) for boys and, using the new predic-tion equations, these were 17.11 (6.25) for girls and 16.93 (6.02) for boys. The mean of the differences of paired values in body-fat percentage was zero. The mean (SD) of the differences of paired values for body-fat percentage derived by the D 2 O technique and the new equations, applied on an independent sample of 23 infants (11 girls and 12 boys) were -0.93 (6.56) for girls and 1.14 (2.43) for boys; the 95% confidence limits of the differences of paired values for body-fat percentage were -2.03 to +3.89 for girls and -0.26 to +2.54 for boys. Given that the trajectories of growth during infancy and childhood are a major risk factor for a group of diseases in adulthood, including coronary heart disease and diabetes, these predictive equations should be useful in field studies

Effect of zinc supplementation on morbidity and growth in hospital-born, low-birth-weight infants

Background: Low-birth-weight infants may have impaired zinc status, but little is known about the effect of zinc supplementation. Objective: The objective was to investigate the effect of daily zinc supplementation on morbidity and anthropometric status in hospital-born, low-birth-weight infants. Design: In a double-blind, randomized, placebo-controlled trial, 2052 hospital-born term infants with a birth weight ≤2500 g were randomly assigned to receive zinc or placebo. The zinc group received elemental zinc: 5 mg/d for those infants between ages 2 wk and 6 mo and 10 mg/d for those infants aged >6 mo. All-cause hospitalizations, prevalence of diarrhea, acute lower respiratory tract infections, visits to health care providers, weights, and lengths were ascertained at 3, 6, 9, and 12 mo of age. Results: The supplement was consumed for >85% of the follow-up period. Mean plasma zinc at 12 mo of age was higher in the zinc group (100.2 μg/dL) than in the control group (73.3 μg/dL) (difference in means: 26.9; 95% CI: 19.6, 34.2). The 24-h and 7-d prevalence of diarrhea and acute lower respiratory tract infections was similar at 3, 6, 9, and 12 mo. Care-seeking for illness was significantly lower in the zinc group (difference in proportions: -5.7; 95% CI: -9.9, -1.4; P < 0.05) at 9 mo. The numbers of hospitalizations, weights, and lengths were all similar at all 4 assessments. Conclusion: Hospital-born, term, low-birth-weight infants do not seem to benefit substantially from zinc supplementation that meets the Recommended Dietary Allowance for zinc in terms of morbidity or physical growth during infancy in this setting

Newborn Aides: An Innovative Approach in Sick Newborn Care at a District-level Special Care Unit

A Sick Newborn Care Unit (SNCU), established in a district hospital in India, substantially reduced the neonatal mortality rate in the district; it, however, suffered from a dearth of trained nurses. Local girls with 10-12 years of school education underwent structured and hands-on training for six months, followed by a six-month internship at the SNCU and were assigned to it as stipendiary ‘Newborn Aides’. Based on the results of formal examinations, internal on-the-job assessment and interview of doctors, nurses, and parents and their technical skills and motivation were rated very high. Although the incremental cost of training is small, the cost of sustaining them, i.e. stipend and replacing attrition, needs to be addressed. Trained Newborn Aides may substantially alleviate human-resource constraint for SNCUs and Sick Newborn Stabilization units in smaller peripheral hospitals for care of sick newborns at an affordable cost

Association between Helicobacter pylori infection and increased risk of typhoid fever

Helicobacter pylori infection has been reported to increase the risk of cholera. This nested case-control study was conducted to determine whether H. pylori infection is associated with occurrence of typhoid fever. Eighty-three case subjects of culture-proven typhoid fever were identified through a 1-year surveillance of subjects aged 0-40 years in an urban slum. Two age- and sex-matched neighborhood control subjects were concurrently selected for each case subject. Serum anti-H. pylori immunoglobulin G antibodies were measured in case and neighborhood control subjects. For determining other risk factors, 2 additional community control subjects per case were selected. There was a significant association between the presence of serum anti-H. pylori immunoglobulin G antibodies and typhoid fever (adjusted odds ratio, 2.03; 95% confidence interval, 1.02-4.01). Illiteracy, being part of a nuclear family, nonuse of soap, and consumption of ice cream were also associated with a significantly greater risk of typhoid fever. This study provides the first empiric evidence that H. pylori infection is associated with an increased risk of typhoid fever

Helicobacter pylori Infection in the Young in Bangladesh: Prevalence, Socioeconomic and Nutritional Aspects

Background The gastric acid barrier, an important host defence against small bowel infection, may be compromised by infection with Helicobacter pylori. In developing countries, H.pylori infection occurs early in life and prevelance of hypochlorhydria is high particularly in the malnourished, which may predispose a child to repeated gastrointestinal Infection and diarrhoea. Diarrhpea being a leading cause a childhood mortality and morbidity in developing countries, we investigated the prevelance of H. pylori infection in children in poor Bangladeshi community and explored its association with socioeconomic and nutritional status. Methods The study was conducted in a poor periurban community among 469 children aged -99months. Parents were interviewed ising a questionnaire. To detect active infection with H. pyloria13 C-urea broath test was performed and weight was recorded on a beam balance with a sensitivity of 20g. Results In all, 61% of 36 infants aged 1-3 months were positive for H. pylori, this rate dropped steadily with increasing age and was 33% in 10-15 month old children and then rose to 84% in 6-9 year olds. Overall H. pylori infection had no association with nutritional state of the child or family income but the infection rate was 2.5 times higher in children of mothers with no schooling. Conclusions The H. pylori infection rate is very high in early infancy in a poor periurban community of Bangladesh. The reason for a drop in the infection rate infancy is unclear but could be due to initial clearance of the infection by the body's defence mechanisms but with possible alteration of the gastric mucosa which sustains infection. Maternal education may be protective and may operate through some underlined proximate behavioural determinants. The rate of H. pylori infection and young children may predispose them to reapeated gastrointestinal infection and diahorrea

Directing diarrhoeal disease research towards disease-burden reduction

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions, the efficacy and effectiveness of the intervention resulting from the research, the maximal potential for disease-burden reduction of the interventions derived from the research, the affordability, deliverability, and sustainability of the intervention supported by the research, and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015

Costs of Illness Due to Typhoid Fever in an Indian Urban Slum Community: Implications for Vaccination Policy

Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to facilitate the use of available anti-typhoid vaccines in developing countries. This one-year prospective surveillance was carried out in an urban slum community in Delhi, India, to estimate the costs of illness for cases of typhoid fever. Ninety-eight culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified during the surveillance. Estimates of costs of illness were based on data collected through weekly interviews conducted at home for three months following diagnosis. Private costs included the sum of direct medical, direct non-medical, and indirect costs. Non-patient (public) costs included costs of outpatient visits, hospitalizations, laboratory tests, and medicines provided free of charge to the families. The mean cost per episode of blood culture-confirmed typhoid fever was 3,597 Indian Rupees (US$ 1=INR 35.5) (SD 5,833); hospitalization increased the costs by several folds (INR 18,131, SD 11,218, p<0.0001). The private and non-patient costs of illness were similar (INR 1,732, SD 1,589, and INR 1,865, SD 5,154 respectively, p=0.8095). The total private and non-patient ex-ante costs, i.e. expected annual losses for each individual, were higher for children aged 2-5 years (INR 154) than for those aged 5-19 years (INR 32), 0-2 year(s) (INR 25), and 19-40 years (INR 2). The study highlights the need for affordable typhoid vaccines efficacious at 2-5 years of age. Currently-available Vi vaccine is affordable but is unlikely to be efficacious in the first two years of life. Ways must be found to make Vi-conjugate vaccine, which is efficacious at this age, available to children of developing-countries